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The purpose of this study was to investigate if brief treatment for alcohol dependence in primary care with the 15-method was as effective as specialist addiction care. In addition, we sought to investigate trajectories for change of alcohol consumption.This study was a randomized controlled noninferiority trial, between-groups parallel design, with a noninferiority limit of 50 g of alcohol per week. A total of 288 adults fulfilling ICD-10 criteria for alcohol dependence were randomized to treatment in primary care or specialist outpatient care at a university addiction clinic. The primary outcome was change in weekly alcohol consumption at the 12-month follow-up. Secondary outcomes were heavy drinking days, severity of dependence, consequences of drinking, psychological health, quality of life, satisfaction with treatment, and biomarkers. Trajectories were investigated using change in World Health Organization drinking risk levels.The intention-to-treat analysis (n = 231) showed that the estimated weekly alcohol consumption in primary care was 18.2 g (95% CI [14.9, 51.3]) higher compared with specialist care (p = .28). Noninferiority was not demonstrated as the confidence interval exceeded the noninferiority limit. The secondary outcomes showed no differences between primary care and specialist care except that patients randomized to specialist care were more satisfied with treatment. The analyses of trajectories showed the main part of change in consumption occurred from baseline to the 6-month follow-up and was maintained to the 12-month follow-up.Although noninferiority could not be demonstrated, based on similar trajectories and sustained reduction of alcohol use, this study indicates brief treatment of alcohol dependence in primary care with the 15-method is a feasible and promising approach.

Aims Community Reinforcement Approach and Family Training (CRAFT) is a support program for concerned significant others (CSOs) to identified persons (IPs) with alcohol use disorders, with the purpose of engaging IPs to treatment and to improve CSO functioning. The purpose of the present study was to investigate the efficacy of an internet-based version of CRAFT (iCRAFT). Methods Randomized controlled trial comparing iCRAFT with a wait-list (WL) condition with a nation-wide uptake in Sweden. A total of 94 CSOs to a treatment refusing IP, who described the IP according to DSM-IV criteria for alcohol dependence or abuse, were included in the study. iCRAFT consisted of five weekly administered therapist-guided modules with the following content: (a) improve CSOs’ own mental health, (b) improve the CSOs skills in asking the IP to seek treatment, (c) positive communication skills training, (d) contingency management of IP drinking behavior. Main outcome measure was IPs initiative to seek treatment measured at 24 weeks. Secondary outcomes were IP’s daily alcohol consumption, CSOs mental health, quality of life and relational satisfaction. Results Of 94 participants, 15 CSOs reported IP treatment initiative during the study period. Of these, 10 belonged to the iCRAFT condition and five to the WL condition. The difference between conditions was nonsignificant, and the results were inconclusive. Participants in iCRAFT showed short-term improvements regarding depressive symptoms, quality of life and relational happiness. Conclusion This study was unable to demonstrate substantial changes in the iCRAFT program regarding IP treatment seeking or CSO mental health.

AIMS: Exercise is increasingly being studied as treatment for alcohol use disorder (AUD). We examined the effects of an acute bout of exercise on alcohol craving, heterogeneity of response, and factors associated with reductions in craving. METHODS: Within the context of a randomized controlled trial, we conducted an exploratory, single-arm study. In total, 117 adults with AUD (52.7 years; SD = 12.3; 68.4% female) and indications of alcohol craving (Desire for Alcohol Questionnaire, DAQ-short version total score >8) were included. The intervention was a 12-min sub-maximal fitness test performed on a cycle ergometer. We examined changes in participant's self-rated desire for alcohol immediately before and after exercise. Personal, clinical, and exercise-related factors associated with reductions (≥0.5 SD) in craving were identified using hierarchical logistic regression. RESULTS: In the total sample craving reduced from pre-to post-exercise (p

BACKGROUND: Exercise is increasingly being used in the treatment of alcohol use disorder (AUD). We examined the short-term effects of acute exercise on alcohol craving, mood states and state anxiety in physically inactive, non-treatment seeking adults with AUD. METHODS: Exploratory, single-arm study. In total, 140 adults with AUD (53.7 ± 11.8 years; 70 % female) were included in a randomized controlled trial (RCT) to study effects of physical activity on alcohol consumption. This acute exercise study was nested within the larger RCT. The intervention was a 12-minute sub-maximal fitness test performed on a cycle ergometer. Participants self-rated their desire for alcohol (DAQ) and completed mood (POMS-Brief) and state anxiety (STAI-Y1) questionnaires 30-minutes before exercise, immediately before, immediately after, and 30-minutes post. Ratings of perceived exertion (RPE) were collected. Effects of exercise were assessed using RM-ANOVA and dependent sample t-tests with effect sizes (Hedges g). RESULTS: In total, 70.6 % had mild or moderate AUD (DSM-5 criteria = 4.9 ± 2). The intervention was generally perceived as 'strenuous' (RPE = 16.1 ± 1.6). In the total sample, there was a main effect of time with reductions in alcohol craving [F(3,411) = 27.33, p < 0.001], mood disturbance [F(3,411) = 53.44, p < 0.001], and state anxiety [F(3,411) = 3.83, p = 0.013]. Between-group analyses indicated larger magnitude effects in those with severe compared to mild AUD, however, AUD severity did not significantly moderate the within-group improvements: group x time interaction for alcohol craving [F(6,411) = 1.21, p = 0.305]. Positive effects of exercise were maintained 30-minutes post-exercise. CONCLUSION: A short bout of aerobic exercise reduced alcohol craving and improved mood states in adults with AUD. ispartof: DRUG AND ALCOHOL DEPENDENCE vol:220 ispartof: location:Ireland status: published

The COVID‐19 pandemic and subsequent restrictions have resulted in additional challenges for persons with alcohol use disorders as well as for the effective operation of alcohol controls in different societies. The challenges are different in different systems and economies. Crises such as these often provide governments with opportunities to remake systems. We use the recent experience from India, which rapidly shifted between total countrywide prohibition of alcohol and unrestricted sales during this brief period, to argue against using the present crisis to bring about quick changes in alcohol policy in India. Instead, we advocate sustained, incremental pressure to develop and enforce alcohol control measures in public health delivery systems, in addition to demand reduction measures.

Alcohol's impact on global health is substantial and of a similar order of magnitude to that from COVID-19. Alcohol now also poses specific concerns, such as increased risk of severe lung infections, domestic violence, child abuse, depression and suicide. Its use is unlikely to aid physical distancing or other preventative behavioural measures. Globally, alcohol contributes to 20% of injury and 11.5% of non-injury emergency room presentations. We provide some broad comparisons between alcohol-attributable and COVID-19-related hospitalisations and deaths in North America using most recent data. For example, for Canada in 2017 it was recently estimated there were 105 065 alcohol-attributable hospitalisations which represent a substantially higher rate over time than the 10 521 COVID-19 hospitalisations reported during the first 5 months of the pandemic. Despite the current importance of protecting health-care services, most governments have deemed alcohol sales to be as essential as food, fuel and pharmaceuticals. In many countries, alcohol is now more readily available and affordable than ever before, a situation global alcohol producers benefit from and have helped engineer. We argue that to protect frontline health-care services and public health more generally, it is essential that modest, evidence-based restrictions on alcohol prices, availability and marketing are introduced. In particular, we recommend increases in excise taxation coupled with minimum unit pricing to both reduce impacts on health-care services and provide much-needed revenues for governments at this critical time.

Background and aims Most people with alcohol use disorder (AUD) are never treated. Internet-based interventions are effective in reducing alcohol consumption and could help to overcome some of the barriers to people not seeking or receiving treatment. The aim of the current study was to compare internet-delivered and face-to-face treatment among adult users with AUD. Design Randomized controlled non-inferiority trial with a parallel design, comparing internet-delivered cognitive-behavioural therapy (ICBT) (n = 150) with face-to-face CBT (n = 151), at 3- and 6-month follow-ups. Setting A specialized clinic for people with AUD in Stockholm, Sweden. Participants were recruited between 8 December 2015 and 5 January 2018. Participants A total of 301 patients [mean age 50 years, standard deviation (SD) = 12.3] with AUD, of whom 115 (38%) were female and 186 (62%) were male. Intervention and comparator Participants were randomized in blocks of 20 at a ratio of 1 : 1 to five modules of therapist-guided ICBT or to five modules of face-to-face CBT, delivered over a 3-month period. The same treatment material and the same therapists were used in both groups. Measurements The primary outcome was standard drinks of alcohol consumed during the previous week at 6-month follow-up, analysed according to intention-to-treat. The pre-specified non-inferiority limit was five standard drinks of alcohol and d = 0.32 for secondary outcomes. Results The difference in alcohol consumption between the internet and the face-to-face group was non-inferior in the intention-to-treat analysis of data from the 6-month follow-up [internet = 12.33 and face-to-face = 11.43, difference = 0.89, 95% confidence interval (CI) = -1.10 to 2.88]. The secondary outcome, Alcohol Use Disorder Identification Test score, failed to show non-inferiority of internet compared with face-to-face in the intention-to-treat analysis at 6-month follow-up (internet = 12.26 and face-to-face = 11.57, d = 0.11, 95% CI = -0.11 to 0.34). Conclusions Internet-delivered treatment was non-inferior to face-to-face treatment in reducing alcohol consumption among help-seeking patients with alcohol use disorder but failed to show non-inferiority on some secondary outcomes.

Background: Several components of the Swedish alcohol policy, e.g., pricing and availability, weakened when Sweden joined the EU in 1995. To counteract the possible negative effects of this, emphasis was placed on the local level as an important arena of alcohol prevention. Thus, considerable efforts were made to strengthen alcohol prevention in Swedish municipalities. Objectives: The aim of this study was to examine whether local alcohol prevention reduced consumption and alcohol-related harm in Swedish municipalities. Methods: Alcohol prevention was monitored using a composite measure called the Alcohol Prevention Magnitude Measure (APMM), with subcategories of staff and budget, inspections and licenses, policy, activities, and cooperation. APMM and its categories were analysed in relation to alcohol consumption and harm over time, 2006-2014. A fixed effects model was used with 63% (N=182, consumption) and 71% (N=207, harm) of 290 Swedish municipalities, respectively, included in the analyses. Results: The main results suggest that when APMM increases with 1 percent, the alcohol-related mortality decreases with 0.26 percent, controlled for changes in population size, median income, unemployment, and post-secondary education. In light of this result, the estimated effect of APMM on alcohol consumption (sales) is small (0.02 percent decrease); possible explanations for this are discussed in the article. Conclusion: The overall results indicate that local alcohol prevention initiatives in Sweden have reduced some forms of alcohol-related harm, not least alcohol-related mortality, during the period 2006-2014. Further studies are needed to assess the generalizability of the present study.

Background Alcohol dependence is a common disorder with a continuum regarding severity. Most alcohol-dependent persons have a moderate level of dependence and live under socially orderly conditions. Treatment-seeking in this group is low, mainly due to stigma and because treatment options are seen as unappealing. Alcohol is a relevant topic to discuss in many primary care (PC) consultations and PC is less stigmatizing to visit compared to addiction care units for people with alcohol problems. However, general practitioners (GPs) hesitate to engage in treating alcohol problems due to time constraints and lack of knowledge. Screening and brief interventions are effective for high consumers but there are few studies on dependence. Methods This is a two-group, parallel, randomized controlled trial (RCT). The aim is to study whether an Internet-based Cognitive Behavioral Treatment (iCBT) when added to treatment as usual (TAU) is more effective than TAU only for alcohol dependence in PC. Two hundred and sixty adults with alcohol dependence will be included. Participants are randomized to iCBT and TAU or TAU only. The primary study outcome is alcohol consumption in grams per week and heavy-drinking days. Secondary outcomes include alcohol-related problem severity, number of diagnostic criteria for alcohol dependence, depression and anxiety symptoms, health-related quality of life and biochemical markers for high consumption and liver pathology. Data will be analyzed using mixed-effect models. Discussion Internet-based interventions are attractive to, and have been shown to reach, people with alcohol problems. Yet there are no studies investigating the efficacy of Internet treatment of alcohol dependence in PC. In this study we hypothesize that iCBT when added to TAU will improve treatment outcome for alcohol dependence in PC, compared to TAU only. If effective, iCBT can be distributed to the public to a low cost for a stakeholder and has the opportunity to reduce both short-term and long-term public health costs. Trial registration ISRCTN69957414. Retrospectively registered on 7 June 2018.

Arora, M., Tewari, A., Bassi, S., Chauhan, K., Bhasin, S., Bakshi, A., & Andreasson, S. (2017). Exploring perceptions of alcohol use in two Indian states: A qualitative study from Delhi and Haryana, India. The International Journal Of Alcohol And Drug Research, 6 (1), 1-6. doi: http://dx.doi.org/10.7895/ijadr.v6i1.238 Aims: To explore perceptions and determinants influencing alcohol consumption, with a view to inform development of suitable policies to control alcohol consumption. Methodology: Focus group discussions (FGDs) ( n =24) were conducted in two Indian states among the rural Haryana ( n =8 FGDs; 58 participants) and urban Delhi ( n =16 FGDs; 113 participants) populations. Purposive sampling was used to recruit the participants, who were from high and low socioeconomic status (SES) groups and in the age group of 18–58 years. Results: Different factors influence alcohol consumption in high and low SES groups. The age of initiation is now as low as 10–12 years, attributable to the recent trend of increased accessibility. The participants agreed that alcohol consumption has now become a more acceptable part of daily living, whereas earlier it was limited to special occasions and festivals. This has contributed to an increase in drinking. Drinking among women was earlier a taboo, but now women (mainly of high SES), are often seen drinking at social gatherings. The respondents mentioned weak enforcement of regulatory policies related to alcohol consumption and sales. Conclusions: A shift in attitudes was observed towards drinking. Drinking is increasingly seen as a part of daily life. The availability of alcohol is perceived to be increasing and restrictions on sale are not effectively enforced. There is an urgent need to re-evaluate the alcohol policy from a public health perspective in India.

Background Government alcohol monopolies were created in North America and Scandinavia to limit health and social problems. The Swedish monopoly, Systembolaget, reports to a health ministry and controls the sale of all alcoholic beverages with > 3.5% alcohol/volume for off-premise consumption, within a public health mandate. Elsewhere, alcohol monopolies are being dismantled with evidence of increased consumption and harms. We describe innovative modelling techniques to estimate health outcomes in scenarios involving Systembolaget being replaced by 1) privately owned liquor stores, or 2) alcohol sales in grocery stores. The methods employed can be applied in other jurisdictions and for other policy changes. Methods Impacts of the privatisation scenarios on pricing, outlet density, trading hours, advertising and marketing were estimated based on Swedish expert opinion and published evidence. Systematic reviews were conducted to estimate impacts on alcohol consumption in each scenario. Two methods were applied to estimate harm impacts: (i) alcohol attributable morbidity and mortality were estimated utilising the International Model of Alcohol Harms and Policies (InterMAHP); (ii) ARIMA methods to estimate the relationship between per capita alcohol consumption and specific types of alcohol-related mortality and crime. Results Replacing government stores with private liquor stores (Scenario 1) led to a 20.0% (95% CI, 15.3–24.7) increase in per capita consumption. Replacement with grocery stores (Scenario 2) led to a 31.2% (25.1–37.3%) increase. With InterMAHP there were 763 or + 47% (35–59%) and 1234 or + 76% (60–92%) more deaths per year, for Scenarios 1 and 2 respectively. With ARIMA, there were 850 (334–1444) more deaths per year in Scenario 1 and 1418 more in Scenario 2 (543–2505). InterMAHP also estimated 10,859 or + 29% (22–34%) and 16,118 or + 42% (35–49%) additional hospital stays per year respectively. Conclusions There would be substantial adverse consequences for public health and safety were Systembolaget to be privatised. We demonstrate a new combined approach for estimating the impact of alcohol policies on consumption and, using two alternative methods, alcohol-attributable harm. This approach could be readily adapted to other policies and settings. We note the limitation that some significant sources of uncertainty in the estimates of harm impacts were not modelled.

Aims National alcohol policy in Sweden has to a certain extent grown weaker, and there has instead been an increased focus on strengthening local alcohol prevention. Swedish municipalities carry out a variety of alcohol prevention activities, but there is little knowledge of how the magnitude of all these activities has developed over time. One reason for this lack of information is the limitation of tools for monitoring prevention activities locally. The aim of this study is 1) to develop an Alcohol Prevention Magnitude Measure (APMM) based on local data and 2) to analyse the development of local alcohol prevention by using APMM. Data The APMM is based on 37 different indicators of local prevention. Data derives from web-based surveys comprising all Swedish municipalities and from information on licensed premises at the local level. Results The results reveal that local alcohol prevention in Sweden, as measured by the APMM, has increased generally between 2006 and 2010. The increase is the result of more local policies and activities. Conclusion The results indicate that the APMM captures real changes at the local level, as the APMM increased significantly in community intervention municipalities compared to others.

Background A primary concern within the healthcare system is to make treatment more accessible as well as attractive for the great majority of alcohol-dependent people who feel reluctant to participate in the treatment programs available. This paper presents the protocol for a randomized controlled trial (RCT) to test the efficacy of two different technical devices (mobile phone application and breathalyzer) on alcohol consumption. Methods The study is a three-armed RCT with follow-ups 3 and 6 months after randomization. In total, 375 adults (age 18+ years) diagnosed with alcohol use disorder (AUD) will be invited to participate in a 3-month intervention. The primary outcome is the number of days with heavy drinking, defined as four or more standard drinks (12 g alcohol/drink) and measured by the timeline follow back (TLFB) and Alcohol Use Disorder Identification Test (AUDIT) instruments at 3-month and 6-month follow-up. Secondary outcome measures include weekly alcohol consumption, measured by the TLFB, AUDIT, and phosphatidylethanol in blood values at 3-month and 6-month follow-up (number of days with blood alcohol concentration levels exceeding 60 mg/100 ml). Discussion Improving ways of collecting data on alcohol consumption, as well as the treatment system with regards to AUD, is of vital importance. Mobile phone technology, with associated applications, is widely recognized as a potentially powerful tool in the prevention and management of disease. This study will provide unique knowledge regarding the use of new technology as instruments for measuring alcohol consumption and, also, as a possible way to decrease it. Trial registration ISRCTN, ISRCTN14515753. Registered on 31 May 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-3137-y) contains supplementary material, which is available to authorized users.

Aims: We investigate (a) alcohol consumption in association with type 2 diabetes, taking heavy episodic drinking (HED), socioeconomic, health and lifestyle, and psychosocial factors into account, and (b) whether a seemingly protective effect of moderate alcohol consumption on type 2 diabetes persists when stratified by occupational position. Methods: This population-based longitudinal cohort study comprises 16,223 Swedes aged 18–84 years who answered questionnaires about lifestyle, including alcohol consumption in 2002, and who were followed-up for self-reported or register-based diabetes in 2003–2011. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated in a multivariable-adjusted logistic regression model for all participants and stratified by high and low occupational position. We adjusted for HED, socioeconomic (occupational position, cohabiting status and unemployment), health and lifestyle (body mass index (BMI), blood pressure, smoking, physical inactivity, poor general health, anxiety/depression and psychosocial (low job control and poor social support) characteristics one by one, and the sets of these factors. Results: Moderate consumption was inversely associated with type 2 diabetes after controlling for health and lifestyle (OR=0.47; 95% CI: 0.29–0.79) and psychosocial factors (OR=0.40; 95% CI: 0.22–0.79) when compared to non-drinkers. When adjusting for socioeconomic factors, there was still an inverse but non-significant association (OR=0.59; 95% CI: 0.35–1.00). In those with high occupational position, there was no significant association between moderate consumption and type 2 diabetes after adjusting for socioeconomic (OR=0.67; 95% CI: 0.3–1.52), health and lifestyle (OR=0.70; 95% CI: 0.32–1.5), and psychosocial factors (OR=0.75; 95% CI: 0.23–2.46). On the contrary, in those with low occupational position, ORs decreased from 0.55 (95% CI: 0.28-1.1) to 0.35 (95% CI: 0.15–0.82) when adjusting for psychosocial factors, a decrease that was solely due to low job control. HED did not influence any of these associations. Conclusions: Moderate alcohol consumption is associated with a lower risk of type 2 diabetes, after adjusting for HED, health and lifestyle, and psychosocial characteristics. The association was inverse but non-significant after adjusting for socioeconomic factors. When stratified by occupational position, there was an inverse association only in those with low occupational position and after adjusting for low job control.

Background Help-seeking for alcohol use disorders (AUDs) is low and traditional treatments are often perceived as stigmatizing. Physical activity has positive effects on mental and physical health which could benefit this population. We propose to compare the effects of aerobic training, yoga, and usual care for AUDs in physically inactive Swedish adults. Methods This is a three-group, parallel, single-blind, randomized controlled trial (RCT). In total, 210 adults (aged 18–75 years) diagnosed with an AUD will be invited to participate in a 12-week intervention. The primary study outcome is alcohol consumption measure by the Timeline Follow-back method and the Alcohol Use Disorders Identification Test (AUDIT). Secondary outcomes include: depression, anxiety, perceived stress, sleep quality, physical activity levels, fitness, self-efficacy, health-related quality of life, and cognition. Blood samples will be taken to objectively assess heavy drinking, and saliva to measure cortisol. Acute effects of exercise on the urge to drink alcohol, mood, and anxiety will also be assessed. Discussion The treatment potential for exercise in AUDs is substantial as many individuals with the disorder are physically inactive and have comorbid health problems. The study is the first to assess the effects of physical activity as a stand-alone treatment for AUDs. Considerable attention will be given to optimizing exercise adherence. Both the feasibility and treatment effects of exercise interventions in AUDs will be discussed. The Ethical Review Board (EPN) at Karolinska Institutet has approved the study (DNR: 2017/1380-3). Trial registration German Clinical Trials Register, ID: DRKS00012311. Registered on 26 September 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2435-0) contains supplementary material, which is available to authorized users.

Aim To investigate if treatment for alcohol dependence in primary care is as effective as specialist addiction care. Method Randomized controlled non-inferiority trial, between groups parallel design, not blinded. The non-inferiority limit was set to 50 grams of alcohol per week. About 288 adults fulfilling ICD-10 criteria for alcohol dependence were randomized to treatment in primary care (men n = 82, women n = 62) or specialist care (men n = 77, women n = 67). General practitioners at 12 primary care centers received 1-day training in a treatment manual for alcohol dependence. Primary outcome was change in weekly alcohol consumption at 6-months follow-up compared with baseline, as measured with timeline follow back. Secondary outcomes were heavy drinking days, severity of dependence, consequences of drinking, psychological health, quality of life, satisfaction with treatment and biomarkers. Results Intention-to-treat analysis (n = 228) was statistically inconclusive, and could not confirm non-inferiority for the primary outcome, since the high end of the confidence interval exceeded 50 grams (estimated mean weekly alcohol consumption was 30 grams higher in primary care compared with specialist care; 95% confidence interval -10.20; 69.72). However, treatment in specialist care was not significantly superior to primary care (P = 0.146). Subanalysis suggests that specialist care was superior to primary care only for patients with high severity of dependence. Conclusions Treatment for alcohol dependence in primary care is a promising approach, especially for individuals with low to moderate dependence. This may be a way to broaden the base of treatment for alcohol dependence, reducing the current treatment gap.

In 2016, the International Network on Brief Interventions for Alcohol & Other Drugs convened a meeting titled "Rethinking alcohol interventions in health care". The aims of the meeting were to synthesize recent evidence about screening and brief intervention and to set directions for research, practice, and policy in light of this evidence. Screening and brief intervention is efficacious in reducing self-reported alcohol consumption for some with unhealthy alcohol use, but there are gaps in evidence for its effectiveness. Because screening and brief intervention is not known to be efficacious for individuals with more severe unhealthy alcohol use, recent data showing the lack of evidence for referral to treatment as part of screening and brief intervention are alarming. While screening and brief intervention was designed to be a population-based approach, its reach is limited. Implementation in real world care also remains a challenge. This report summarizes practice, research, and policy recommendations and key research developments from our meeting. In order to move the field forward, a research agenda was proposed to (1) address evidence gaps in screening, brief intervention, and referral to treatment, (2) develop innovations to address severe unhealthy alcohol use within primary care, (3) describe the stigma of unhealthy alcohol use, which obstructs progress in prevention and treatment, (4) reconsider existing conceptualizations of unhealthy alcohol use that may influence health care, and (5) identify efforts needed to improve the capacity for addressing unhealthy alcohol consumption in all world regions.

Summary Objectives This pilot study explores the feasibility of yoga as part of a treatment program for alcohol dependence. Design Eighteen alcohol dependent patients were randomized to receive either treatment as usual or treatment as usual plus yoga. Assessments were taken at baseline and six month follow-up. Setting ‘Riddargatan 1': an outpatient alcohol treatment clinic located in Stockholm, Sweden. Interventions Treatment as usual consisted of psychological and pharmacological interventions for alcohol dependence. The 10-week yoga intervention included a weekly group yoga session. Participants were encouraged to practice the yoga movements at home once per day. Main outcome measures Alcohol consumption (timeline follow-back method, DSM-IV criteria for alcohol dependence, and the Short Alcohol Dependence Data questionnaire), affective symptoms (the Hospital Anxiety and Depression Scale), quality of life (Sheehan Disability Scale) and stress (the Perceived Stress Scale and saliva cortisol). Results Yoga was found to be a feasible and well accepted adjunct treatment for alcohol dependence. Alcohol consumption reduced more in the treatment as usual plus yoga group (from 6.32 to 3.36 drinks per day) compared to the treatment as usual only group (from 3.42 to 3.08 drinks per day). The difference was, however, not statistically significant ( p =0.17). Conclusions Larger studies are needed to adequately assess the efficacy and long-term effectiveness of yoga as an adjunct treatment for alcohol dependence.

BackgroundThe aim of the study was to determinate whether schizophrenia patients with a history of cannabis use have a different prognosis, with regards to readmission and hospital duration, compared with those without a history of cannabis use.MethodThe present investigation was a cohort study of 50 087 Swedish men with data on cannabis use at the ages of 18–20 years. A total of 357 cases of schizophrenia were identified from in-patient care and followed up from 1973 to 2007.ResultsSchizophrenia patients with a history of cannabis use had a higher median duration of first hospital episode (59 days v. 30 days). Patients with a history of cannabis use had a higher median rate of readmission (10 times v. four times). Also, total number of hospital days was higher in patients with a history of cannabis use compared with those without (547 days v. 184 days). Patients with a history of cannabis use had an increased odds of having more than 20 hospital readmissions compared with non-users [3.1, 95% confidence interval (CI) 1.3–7.3] as well as an increased odds of hospital admission lasting more than 2 years (2.4, 95% CI 1.1–7.4) after controlling for diagnosis of personality disorders, family socio-economic position, IQ score, civil status, place of residence, risky use of alcohol and use of other drugs. Patients with a history of cannabis use were less likely to have paranoid schizophrenia compared with never users (8% v. 17%) in the first admission.ConclusionsSchizophrenia patients with a history of cannabis use had a significantly higher burden of lifetime in-patient care than non-cannabis users. Not only does cannabis increase the risk of schizophrenia, but also our findings indicate that the course and prognosis of schizophrenia may be more severe than schizophrenia cases in general.

BACKGROUND: Adolescents' alcohol consumption is a public health concern in Sweden as well as in many other countries. Underage drinking is associated with increased risks of alcohol-related injuries, risky sexual behaviours and dependence later in life. Different strategies have been used in the effort to prevent this behaviour, and to postpone the onset of alcohol. The Strengthening Families Programme 10-14 (SFP 10-14) from the USA has been highlighted as one of the more effective prevention programmes. The aim of the present article was to evaluate the effectiveness of a culturally adapted Swedish version of the SFP 10-14. METHODS: This was a cluster randomized controlled trial including 587 sixth-grade students (age 12) and their parents in 19 elementary schools in Stockholm. Schools were randomly assigned to either control (9 schools, 216 students) or to the family skills training intervention (10 schools, 371 students). The SFP Swedish version consisted of two parts with seven and five sessions, respectively, held separately for youths and parents except two joint family sessions. Measures of students' self-reported episodes of drunkenness, smoking, illicit drug use and other norm-breaking behaviours were collected at baseline (March 2003) and at three subsequent yearly surveys. Data were analysed using multilevel models with an intention-to-treat approach. RESULTS: No preventive effects were found for smoking, alcohol and illicit drug use and other norm-breaking behaviours, nor did moderators affect the outcome. CONCLUSION: The Swedish version of the SFP 10-14 was not effective in preventing youths' substance use in a Swedish context. Language: en

Aims: The aim of the study was to investigate preferences in the general population regarding type of treatment for alcohol problems and the preferred setting for delivery of treatment and reasons for not seeking treatment for alcohol problems. Method : Data were from a random, cross-sectional, interview survey of 9005 of the Swedish general population. Proportions of respondents preferring a certain treatment and source of treatment, and reasons suggested for why people do not seek treatment, were analysed in relation to number of standard drinks, employment status, education and income. Results: Most frequently endorsed forms of treatment were alcoholics anonymous or similar support groups and psychotherapy. More than 50% preferred psychiatric or addiction specialist treatment. Around 10% preferred primary health care and around 20% the occupational health services. About 5% preferred the social services. Respondents rated ‘feeling ashamed’ as the most important reason why people would not seek help for alcohol problems. Conclusion: Large majorities of the respondents preferred treatment in the health care services and few in the social services. Internet-based treatment and pharmacological treatment attracted few respondents, the majority preferring more traditional forms of treatment. Alcohol treatment remains a stigmatized field, evidenced by shame being the most commonly reported reason for not seeking treatment.

The severity of alcohol dependence can be estimated by the number of DSM-IV criteria that are fulfilled for this disorder. This paper describes the proportions in a general population sample that meet different numbers of diagnostic criteria for alcohol dependence and their association with drinking and social background factors. Data came from a random, cross-sectional, self-report survey of adults from 12 Swedish communities. 28,800 persons, age 19-70, were surveyed through postal questionnaires. 14,706 questionnaires (51%) could be used for analysis. Alcohol dependence was assessed by questions relating to the seven DSM-IV criteria for alcohol dependence. Alcohol consumption and social background factors were examined in relation to alcohol dependence. A total of 73.8% of the general population fulfilled no criteria for alcohol dependence; 4.0% reported 3 or more criteria and qualified for the diagnosis of alcohol dependence. There were trends toward an increasing number of dependence criteria with increasing consumption levels and negative social background factors. The majority of people with alcohol dependence however did not drink at the highest consumption levels, did not live alone, and were not unemployed. Given the current definition of alcohol dependence the majority of people have few criteria fulfilled (3 or 4) and few social problems. This has important implications for treatment as dependence with low severity may require less treatment and less specialist involvement.

CITATION: Watson, R., et al. 2016. Proceedings of the 13th annual conference of INEBRIA. Addiction Science & Clinical Practice, 11:13, doi:10.1186/s13722-016-0062-9.

Aims To evaluate long‐term effects of a multi‐component community‐based club drug prevention programme. Design A pre‐ (2003) and post‐intervention study (2004 and 2008) design. Setting High‐risk licensed premises in central Stockholm, Sweden. Participants The intervention programme, 'Clubs against Drugs', included community mobilization, drug‐training for doormen and other staff, policy work, increased enforcement, environmental changes and media advocacy and public relations work. Measurement The indicator chosen for this study was the frequency of doormen intervention towards obviously drug‐intoxicated guests at licensed premises. Professional male actors (i.e. pseudopatrons) were trained to act impaired by cocaine/amphetamines while trying to enter licensed premises with doormen. An expert panel standardized the scene of drug intoxication. Each attempt was monitored by two male observers. Findings At the follow‐up study in 2008 the doormen intervened in 65.5% of the attempts (n = 55), a significant improvement compared to 27.0% (n = 48) at the first follow‐up in 2004 and to 7.5% (n = 40) at baseline in 2003. Conclusion The 'Clubs against Drugs' community‐based intervention programme, a systems approach to prevention, appears to increase the frequency and effectiveness of club doormen's interventions regarding obviously drug‐intoxicated guests.

PurposePRIME for Life is an alcohol risk reduction program that has been used and refined in the USA for over 20 years. A Swedish version of the program has recently been adapted for use among Swedish high‐school students (age 18‐19). The objective of the study is to evaluate the effects of the program on youth alcohol consumption (including high risk drinking), attitudes and knowledge about the effects of alcohol use.Design/methodology/approachThe authors conducted a randomised controlled trial involving 23 schools and 926 students. Data collection was conducted with questionnaires focusing primarily on drinking behaviour. Participants were followed up at five and 20 months to assess changes in drinking behaviour, knowledge and attitudes towards alcohol.FindingsNo significant program effects on drinking behaviour were found. Knowledge about the effects of alcohol consumption on health increased after the intervention, as did negative attitudes towards alcohol, but these effects eroded over time.Originality/valueDespite being widely used in the USA and Sweden, the impact of PRIME for Life is under‐reported in the literature. This is the first independent evaluation of the program focusing on high school age youth. The findings do not support the efficacy of the program as a risk reduction or behaviour change tool in a school environment.

Aim: To study the mortality and causes of death among homeless men and women in relation to the risk indicators, previous treatment for alcohol and drug abuse, previous treatment for mental disorders and non-Swedish citizenship. Methods: The mortality was studied in a cohort comprising 1,757 men and 526 women compared with the general population and persons with inpatient treatment for alcohol- and drug-related disorders. The follow-up period was from 1995 to 1997 until the end of 2005. The causes of death were analyzed. Results: 421 deaths occurred during the follow-up period. The relative risk of death was 3.1, with no difference in mortality between homeless men and homeless women. Previous treatment for alcohol and drug abuse disorders was related to excess mortality and previous treatment for mental disease to lower mortality. Homeless people with inpatient treatment for alcohol or drug use disorders had no higher mortality than the general population in Stockholm with a similar history. There was a dominance of alcohol- and drug-related causes of death. Discussion: Compared with previous studies of homeless people in Stockholm the excess mortality among men found in this study is of the same magnitude. Mortality among women is lower. The mortality rate in homeless people with previous treatment for an alcohol and illicit drug use disorder did not differ from those treated for these disorders in the general population. Conclusions: The most important finding is that excess mortality among homeless men and women in Stockholm is entirely related to alcohol and drug abuse.

IntroductionPartners and children of individuals with alcohol use disorder (AUD) present with impaired quality of life and mental health, yet seldom seek or participate in traditional supportive interventions. Engaging the parent/partner without AUD in treatment is a promising way of supporting behavioural change in both the child and the parent with AUD. Universal parent-training (PT) programmes are effective in increasing children’s well-being and decreasing problem behaviours, but have yet to be tailored for children with a parent with AUD. Community Reinforcement Approach And Family Training (CRAFT) programmes are conceptually similar, and aim to promote behavioural change in individuals with AUD by having a concerned significant other change environmental contingencies. There has been no study on whether these two interventions can be combined and tailored for partners of individuals with AUD with common children, and delivered as accessible, online self-help.Methods and analysisn=300 participants with a child showing mental health problems and partner (co-parent) with AUD, but who do not themselves present with AUD, will be recruited from the general public and randomised 1:1 to either a four-module, online combined PT and CRAFT programme or a psychoeducation-only comparison intervention. Primary outcome will be the child’s mental health. Additional outcomes will cover the partner’s drinking, the participants own mental health and drinking, the child’s social adjustment, treatment seeking in all three parties and parental self-efficacy. Measures will be collected preintervention, mid-intervention and postintervention, and three times during a 2-year follow-up period. Data will be analysed using mixed-effects modelling.Ethics and disseminationThis study has been approved by the Stockholm Regional Ethical Review Board (2016/2179-31). The results will be presented at conferences and published as peer-reviewed publications.Trial registration numberISRCTN38702517; Pre-results.

Objective To explore the effects of brief training in Motivational interviewing (MI) for medical students. Design Video recordings of consultations between 113 final-year medical students and simulated patients were scored blind by two independent raters with the Motivational Interviewing Skill Code (MISC). Half of the students participated in a four-hour motivational interviewing workshop while the other half did not. Results Differences between the two groups were statistically significant for five of six global MISC variables. All differences were in the expected direction, with higher scores in the group that had received MI training. There were also statistically significant group differences in the expected direction on several behavioural measures. The group that received MI training asked fewer closed questions and more open questions; they summarized, affirmed and emphasized patient control more often, and directed and confronted less often. Conclusion Four hours of training has a measurable effect on medical students’ style and verbal behaviour in simulated patient consultations, but is not sufficient to become proficient in motivational interviewing.

The Swedish National Institute of Public Health is responsible for monitoring alcohol and alcohol related problems in Sweden. Four categories of indicators have been developed and are followed. 1) Determinants of drinking, e.g. availability; these include business hours in the retail monopoly stores, number of licensed premises, and business hours. 2) Consumption indicators include alcohol sales at the retail monopoly stores in all municipalities as well as sales at licensed premises and beer sales at grocery shops and other stores. Estimates of unrecorded consumption is based on survey data. 3) Harms data include alcohol related mortality and morbidity and alcohol related crime. 4) Two indicators of prevention activity in the communities are being developed: the first is an organizational index based on the number of staff employed by the municipality to work with alcohol and drug prevention, existence of a current municipal alcohol and drug policy, number of licensed premises per 10,000 inhabitants, enforcement activity and organized cooperation with other agencies in the community, e.g. the police, NGO's, and local businesses. The second is an activity index which is based on the number of prevention activities conducted in the communities.

PurposeThe purpose of this paper is to examine factors predicting parental participation and retention in a Swedish version of the Strengthening Families Programme (SFP).Design/methodology/approachThis study is based on data from a randomised controlled trial to evaluate the effects of the Swedish version of the SFP. The sample involves 441 parents of sixth graders, and the data are obtained from parents' questionnaires measuring demographics, parental warmth, rule setting, perception of norm‐breaking behaviours, knowledge of school performance, and parents' attitude towards adolescents and alcohol. Predictors of parental participation and retention are analysed with multiple logistic regressions.FindingsThere were two significant predictors for programme recruitment: having a low score on a scale measuring parents' emotional warmth and having a more restrictive attitude towards youth and alcohol. Retention was associated with being born in Sweden, and having a low score on the scale measuring warmth.Practical implicationsThere are few predictors of participation and retention in the Swedish version of the SFP, indicating that the programme seem to attract all types of parents in the general population. The fact that a low level of warmth predicts participation indicates that parents with a stronger need for support are recruited. Retention was greater among those who were born in Sweden, which indicates that efforts might be needed to meet the needs of those coming from another country.Originality/valueRecruiting and retaining parents into family programmes is challenging and it is important to identify the underlying factors for successful recruitment.

Purpose – The purpose of this paper is to evaluate the effectiveness of the PRIME for Life risk reduction program in reducing alcohol consumption and improving knowledge and attitudes towards alcohol use in male Swedish military conscripts, aged 18 to 22 years.Design/methodology/approach – A quasi‐experimental design was used in which 1,371 military conscripts from ten regimens were assigned to either a control or program intervention group. Changes in alcohol consumption, knowledge and attitudes towards alcohol use were assessed with self‐report questionnaires at baseline, and again 5 months and 20 months after the program.Findings – Pre to post program reductions in total alcohol consumption and “high risk” consumption were reported in both the control and intervention group. There were no statistically significant group interactions over time, indicating that factors beyond the intervention alone were responsible for the reductions in alcohol consumption. Attitudes towards consumption improved signific...

Introduction: Alcohol consumption and drug use, as well as alcohol- and drug-related problems, vary considerably in different regions in Sweden, and between men and women of different ages. Aim: The aim of the present study was to examine the regional, gender and socioeconomic distribution of risk consumption of alcohol, alcohol dependency and drug use in a random sample in Sweden. Material and methods: In both May 2003 and 2004, 7200 gender-stratified adults (a total of 14,400), randomly selected from 12 regions in Sweden, were contacted by mail, and asked to fill out an enclosed questionnaire. The questionnaire concerned use of alcohol, alcohol-related problems, and use of illicit drugs. Results: Heavy alcohol consumption and cannabis use were more frequent in the south of Sweden than in the north, and the further north, the lower the frequency. Alcohol and drug use decreased with age, and was higher for men than for women. On average, 11.5% of all men and 5.0% of all women consumed alcohol intensively at least weekly, 8.6% of men and 4.5% of women had a generally high alcohol consumption, 4.1% of men and 2.5% of women were alcohol addicted, and 2.9% of men and 1.3% of women had used cannabis during the last 12 months. Conclusions: High alcohol consumption and use of illegal drugs seem to be more prevalent in those parts of Sweden that are closer to the European continent. In our opinion, this might be an effect of the closeness to other European countries with lower prices for alcohol, less strict alcohol control policies, and higher availability of drugs. Consideration of regional, gender and age differences in problems related to alcohol and drugs seem to be important in the planning and development of preventive activities.

PurposeThe purpose of this paper is to describe the adaptation and programme development of the Strengthening Families Programme to a Swedish setting.Design/methodology/approachA descriptive approach was employed with a focus on the cultural adaptation and programme development. This included meetings with two reference groups, a telephone interview with parents, translation of materials and production of videos and manuals. A pilot study was conducted which included course evaluations by students and parents, meetings with teachers and group leaders and a focus group interview with parents.FindingsThe programme format was altered in the Swedish version so that the youth sessions were held earlier during the day and the parent sessions later in the evening. Instead of having one family session at every meeting, the Swedish version included two family sessions in all. In the Swedish version, the booster sessions were incorporated as a regular part of the programme. In addition, more emphasis on alcohol and other drugs was added as well as an extra session. Following the evaluation of the pilot study, the materials were revised, with the inclusion of a “milder” vocabulary concerning disciplinary matters.Practical implicationsIt seems to be possible to disseminate the core elements in family programmes between different cultures, especially if care is taken to make adjustments to local conditions.Originality/valueThis paper makes a contribution to the research on how to culturally adapt prevention programmes.

Aims: To discuss three alternative roles and associated challenges for researchers as participants in community action projects for prevention of alcohol and other drug problems.Methods: To underta...

The objective of this study was to evaluate a research and development project to reduce alcohol and drug use-related problems, conducted during 2003-2005, in six urban and rural municipalities in Sweden, Umeå, Kramfors, Solna, Kalmar, Laholm, and Lund. The development of alcohol and drug use trends and patterns will be followed through 2008 in the six targeted intervention communities and in the six matched control communities. The evaluation includes archival data, survey data, observational data, as well as process measures. The six communities have gradually reoriented their thinking about prevention from a single focus on youth activities to a broader approach involving the whole population. The project's and the study's limitations are noted and future needed research is suggested.

Although alcohol consumption is a leading cause of preventable death and social problems worldwide, many studies have found an association between low-dose consumption and reduced risk of cardiovascular (CVD) disease. Despite important limitations in the underlying research, this idea has been promoted extensively, used to argue against the adoption of effective alcohol policies and led some doctors to advise patients to drink for better health. There are a number of grounds for scepticism about these claims. There have been no randomised studies of low-dose alcohol consumption with disease or death outcomes to confirm findings from non-randomised studies. There are many methodological problems with observational studies, most importantly confounding and misclassification. In contrast to observational studies, a recent large Mendelian randomisation study found that having a genetic disposition that causes less drinking was associated with a significantly reduced risk of coronary disease, even among those who consume modest amounts of alcohol. Recent research has also challenged some of the purported mechanisms for the protective effect of moderate drinking, eg the effect on and impact of blood lipids. This paper will provide methodological critique of the scientific basis for the claim that low-dose alcohol confers health benefits. It is concluded that the protective effects of moderate drinking may be spurious. Governments should strengthen effective alcohol control policies to reduce alcohol-related deaths, social problems and economic costs. Physician advice to patients should focus on reducing consumption among current drinkers, and should discourage drinking initiation or increased consumption on the basis of health-related considerations.

AIMS: (i) To compare actual developments of alcohol-related harm in Sweden with estimates derived prior to major policy changes in 1995 and (ii) to estimate the effects on consumption and alcohol-related harm of reducing alcohol prices in Sweden. DESIGN: Alcohol effect parameters expressing the strength of the relationship between overall alcohol consumption and different alcohol-related harms were obtained from ARIMA (Auto Regressive Integrated Moving Average) time-series analyses. MEASUREMENTS: Measures of Swedish alcohol-related mortality (liver cirrhosis, alcoholic psychosis, alcoholism and alcohol poisoning), accident mortality, suicide, homicide, assaults and sickness absence from 1950 to 1995. FINDINGS: Previous estimates of alcohol-related harm based on changes in alcohol consumption for the period 1994-2002 for Sweden were, in some cases (e.g. violent assaults and accidents), relatively close to the actual harm levels, whereas in other cases (e.g. homicides, alcohol-related mortality and suicide) they diverged from observed harm levels. A tax cut by 40% on spirits and by 15% on wine is estimated to increase total per capita alcohol consumption by 0.35 litre. This increase is estimated to cause 289 additional deaths, 1627 additional assaults and 1.6 million additional sickness absence days. CONCLUSIONS: The estimates of future changes in harm based upon even relatively modest increases in alcohol consumption produce considerable negative effects, with large economic consequences for the Swedish economy. The additional alcohol-related deaths, for instance, amount to more than half the number of yearly traffic fatalities in Sweden. Language: en

The aim of this research was to study the sustainable effects of a community action program on alcohol service to intoxicated patrons at licensed premises.Since 1996, the hospitality industry and authorities in Stockholm, Sweden, have been cooperating to reduce problems related to alcohol consumption at licensed premises. The intervention has included community mobilization, training in responsible beverage service (RBS) and enforcement. A pretest in 1996 and follow-ups in the 1999 and 2001 designs were used to study licensed premises in Stockholm. Male actors portraying intoxicated patrons visited the licensed premises and attempted to order beer. Observers were present at each visit. At the pretest, 92 licensed premises were visited, 47 in north central Stockholm and 45 in south central Stockholm. In 1999, 103 establishments were visited, 61 in north central Stockholm and 42 in south central Stockholm. At the latest follow-up in 2001, 100 licensed premises were visited, 56 in north central Stockholm and 44 in south central Stockholm.The results from the latest follow-up in 2001 showed a statistically significant improvement over those of earlier measures, with a refusal rate of 70% compared with 47% in 1999 and 5% in 1996. There were improvements in both study areas (i.e., north and south central Stockholm).There has been a significant improvement in the rate of refusal of alcohol service at licensed premises in Stockholm during the project period. The reason for this is probably a combination of the intervention efforts: community mobilization, RBS training and a more efficient monitoring of alcohol service by authorities.

This study evaluated the effects of a community alcohol prevention program on the frequency of alcohol service to young adults at licensed premises in Stockholm, Sweden. We used a pretest (1996)-posttests (1998 and 2001) design with intervention and control areas. The multicomponent intervention combines training of serving staff in responsible beverage service, policy initiatives, and enforcement of existing alcohol regulations. Adolescents 18 years old (the legal drinking age on licensed premises in Sweden), but younger looking according to an expert panel, visited licensed premises in pairs, where each adolescent ordered a beer. At baseline in 1996, the adolescents made 600 attempts to order. At follow-up in 1998, the number of attempts to order was 252, and at the second follow-up in 2001, the adolescents made 238 attempts. We found no statistically significant differences between the intervention and control areas. Overall, the frequency of alcohol service to adolescents on licensed premises in these areas of Stockholm decreased significantly over time, from 45 to 41 and to 32%, in 1996, 1998, and 2001, respectively. The decrease in alcohol service in 2001 was statistically significant compared to the baseline in 1996. One explanation for this improvement could be more effective enforcement of existing alcohol laws in both the intervention and control areas. We also found that licensed premises that used doormen to screen potential customers were less likely to sell to minors.

The objective of this article is to evaluate the level of institutionalization of a community action program targeting licensed premises in Stockholm. Five key factors were identified for institutionalization: adoption, sustainability, key leader support, structural changes, and compliance. A scale was developed to assess the strength of each factor. The results indicate a high degree of institutionalization (score 13 on a scale from 5 to 15). The authors conclude that the program activities have been sustained at a high level. A written agreement ensures that the participating organizations take responsibility for the continuing work.

This article represents the proceedings of a symposium at the 2002 annual meeting of the Research Society on Alcoholism in San Francisco, CA, organized and cochaired by Mats Berglund and Sten Thelander. The presentations were (1) Preventive interventions against hazardous consumption of alcohol, by Mikko Salaspuro; (2) Treatment of alcohol withdrawal, by Johan Franck; (3) Psychosocial treatment for alcohol problems, by Sven Andreasson and Agneta Ojehagen; and (4) Pharmacological treatment of alcohol dependence, by Mats Berglund.

The aim of this study was to compare two short-term treatments for alcohol-related problems. The study was performed at an outpatient clinic for substance misuse, and subjects (65 men and 28 women) were recruited through advertisements in the local newspaper. The subjects were randomized to either a four-session guided self-change group or a one-session advice group. Alcohol consumption, degree of alcohol dependence, negative consequences of drinking, and health-related quality of life were measured or assessed, respectively, by using the timeline follow-back technique, the Short Alcohol Dependence Data (SADD) questionnaire, The Drinker Inventory of Consequences questionnaire, and the Nottingham Health Profile questionnaire. Biological markers for high alcohol consumption [carbohydrate-deficient transferrin (CDT) and gamma-glutamyl transferase (gamma-GT) levels] were analyzed. All assessments were made at baseline and at 9- and 23-month follow-up periods after treatment. Self-reported alcohol consumption was significantly reduced (P

Aims To evaluate the effects of a community alcohol prevention programme on the frequency of alcohol service to intoxicated patrons at licensed premises. Design Pretest (1996)–post-test (1999) design. Setting Licensed premises in Stockholm, Sweden. Intervention The community alcohol prevention programme, including server training in responsible beverage service (RBS) and policy initiatives in the community, has been conducted since 1996. Participants and measurements Actors were hired to enter licensed premises, enact a scene of severe intoxication and attempt to order a beer. At the baseline in 1996, actors visited 92 licensed premises, 47 from the central part of Stockholm and 45 from the southern part of Stockholm. At the follow-up in 1999, 103 licensed premises were visited, 61 from the central part of Stockholm and 42 from the southern part of Stockholm. Observers monitored each visit. Findings At follow-up the actors were denied service of alcohol at 47% of the licensed premises, a statistically significant improvement compared to 5% in the baseline study. Conclusions Licensed premises refused service of alcohol to intoxicated patrons to a much greater extent than in the baseline study. The improved results can probably be explained by a combination of policy initiatives in the community, changes in the overall enforcement environment and RBS training.

McCambridge and Saitz have written an excellent review on brief interventions for alcohol in primary care.1 Given the substantial harm caused by alcohol, it still makes good sense for practitioners to discuss alcohol and other drugs with their patients. But how? To begin with, screening needs to change. Practitioners have …