Swimming upstream: how and why an alcohol misuse screening and intervention service using the AUDIT can have limited impact in primary care

Abstract

An alcohol-screening project using the AUDIT questionnaire (World Health Organisation 1992a) was undertaken in several primary healthcare centres in the eastern sector of Cardiff in 1997/1998. The aim of the project was three-fold: &#148 to raise awareness of problematic drinking in primary healthcare attenders &#148 to encourage GPs to perform brief alcohol education with their patients in addition to laboratory screening &#148 to offer primary care attenders identified as 'alcohol problem very likely' (AUDIT score greater than eight) a brief motivational interviewing counselling session with the nurse co-ordinating the project. This paper describes the process of implementing the screening and counselling service. Methods of AUDIT questionnaire distribution, reasons given for screening and cooperation of primary healthcare staff each have an impact on results. When administered anonymously in a pilot project, the AUDIT questionnaire identified very high rates of problematic drinking. Fifty-eight per cent of all those screening positive had some recorded intervention by their GP, but the majority were highly resistant to further counselling. The views of the primary healthcare staff involved in the project and those patients who attended for counselling are discussed.

• Alcohol Misuse
• Brief Intervention
• Primary Healthcare