Do stepped care interventions for older hazardous alcohol users reduce alcohol consumption, compared with a minimal intervention at 12 months post randomisation?

A wealth of evidence documents the detrimental impact of excessive alcohol consumption. In older populations it is associated with increased risk of coronary heart disease, hypertension, stroke, a range of cancers, as well as falls, early onset of dementia and other cognitive deficits. Physiological changes occurring as part of the ageing process mean older people experience alcohol related problems at lower consumption levels. There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol intake in populations identified opportunistically in primary care settings. ‘Stepped’ care interventions involve delivery of more intensive and invasive interventions only to those in the population who fail to respond to less intensive treatment and provide a potentially resource-efficient means of meeting the needs of this population. 500 eligible, consenting participants attending primary care appointments are screened. Those with alcohol use disorders are randomised with equal probability to either a minimal ‘treatment as usual’ intervention or a more invasive stepped care programme – successive steps of increasing intensity incorporating:

Step 1 – behavioural practice nurse delivered counselling

Step 2 – three sessions of intensive motivational enhancement with a trained therapist
Progression to successive steps depends on outcomes of the previous step. Both approaches have seen reduced alcohol consumption in other studies, but where neither is beneficial, participants move to

Step 3 – referral to specialist alcohol services

Outcomes are measured and compared at baseline and various stages of the trial to evaluate effectiveness of the stepped care programme. The primary outcome is measured using average standard drinks per day and secondary outcome measures include health related quality of life and health utility. The study incorporates a comprehensive economic analysis, including use of social and health care resources, to assess relative cost-effectiveness of the interventions.

Start date: 01/01/2008 End date: 30/09/2012

Funder: Health Technology Assessment Programmes via the Univeristy of York

Funding: £15,1944

Publication: The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) – A randomised control trial protocol

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