Alcohol is a big problem• 23% adults hazardous or harmful drinkers (7.1M)• Consumption doubled in adolescents in past 10 yrs• 3.6% alcohol dependent (1.1M) (Drummond et al., 2005)• Only 1 in 18 access treatment (Drummond et al., 2005)• 25,000 premature deaths annually• Cost of alcohol misuse £25bn per annum• 3rd leading cause of disability in Europe• 40% A&E attendances (Drummond et al., 2003)• Prevalence high in CJS (SIPS project, 2010):

– 78% prison; 65% probation; 58% police custody• Mental health services- 49%; PHC – 30% (Coulton et al., 2006)• Alcohol Dependence: 25 years of potential life lost

Professor Colin Drummond Professor Colin Drummond Alcohol Research Group, Addictions CAGAlcohol Research Group, Addictions CAG

SIPS research programme• Funded by Department of Health: Led by IOP• 3 cluster randomised clinical trials of alcohol screening and

brief intervention (PHC, AED, CJS)• Research questions:

– What are the barriers/facilitators to implementation?– What is the most effective screening method?– What is the most cost effective intervention approach?

• Screened 10,521; 40% AUD +ive; 2,485 recruited• 17% reduction in AUD at 12 months across trials• No difference between interventions of different intensity• What’s next:

– SIPS Junior NIHR programme grant– ASBI for 10-17 year olds in AED– Cohort study (NIHR BRC): impact of alcohol on development

3

Assertive Community Treatment in Alcohol Dependence (ACTAD)

• Typically high level of drop out and poor outcome• Initial pilot work on ACT methods (Passetti et al., 2008)• MRC pilot trial of ACT in chronic relapsing AD• Research questions:

– Is ACT feasible/acceptable to implement in alcohol treatment?– Does ACT lead to improved treatment engagement?– Does ACT lead to improved clinical outcomes?

• 90 patients in 3 South London specialist CDATs• Random allocation to

– Assertive community Treatment, or– Treatment as usual

• Results so far– ACT high level of acceptability with patients and staff– High level of engagement (100% at 12 months)

• What’s next?– Clinical outcomes 6 & 12 months– ACTAD II –full RCT (NIHR HTA)– CHAOS – ACT targeting frequent flyers (NIHR programme grant)