The long and winding road to widespread implementation of screening and brief intervention for
alcohol problems. A historical overview with special attention to the WHO initiatives
Engelsk titel: The long and winding road to widespread implementation of screening and brief intervention for
alcohol problems. A historical overview with special attention to the WHO initiatives
Författare:
Aasland OG
;
Nygaard P
;
Nilsen P
Email: olaf.aasland@legeforeningen.no
Språk: Eng
Antal referenser: 20
Dokumenttyp:
Översikt
UI-nummer: 09023107
Sammanfattning
Before 1970, special institutions, often prison-like, were built for the severely dependent. The
effect of this type of treatment, often lasting for months or even years, was hard to document
scientifically. During the 1970s several steps were taken towards a more preventive strategy
that involved delivery of alcohol interventions in general health care settings, particularly
within primary health care.
The World Health Organisation’s (WHO) introduction of the concepts of hazardous and
harmful drinking represented a shift from the traditional dichotomous view of individuals
being alcoholic-or-not to a continuum where, in line with Rose’s "prevention paradox", a
large number of people with low risk may give rise to more cases of disease than the small
number with high risk. The need for efficient methods to detect persons with various degrees
of alcohol risk was evident, and a WHO multi-national project that resulted in the publication
of AUDIT (Alcohol Use Disorders identification Test) was carried out in the mid 1980s.
The usefulness of this principle of case finding was then investigated in a subsequent
multinational WHO project of brief intervention, as well as in several other similar projects.
Many of these projects have proven quite efficient, but screening and brief intervention for
alcohol problems is still not standard procedure in primary health care. The paper discusses
some of the reasons why.