Introduction to SIPS

1
Introduction to SIPS

• Professor Colin Drummond
• Institute of Psychiatry
• Kings College London

2
Topics

• What do we already know about screening and brief
  interventions?
• What research questions will SIPS address?
• What is SIPS and how did it come about?
• What will come out of SIPS over the next year?

3
What do we already know?
4
(No Transcript)
5
Source Anderson Baumberg, 2006
6
Alcohol Its a drug Jim, but not as we know it.
7
Alcohol is a toxic and dependence producing DRUG

• Acute effects
• Highly variable
• Pleasure, relaxation
• Impaired judgement, coordination, balance
• Mood effects
• Argumentativeness and aggression
• Drowsiness
• Impaired consciousness
• Coma, respiratory depression and death.

• Chronic effects
• Toxic effects on organs
• Over 60 diseases
• Psychiatric disorders
• Foetal alcohol effects
• Psychoactive effects alcohol dependence
• 3rd leading cause of disability after tobacco and
  hypertension
• No universally safe level

8
Alcohol use disorders prevalenceDrummond et
al., 2005

• 26 of the adult population have an alcohol use
  disorder (AUD)
• Includes 38 of men 16 of women aged 16-64
• 23 of the adult population are hazardous or
  harmful alcohol users (7.1 million people in
  England)
• 21 of men and 9 of women engage in binge
  drinking
• Prevalence of alcohol dependence is 3.6 overall,
  6 among men, and 2 among women (1.1 million
  people in England)

Alcohol dependence is considerably more prevalent
than drug abuse
Alcohol Needs Assessment Research Project, 2005
9
Chronic liver disease and cirrhosis mortality
rates per 100,000 population, 1950-2006
10
(No Transcript)
11
National AE study Drummond et al., 2003

• Funded by Strategy Unit/Dept of Health
• Maximum burden of alcohol on AE departments
• Regional variations
• 36 randomly selected AEs in England (18)
  stratified by region and urban/rural
• 116 researchers, 25 regional coordinators
• All AE attenders gt 18 years between 0900 and
  0859hr Saturday/Sunday

12
(No Transcript)
13
National AE study

• Predictors of ETOH
• Young, white, males, single/divorced, unemployed,
  living with parents or NFA, frequent attenders
  (1.6x)
• More often brought by police/ambulance
• Reasons for attendance
• Violent assaults involving weapons, RTA,
  psychiatric emergency, DSH
• Weapons fists, knives, shoes, glasses
• Locations clubs, pubs, public transport
• Correlations with general population data
• Fridays and Saturdays Estimated 1,000,000
  alcohol related AE attendances per annum

14
Screening and referral to an alcohol health
worker in AED (Crawford et al., 2004, Barratt et
al., 2005)

• Pragmatic RCT comparing leaflet with referral to
  Alcohol Health Worker
• Screening using Paddington Alcohol Test
• 599 randomised
• AHW group less drinking than leaflet
• Fewer AED attendances (mean 0.5)
• AHW more cost effective

15
SBI in primary care

• Prevalence 20-30
• Frequent attenders
• Screening health promotion role
• Early detection intervention
• Effect of alcohol intervention on health outcomes
• 5-30 min of targeted advice

16
Evidence-Base for SBI

• Freemantle 1993 - 6 trials in primary care
• 24 drop in consumption (95 CI 18 to 31)
• Moyer 2002 56 trials, 34 relevant to PHC
• Consistent positive effect, NNT 8-12 (smoking20)
• Cost savings found at 4 years in the USA
• Kaner 2007 29 trials in PHC AE
• Consistent positive effects 7 drinks less/week
• Evidence strongest for men, less work on women
• No significant benefit of longer versus shorter BI

17
What is known already about SBI?

• AE SBI is effective and cost effective in
  academic centres (e.g. St Marys Model)
• Primary Health Care SBI is effective and some
  evidence of cost effectiveness across range of
  international settings
• General Hospital SBI less effective
• General lack of research in UK
• In all cases SBI effective for opportunistic
  intervention in non-treatment seeking
  populations. Less effective for treatment
  seeking/alcohol dependent patients

18
What is not known about SBI?

• AE can it be effectively implemented outside
  academic centres in UK?
• PHC is it cost effective and can it be
  implemented in typical PHC setting?
• CJS is it feasible to implement SBI, and is it
  effective?
• All settings
• What are the best screening tools (short vs
  longer) and method (universal vs targeted)?
• Is extended BI better than 5 min advice?
• What are the barriers/facilitators for
  implementation in the typical setting?
• Effectiveness in females, young, BME

19
Alcohol Screening and Brief Intervention Research
ProgrammeSIPS
AE St. Marys


'Scientia Vincit Timorem'
20
Programme design

• Funded by Department of Health for 3 years
• Jointly led by IOP Newcastle University
• 3 cluster randomised clinical trials of alcohol
  screening and brief intervention (PHC, AED, CJS)
  to assess
• What are the barriers/facilitators to
  implementation in a typical setting?
• What is the most effective screening method?
• What is the most effective and cost effective
  intervention approach?
• Total target of 2,403 subjects, completed 2,600
  July 2009
• 6 and 12 months follow up, currently 80 _at_ 6
  months (mainly phone)

21
SIPS Research Project Group

• Kings College London
• Prof C Drummond (CI)
• Dr J Myles PI
• Dr P Deluca PI
• Mr T Phillips PI
• Ms K Perryman PI
• Dr M Cochrane
• Ms D Jeffery
• Dr M Hobbs
• Ms R Cappello
• Mr S Keating
• Ms L James
• Ms L Rail
• Ms J Reid
• Ms R Lee
• Mr S Gordon
• Ms L Floodgate
• Mr D Kerr
• Mr H Mosaheb

• Newcastle
• Prof E Kaner (DCI)
• Prof C Day PI
• Dr E Gilvarry PI
• Dr P Cassidy PI
• Dr D Newbury-Birch PI
• Prof Nick Heather PI
• Ms K Jackson
• Ms N Brown
• Ms M Clifford
• Ms E Phinn
• Ms C Shaw
• Ms R McGovern
• Ms A Hindhaugh
• Ms G Hawdon
• Ms D Carpenter
• Mr G Scott
• Ms J Armstrong
• Ms D MacDonald

22
9 Clusters
1 AED 2/3 PHC 2/3 CJS
1 AED 2/3 PHC 2/3 CJS
Newcastle General
Darlington Memorial
1 AED 2/3 PHC 2/3 CJS
1 AED 2/3 PHC 2/3 CJS
1 AED 2/3 PHC 2/3 CJS
Hexham
South Tyneside
Winchester
1 AED 2/3 PHC 2/3 CJS
1 AED 2/3 PHC 2/3 CJS
1 AED 2/3 PHC 2/3 CJS
1 AED 2/3 PHC 2/3 CJS
Kings College
St Thomass
Central Middlesex
North Middlesex
23
How will we assess effectiveness?

• Effectiveness of implementation
• Extent of screening and intervention activity
• Attitudes to SBI implementation
• Patient outcome measures
• Alcohol consumption (extended AUDIT-C)
• Alcohol related problems
• Health related quality of life
• Health related and wider societal costs

24
Website

• www.sips.kcl.ac.uk

25
Training and intervention tools
26
Presentations

• Accident and Emergency study Dr Paolo Deluca
• Primary care study Prof Eileen Kaner
• Criminal justice study Dr Dorothy Newbury-Birch
• Early findings on screening Prof Simon Coulton
• Discussant Dr Peter Anderson