Screening and brief interventions for harmful alcohol use: where to now?

To the Editor: We read with great interest the article by Holmwood1 which provides a new perspective on alcohol screening, brief intervention and referral to treatment (SBIRT) in primary care settings. Holmwood argues that even though addressing unhealthy alcohol consumption in clinical practice has its place, the effectiveness of SBIRT in reducing alcohol intake is supported by little evidence. The author concludes that emphasis should be placed on strategies with the strongest evidence, such as harm reduction policies.

We agree with Holmwood that effective strategies to reduce alcohol consumption should be adopted, and SBIRT itself will not solve the problem entirely. As the author pointed out, the 2018 Cochrane review2 shows that the effect of SBIRT on the reduction of alcohol consumption might be limited. Yet, as stated in the review, we emphasise that while the reduction of alcohol consumption due to brief intervention is relatively small, the benefit on the population level and public health is still likely to be positive.2

With an alcohol intake of 11.9 L per capita (aged 15 years or older), the Czech Republic ranked in the third place in the world in 2019.3 In the Czech Republic, health care professionals are obliged by law to provide SBIRT to their patients.4 However, studies among Czech patients show that less than half of them are asked about their alcohol consumption by their doctor, and only 7.9% of patients are advised to lower their alcohol consumption.5 Studies among Czech doctors report that a quarter do not provide brief intervention to any of their patients.5 It would be interesting to know related information from Australia, but with respect to Czech data, we believe there should be an increased emphasis on the education and training of health care professionals in SBIRT and on supporting general practitioners in providing brief interventions (eg, adequate financial reimbursement of their time) to increase the use of SBIRT in clinical practice. That way, SBIRT can be used to its full potential and complement other strategies to address the high alcohol consumption and related harms.