Volume 219 - Issue 11
A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial
Author: Alain Braillon
Med J Aust 2023; 219 (11): 559-560. || doi: 10.5694/mja2.52162
Published online: 11 December 2023
Published online: 11 December 2023
Comment
To the Editor: Grigg and colleagues must be commended for their randomised controlled trial (RCT).1 However, their conclusion that “the effectiveness of brief alcohol interventions for reducing alcohol consumption in women attending breast screening should be further investigated” deserves comment.
First and foremost, it is unacceptable that no national program for cancer screening has yet implemented evidence‐based interventions to reduce the burden of avoidable causes of cancers (tobacco, alcohol, and obesity).
Second, although brief alcohol interventions can improve awareness of alcohol harms, in my opinion there is no rationale for investigating whether this could reduce consumption. Key considerations are:- In the RCT by Grigg and colleagues, none of the secondary outcomes investigating alcohol consumption, even using subgroup analyses, supported a hypothetical effectiveness.1
- Although brief intervention is usually recommended, its effectiveness remains controversial.2,3 It is time to acknowledge that “brief intervention” is a bazaar of techniques without a defined method. In contrast, motivational interviewing, a cornerstone of care,4 is a well defined and effective technique that can be learned.
- How could a brief intervention be effective against the sophisticated marketing mix of the alcohol industry when public policies are so inadequate? No country has developed a comprehensive policy and key measures are typically avoided. Scotland is the only country to have recently implemented a minimum unit price (£0.50/8g ethanol),5 similar to that in the Northern Territory (AU$1.30/10g ethanol).6 This reduced the prevalence of hazardous drinking but not of harmful levels.5 With respect to health warnings, the Canadian territory of Yukon was a worldwide exception when it mandated cancer warnings in 2017, but this only lasted a few months due to alcohol industry interference.7 Ireland has approved extensive health labelling on alcoholic beverages, including cancer warnings and a calorie count, which is expected to come into force in May 2026.8
Competing interests
No relevant disclosures.
References
- Grigg J, Manning V, Lockie D, et al. A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial. Med J Aust 2023; 218: 511‐519. https://www.mja.com.au/journal/2023/218/11/brief‐intervention‐improving‐alcohol‐literacy‐and‐reducing‐harmful‐alcohol‐use
- Khan A, Tansel A, White DL, et al. Efficacy of psychosocial interventions in inducing and maintaining alcohol abstinence in patients with chronic liver disease: a systematic review. Clin Gastroenterol Hepatol 2016; 14: 191‐202.e4.
- Braillon A, Taiebi F. Treatment of alcohol use disorders: benchmarking Houston, Texas, and Philadelphia, Pennsylvania. Clin Gastroenterol Hepatol 2016; 14: 487.
- Rollnick S, Butler CC, Kinnersley P, et al. Motivational interviewing. BMJ 2010; 340: c1900.
- Stevely AK, Mackay D, Alava MH, et al. Evaluating the effects of minimum unit pricing in Scotland on the prevalence of harmful drinking: a controlled interrupted time series analysis. Public Health 2023; 220: 43‐49.
- Taylor N. Three years of minimum unit pricing in the Northern Territory, what does the evidence say? Drug Alcohol Rev 2023; 42: 912‐914.
- Hobin E, Weerasinghe A, Vallance K, et al. Testing alcohol labels as a tool to communicate cancer risk to drinkers: a real‐world quasi‐experimental study. J Stud Alcohol Drugs 2020; 81: 249‐261.
- Webber J. Ireland to label alcoholic drinks with detailed health warnings. Financial Times 2023; 22 May. https://www.ft.com/content/3d7f5de5‐6d51‐4682‐8c31‐659376fd5602 (viewed Oct 2023).
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