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Introduction to SIPS. Professor Colin Drummond Institute of Psychiatry King’s College London. 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?

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introduction to sips

Introduction to SIPS

Professor Colin Drummond

Institute of Psychiatry

King’s College London

  • 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?


It’s a drug Jim, but not as we know it.

alcohol is a toxic and dependence producing drug
Acute effects

Highly variable

Pleasure, relaxation

Impaired judgement, coordination, balance

Mood effects

Argumentativeness and aggression


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

Alcohol is a toxic and dependence producing DRUG
alcohol use disorders prevalence drummond et al 2005
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

national a e study drummond et al 2003
National A&E studyDrummond et al., 2003
  • Funded by Strategy Unit/Dept of Health
  • Maximum burden of alcohol on A&E departments
  • Regional variations
  • 36 randomly selected A&Es in England (18%) stratified by region and urban/rural
  • 116 researchers, 25 regional coordinators
  • All A&E attenders > 18 years between 0900 and 0859hr Saturday/Sunday
national a e study
National A&E 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 A&E attendances per annum
screening and referral to an alcohol health worker in aed crawford et al 2004 barratt et al 2005
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
sbi in primary care
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
evidence base for sbi
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 (smoking=20)
    • Cost savings found at 4 years in the USA
  • Kaner 2007 – 29 trials in PHC & A&E
    • Consistent positive effects ~7 drinks less/week
    • Evidence strongest for men, less work on women
    • No significant benefit of longer versus shorter BI
what is known already about sbi
What is known already about SBI?
  • A&E: SBI is effective and cost effective in academic centres (e.g. St Mary’s 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
what is not known about sbi
What is not known about SBI?
  • A&E: 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
alcohol screening and brief intervention research programme sips

Alcohol Screening and Brief Intervention Research ProgrammeSIPS

A&E St. Mary’s 'Scientia Vincit Timorem'

programme design
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% @ 6 months (mainly phone)
sips research project group
King’s 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

Ms C Elzerbi

St George’s

Dr A Oyefeso PI


Prof S Coulton PI (now Kent Univ)

Prof C Godfrey PI

Mr S Parrott PI

Prof M Bland PI


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

Imperial College and St Mary’s Hospital

Dr M Crawford PI

Prof R Touquet PI

Alcohol Concern

Mr D Shenker PI

Primary Care Research Network

Mental Health Research Network

SIPS Research Project Group
9 clusters
9 Clusters


2/3 PHC

2/3 CJS


2/3 PHC

2/3 CJS

Newcastle General

Darlington Memorial


2/3 PHC

2/3 CJS


2/3 PHC

2/3 CJS


2/3 PHC

2/3 CJS

South Tyneside




2/3 PHC

2/3 CJS


2/3 PHC

2/3 CJS


2/3 PHC

2/3 CJS


2/3 PHC

2/3 CJS

King’s College

St Thomas’s

Central Middlesex

North Middlesex

how will we assess effectiveness
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

  • 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