Aim To obtain a consensus of expert views on how best to implement screening and brief intervention (SBI) for excessive drinkers in a routine and enduring fashion in primary health care throughout England. Method A Delphi survey of expert opinion in the UK. Participants Seventy-nine experts in SBI, of whom 53 (67%) remained in round 3 of the survey. The expert panel included primary health-care professionals, alcohol-service workers and researchers/ academics. Measurements In round 3, 53 panel members (67% of an initial sample of 79) made ratings on a fivepoint Likert scale of 157 items developed from responses to open ended questions in round 1 and fed back with group median ratings derived from round 2. Consensus was defined as an interquartile range of ƒ1 and attention was mainly directed to items with consensus around median responses of strong agreement or disagreement. Findings A number of clear conclusions emerged from the survey, including the recommendation of routine screening confined to new patient registrations, general health checks and special types of consultation. The employment of a specialist alcohol worker as a member of the primary health-care team was strongly supported, but a model of interprofessional cooperation in the delivery of SBI could also be derived from findings. Other conclusions included the importance for the widespread implementation of SBI of a national alcohol strategy.

Excessive alcohol consumption is a major cause of health and social problems in the UK. Research has shown that alcohol-related problems are responsive to early identification and brief intervention in primary health care. However, primary health care professionals have generally been reluctant to implement alcohol screening and brief intervention into routine practice. Addressing this issue has been the latest focus of an ongoing World Health Organization (WHO) Collaborative Project. The present study (Phase IV) is concerned with the implementation of screening and brief intervention materials and procedures for widespread and routine use in primary health care. KEY WORDS primary care brief intervention screening alcohol misuse Alcohol-related problems and primary care R ecent public health strategy (Secretary of State for Health, 1998; 1999; 2000) has focused on lifestyle factors, including alcohol misuse, as a major cause of ill-health in the population. Excessive alcohol consumption is named as a risk factor in the four national priority areas of cancer, coronary heart disease and stroke, mental health and accidents (Secretary of State for Health, 1999). With inpatient costs alone estimated at between 2% and 12% of NHS expenditure on hospitals, alcohol-related problems are placing a huge burden on the NHS (Royal College of Physicians, 2001).In primary health care, hazardous and harmful drinkers present twice as often as other patients and may constitute 20% of patients on a practice list (Austoker, 1994). However, research has shown that early identification (screening) and brief intervention (5-10 minutes of brief advice plus a self help booklet) is effective in reducing levels of hazardous and

The following are selected and edited abstracts from the Society for the Study of Addiction Annual Symposium, 2-3 November 2000, Leeds, UK