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Excess alcohol intake is associated with many negative effects and is a major cause of mortality and morbidity worldwide. World Health Organization has established a global plan with 10 primary policy areas and interventions and six important action areas to reduce alcohol’s negative effects. However, alcohol intervention programs face several challenges that can hinder their success in assisting patients with alcohol consumption reduction and cessation. The objective of this scoping review was to identify the barriers to the implementation of alcohol intervention programs. The Joanna Briggs Institute recommendations and PCC (participants, concepts, context) eligibility criteria were used for the review. A combination of search phrases was used to narrow the literature search to 2014–2024 English-language papers and original research articles with full access. After removing duplication, 3,846 articles remained from the 5,128 found. After further exclusions, 19 eligible studies were included in this review. Five main barriers to care were identified: service-level barriers, barriers to care seeking, stigma, socio-cultural barriers, and external barriers. Robust regulations and implementation are necessary to effectively address service levels and external barriers. To enhance help-seeking behaviors, alcohol screening should be implemented, strict management policies for alcohol use disorders should be enforced, and accessible alternatives should be provided. Additionally, public health initiatives should focus on changing societal perceptions to counteract alcohol normalization. These efforts must involve both communities and workplaces.
Ethanol, a psychoactive constituent of alcohol, is composed of carbon atoms and a hydroxyl (-OH) functional group. It is frequently referred to as ethanol or ethyl alcohol and is recognized for its stimulatory properties. Ethanol is synthesized via fermentation and distillation. It serves as the principal component of a range of beverages, such as wine, beer, and spirits [1]. Alcohol consumption, especially in excess, is linked to several negative outcomes and is a risk factor for diseases, health impacts, crime, road incidents, and alcohol dependence [2]. Alcohol is a significant cause of mortality and disability worldwide and was responsible for 3.8% of deaths and 4.6% of disability-adjusted life-years (DALYs) lost in 2004. In the same year, alcohol was identified as the eighth most significant risk factor for mortality and listed as the third most significant cause of DALYs [3]. Harmful use of alcohol causes 3,000,000 deaths every year globally, representing 5.3% of all deaths. Alcohol consumption is associated with the risk of developing health problems such as mental and behavioral disorders, including alcohol dependence [2]; major noncommunicable diseases such as liver cirrhosis, some cancers, and cardiovascular diseases; and injuries resulting from violence, road crashes, and collisions [4].
To mitigate the adverse effects of alcohol consumption, the World Health Organization implemented a global plan consisting of recommendations in 10 major policy areas and interventions, with six proposed key action areas: implementation of high-impact strategies/interventions, advocacy, awareness and commitment, partnership, dialogue and coordination, technical support and capacity building, knowledge production and information systems, and resource mobilization [5]. The most effective policies, such as those pertaining to the taxation or pricing of alcohol, fall under the purview of national or regional governments [6,7], and the effects of these policies interact at all levels [8].
Alcohol intervention programs encounter several obstacles that can impede their efficacy in assisting those endeavoring to conquer alcohol consumption. Hence, the objective of this scoping review was to synthesize the barriers to implementing alcohol cessation and intervention programs. Consistent with the literature [9], a scoping review was chosen to provide an overview of the barriers and challenges influencing the implementation of alcohol cessation and interventions in various settings, irrespective of the study design. This review focuses on alcohol cessation interventions that can be implemented in primary care, hospital-based, and community settings, with no emphasis on regulatory policies, including alcohol taxation and pricing, marketing control, and control of the physical availability of alcohol products. This scoping review explored alcohol-cessation interventions applicable to primary care, hospitals, and community settings. Although population-level regulatory policies such as alcohol taxation, marketing controls, and restrictions on physical availability significantly influence alcohol consumption reduction, they are not the focus of this review. The objective was to assess the direct clinical and community-based strategies that healthcare providers and frontline practitioners can easily adopt or adapt. This focused approach corresponds with the necessity for actionable, context-specific interventions in healthcare systems while recognizing the broader significance of policy measures in facilitating cessation efforts.
Methods
This scoping review was conducted using the recommendations provided by the Joanna Briggs Institute (JBI). The JBI approach offers a structured framework for evidence synthesis comprising six stages: formulating research question(s) and inclusion criteria, conducting systematic evidence searches, selecting studies, extracting data with standardized tools, analyzing and presenting results, and engaging with stakeholders when relevant. This methodology is suitable because it accommodates diverse study designs while maintaining rigorous and transparent methods for evidence mapping, aligning with the objective of examining barriers to alcohol cessation interventions [10]. The primary research question of this review was: “What are the current barriers or challenges to the implementation of alcohol cessation and intervention programs globally?”
Eligibility criteria
The eligibility criteria for this review were determined using the PCC (participants, concepts, context) framework.
Participants
The review included adolescent and adult age groups with any definition of alcohol use. The subgroups of participants included all ethnicities, sex, and gender. Studies involving individuals with or without alcohol use disorder (AUD) were eligible if they evaluated screening interventions for AUD. Studies that included participants or service users and service providers were also included when relevant findings were reported. Exclusions were made for studies involving individuals with both AUD and other substance use disorders to focus on specific factors that affect AUD intervention. Studies involving specific diseases or conditions of the population related to AUD were also excluded.
Concept
Primary research, which included both quantitative and qualitative methods, was conducted. In terms of intervention criteria, both psychosocial and pharmacological interventions were of interest, with cessation of alcohol use as the primary outcome. To be eligible, studies must have reported at least one potential characteristic of alcohol cessation or an intervention program that was perceived as a barrier or challenge to implementation. Programs or interventions could occur in any context, such as clinical care or nonclinical settings (e.g., community or workplace). This review examined interventions targeting alcohol cessation, including pharmacological approaches that utilize medications to assist individuals in reducing or abstaining from alcohol consumption and nonpharmacological strategies that implement psychological or behavioral techniques to decrease or eliminate alcohol use, such as brief interventions. Studies were excluded if they only reported the characteristics of specific interventions that lacked generalizability to other interventions (e.g., elements of the user interface of mobile applications).
Context
The review encompasses the literature published globally between 2014 and 2024, focusing on primary studies available in English. The inclusion criteria were designed to capture a diverse range of settings, including both clinical and nonclinical environments, to reflect the multifaceted nature of alcohol cessation interventions. This review recognized the influence of diverse health systems and cultural contexts on the implementation and effectiveness of alcohol cessation interventions by examining the contextual factors reported in the included studies. These factors include healthcare infrastructure, cultural attitudes towards alcohol consumption, and resource availability. The evaluation of these contextual elements relied on the level of detail in the primary studies. The contextual approach facilitates the identification of universal and context-specific barriers, enables comparisons of implementation challenges across various settings, and highlights the determinants of the health system that influence intervention success.
Search strategy and information sources
A search strategy was developed to identify relevant studies on the barriers and challenges to alcohol cessation interventions. The primary databases searched were the Scopus and PubMed databases. Scopus was selected for its extensive coverage across scientific disciplines [11], including the health sciences, whereas PubMed was included to capture biomedical literature that was not indexed in Scopus. The search was conducted on March 10, 2024, using a combination of keywords: (“alcohol” AND “cessation”) OR (“alcohol” AND “intervention”) AND (“barriers” OR “challenges”). The search was limited to original English language research articles published between 2014 and 2024 with full-text availability. Although the selected databases provided substantial coverage, we recognize that the omission of additional pertinent databases, including CINAHL, PsycINFO, Embase, and Web of Science, may have constrained the breadth of our search. CINAHL is known for its focus on nursing and related health literature, offering valuable insights into the public health aspects of alcohol cessation. PsycINFO focuses on the psychological literature, potentially capturing behavioral studies associated with alcohol consumption. Embase provides biomedical and pharmacological data, while Web of Science provides multidisciplinary coverage, including the social sciences. The omission of these databases in this review is a recognized limitation; hence, future reviews should consider their inclusion to broaden the scope of the literature. Gray literature plays a vital role in identifying unpublished or non-peer-reviewed studies, thereby reducing publication bias and offering a more comprehensive understanding of implementation barriers. However, the decision to exclude gray literature was driven primarily by practical factors concerning resource constraints and methodological challenges linked to the systematic identification and appraisal of these sources. The primary objective of this review was to outline the existing published evidence on alcohol cessation interventions and their barriers. Although gray literature can provide additional perspectives, peer-reviewed literature sufficiently addresses this research objective. This review recognized this as a limitation and recommended that future research should include gray literature to enhance the evidence base.
Two levels of screening were conducted: titles and abstracts were assessed by a single reviewer in accordance with the review protocol, followed by full-text evaluation based on the predetermined eligibility criteria. Although the JBI guidelines recommend at least two independent reviewers to minimize bias, logistical constraints necessitated the use of a single reviewer. To mitigate the potential bias introduced by single-reviewer screening, strict adherence to predefined eligibility criteria and transparent reporting of methods were implemented. All full-text screenings were performed by a single reviewer, incorporating a time interval between the initial and repeated screenings to reduce oversight errors. Data charting was performed based on the research questions and objectives. It included the authors, country, study design, study population, setting, type of intervention, outcome or result, barriers, and challenges of alcohol cessation interventions. Barriers or challenges were defined as factors that negatively affected alcohol-cessation interventions. The complete findings of the search and process of the included studies were documented in the final scoping review and displayed in a flow diagram based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR) [12].
Data extraction
Data were extracted by a single reviewer using Microsoft Excel (Microsoft Corp). The data extraction form was piloted and refined as required until the reviewer was comfortable with the data to be extracted and fulfilled the objective. The following elements were extracted.
Publication characteristics: This included first author’s last name, publication year, and country of study or first author’s country.
Study characteristics, demographics, study setting, and tools: study objective(s), data collection tool(s), and type and number of participants were extracted. Study settings included where the study or intervention was delivered and where participants were recruited. Types of tools used to measure outcomes or intervention effectiveness were included.
Intervention data: This comprised no specific intervention (such as a study on access to any treatment) and pharmacological or nonpharmacological intervention. The delivery of the intervention was also included.
Barrier data: Factors that hindered the implementation and effectiveness of the interventions included service use/society or service-level/intervention barriers.
An AI tool was used to prepare this manuscript. Specifically, Quillbot (premium version; Learneo Inc.), a paraphrasing tool, was used to enhance the clarity and coherence of the writing process. This scoping review process did not include a risk of bias evaluation as per the scoping review methodology [13].
Results
A total of 5,128 articles were identified. After removing duplicates, 3,846 articles remained. After further exclusion of articles that were not within the scope of this review at level 1, 255 articles were assessed for eligibility at level 2. Of these, 19 were included in this review (Figure 1).
Characteristics of included studies
The characteristics of the 19 included studies, together with the associated barriers to alcohol cessation and intervention, are summarized in Table 1 [14-30]. The years of publication ranged from 2017 to 2023, and most of the included studies were conducted in high-income countries (n=12; 84.2%). The included studies were randomized controlled trials (n=6; 31.6%), cross-sectional studies (n=5; 26.3%), and qualitative studies (n=5; 26.3%), and three (15.8%) employed a mixed-method study design. The sample size ranged from 10 to 5,284 participants, with the largest study tending to have a mixed-method design.
Seven types of study settings were reported in the included studies, whereby community and primary care were the majority settings at 26.3%, followed by hospitals and schools at 15.8% in each setting; other settings (specialized clinic, special population, and workplace) constituted 5.3%. Overall, seven studies evaluated screening and brief interventions, five studies evaluated independent or technology-based interventions, three studies evaluated a model of care intervention, another three evaluated nonpharmacological psychosocial/workplace interventions, and one evaluated general treatment seeking. The data collection methods and tools used in the 19 studies included the Alcohol Use Disorders Identification Test (AUDIT) questionnaire, interview and focus group discussion, other questionnaires (validated or self-developed), and breathalyzer.
Barriers to implementation of alcohol cessation and intervention
Five main barriers were identified in the 19 included studies: service-level barriers, barriers to care seeking, stigma, sociocultural barriers, and other external barriers. Firstly, 11 out of 19 studies reported service-level barriers, further categorized into capability-related and opportunity-related barriers [14-23]. A study conducted in a US hospital addressed both capability and opportunity barriers [14]. In this study, the barriers to capability included limited familiarity with the treatment drug and difficulty in determining which patients were potential candidates for the drug. The opportunity barrier presented itself as a limited supply of the treatment drug, along with the ambiguity of who should introduce the drug and assess readiness to change.
Second, eight studies reported barriers to care or help-seeking among alcohol users [14,15,19,21,24-26,31]. For example, a latent class analysis of individuals with alcohol-related problems reported that low problem recognition and attitudinal barriers were associated with help-seeking barriers [24]. Other example related to barriers to seeking care was found in a study conducted in the United Kingdom; drinking to cope with multiple stressors is strongly shaped by having observed older relatives drinking heavily throughout their formative years, which emphasizes that alcohol was a common form of escapism [15].
Third, four studies addressed stigma as a barrier to alcohol cessation and interventions [15,27,28,31]. Stigma mostly comes from the community, family members, and healthcare workers. In the workplace, it is related to the fear of being judged by officers in charge of alcohol use problems. Fourth, two studies addressed the socio-cultural barriers to alcohol cessation and intervention [15,31]. Both studies highlighted the stigma attached to AUD among community members. One study reported the social and cultural influences on alcohol consumption, which clashed between religious and cultural norms. Finally, three studies reported that external factors were barriers to alcohol cessation and interventions [17,21,29]. The identified external barriers encompassed bureaucratic processes related to licensing policies, constraints on the measurement tool, and permissive laws and regulations that impact the pricing and accessibility of alcohol.
Discussion
The review identified five primary categories of barriers to the implementation of alcohol cessation interventions across the 19 included studies: service-level barriers, barriers to care-seeking, stigma, socio-cultural barriers, and external barriers. Individual studies have frequently identified various barriers, highlighting the complex challenges associated with the implementation of alcohol cessation programs. A key barrier identified was the presence of service-level barriers, which can be examined using the Capability, Opportunity, Motivation-Behavior (COM-B) model of behavior change, a well-established framework in implementation science for analyzing healthcare delivery challenges [32]. Within the context of this review, two components of service-level barriers—capability and opportunity—were notably significant. The COM-B model posits that for a specific behavior to occur at a particular time, an individual requires both the capability and opportunity to perform that behavior [33]. Capability refers to an individual’s psychological and physical ability to participate in relevant behaviors [33]. In the COM-B model, capability is linked to behavior, both directly and indirectly, through the mediating influence of motivation. Capability-related barriers are related to providers’ lack of training, lack of confidence among providers to provide alcohol use interventions, lack of resources (including insufficient staff, lack of funding, and physical location), lack of time related to providing alcohol interventions, and difficulties in accessing referral services from primary care. Consistent with a systematic review of barriers and facilitators to alcohol screening and brief interventions, the main barriers to effective implementation were a lack of resources, training, support from management, and the excessive workload of the providers [34]. Furthermore, previous studies have consistently found that time constraints are a significant barrier to screening for excessive alcohol consumption [35]. For example, several emergency department physicians indicated that they did not have time to screen patients for excessive drinking, and some expressed concerns about managing patients who screened positive [17]. In primary care, it was found that the lack of time for general practitioners put a higher responsibility on patients to seek help actively [27].
Opportunity refers to external factors beyond the individual that promote or motivate behavior, including both physical and social aspects [32]. Regarding opportunity-related barriers, the included studies reported ambiguities or unclear roles among the providers. Some studies also reported no continuation of alcohol cessation interventions when the manager was no longer in the organization. The readiness of providers to provide intervention and the reachability of alcohol intervention were among the highlighted opportunity barriers.
Barriers to seeking care stem mostly from low alcohol-related problem recognition and a lack of personal relevance. This barrier could be due to factors such as the perception that alcohol use would improve by itself, users’ dissatisfaction with available services, confidentiality issues, and lack of personal resilience, resulting in drinking to cope, and barriers to getting community-level support. Consistent with existing studies, the majority of participants who underwent positive screening for problematic alcohol use did not believe they had a problem [36], reflecting a gap in self-awareness and the perceived necessity for intervention [37]. This inclination can stem from a misperception regarding AUD severity thresholds; individuals often believe that only severe cases necessitate treatment, leading to an underestimation of their own risk [37]. Additionally, a lack of perceived necessity may be reflected in social networks and judicial systems, consequently diminishing the probability of seeking treatment. The notion that treatment utilization varies according to self-reliant attitudes suggests that addressing misconceptions about treatment is essential for intervention, as most individuals with AUD do not recover without it [38]. Stigma remains a significant person-centered barrier to the process of alcohol cessation and intervention [38,39], operating at multiple levels: individual, social, and institutional. Stigma acts as a mechanism to discourage and marginalize maladaptive behaviors, including problematic substance use [40]. The common expression of alcohol-related stigma has been reported in a previous study because it is ingrained within societal and cultural norms [41]. AUD stands out as one of the most extensively stigmatized mental health conditions [42]. This perception leads to self-blame and shame, which impede individuals from seeking treatment [43].
The sociocultural normalization of alcohol notably contributes to the continuation of harmful drinking behaviors [17]. Hence, it is found to be a sociocultural factor impeding alcohol cessation and intervention efforts. Alcohol consumption is deeply rooted in traditions, social rituals, and gender norms of many societies [15,44,45]. For instance, urban areas provide an environment commonly seen as favorable for intoxication among young individuals [46]. When there was a clear distinction between injunctive and descriptive norms, the impact of descriptive norms on drinking behavior was more significant than that of injunctive norms [47]. There is a strong correlation between drinking norms and traditional gender role beliefs in Korea, resulting in an increased prevalence of alcohol consumption among men [44,48]. Some indigenous communities in Malaysia regard alcohol consumption as a fundamental aspect of their cultural identity, complicating their efforts to promote cessation [49-51]. Furthermore, lenient laws and regulations influencing price and availability have been reported to encourage cultural tolerance of alcohol, particularly in high-income countries [21]. Hence, interventions should challenge cultural narratives concerning alcohol consumption while providing appropriate cultural alternatives.
External barriers related to structures and policies can further hinder effective alcohol cessation efforts, whereby it creates an environment in which alcohol is easily accessible and affordable [4,21]. Licensing bureaucracies pose a unique challenge [17,29], as opposing strategies among policymakers and community advocates impede advancement. Certain Alcohol Health Champions promote rigorous enforcement of licensing regulations, whereas others emphasize community education [18]. This absence of consensus results in inconsistent policy implementation. Thus, implementing mandatory health impact assessments for alcohol licenses may facilitate the alignment of licensing decisions with public health objectives. Addressing the detrimental effects of alcohol requires a comprehensive approach involving all levels of government and society. This integration is essential for fostering systemic change. Moreover, evidence highlights the significance of alcohol control policies in reducing health and sex disparities. When cohesively implemented, these strategies can enhance progress toward equitable and sustainable public health outcomes [4].
Strength and Limitation
This scoping review employed a rigorous method to identify and analyze data on a topic in a replicable and transparent manner using a well-established framework. The focus of the research question concerned with the user-, society-, and service- or intervention-level barriers allowed for broader attention to these factors, thus allowing for the formulation of appropriate recommendations for these barriers. Some of the barriers identified, such as cultural drinking norms and lack of awareness of the severity of problems related to alcohol use, are common in most populations, although they seem difficult to modify; however, they could provide a greater view of the barrier landscape. This scoping review’s limitation concerns the restriction of the literature search to articles published in English, resulting in some potentially relevant studies being omitted. Most of the included studies were conducted in high-income countries; hence, the generalizability of the review may be limited.
Conclusion
This review highlights five main barriers to alcohol cessation and interventions: service-level barriers, barriers to care-seeking, stigma, socio-cultural barriers, and other external barriers (licensing policy, constraints in the measurement tool, and permissive laws and regulations that impact the pricing and accessibility of alcohol). Therefore, there is a need to design effective policies and ensure their implementation to address service levels and external barriers related to licensing. Routine screening of alcohol use and strict guidelines on the management of AUD, alongside the promotion of alternative, easily accessible options, should be implemented to address help-seeking barriers. Furthermore, emphasis should be placed on public health strategies for the counter-normalization of alcohol use to shift perceptions and raise awareness. These strategies should include both communities and workplace organizations.
Article Information
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Funding
This scoping review was financially supported by the Universiti Malaysia Sabah Great Grant (GUG06700-2/2024).
Data availability
Not applicable.
Author contribution
Conceptualization: RA, MNBMD, PD, ZNBSA. Data curation: SJ, ZNBSA. Formal analysis: SJ. Funding acquisition: RA. Investigation: SJ. Methodology: SJ, ZNBSA. Resources: RA. Software: SJ. Supervision: RA, MNBMD, PD. Visualization: RA, PD, SJ. Writing–original draft: RA, MNBMD, SJ. Writing–review & editing: ZNBSA, SJ. Final approval of the manuscript: all authors.
Figure. 1.
Articles screening process in the review.
Table 1.
Study characteristics and barriers to the implementation of alcohol intervention
Year (country)
Title [ref]
Setting
Participant
Objective
Study design
Tools used
Intervention
Barriers to implementation
2023 (Australia)
A latent class analysis of perceived barriers to help-seeking among people with alcohol use problems presenting for telephone-delivered treatment [24]
Community
Adults (344)
To determine the proportion of people presenting to telephone-delivered alcohol treatment who are first-time help-seekers, and explored perceived barriers to help-seeking to understand the barriers this format of treatment may help to address.
RCT
AUDIT, Time-line Follow Back measure of past month drinking patterns, Kessler Psychological Distress Scale (K10), US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) list of 15 binary indicator variables identifying perceived barriers to seeking treatment for alcohol problems.
Telephone-delivered support programs
Multiple barriers to accessing treatment were endorsed with fewer than one-third had previously accessed treatment. Latent class analysis revealed a two-class model: a “low problem recognition” class endorsed readiness-for-change and attitudinal barriers; a complex barriers class endorsed stigma, structural, attitudinal and readiness-to-change barriers.
2022 (USA)
Provider perspectives on emergency department initiation of medication assisted treatment for alcohol use disorder [14]
Hospital
HCW (25)
To identify and describe perceived barriers and facilitators to the initiation of ED-based treatment of AUD with NTX.
Qualitative study
Semi-structured interview
Initiation of ED-based treatment of AUD with NTX
(1) Capability barriers; (2) opportunity barriers (physical and social); (3) lack of resources and options for follow up: phone access; (4) logistical barriers; (5) motivational barriers
2022 (UK)
Exploring views on alcohol consumption and digital support for alcohol reduction in UK-based Punjabi-Sikh men: a think aloud and interview study [15]
Community
UK-based Punjabi-Sikh men (15)
To explore UK-based Punjabi-Sikh men’s views on: (1) alcohol consumption within the community; (2) available support for alcohol reduction; and (3) an evidence-informed alcohol reduction app.
Qualitative study
Semi-structured interviews, AUDIT questionnaire
Alcohol reduction app - drink less app
(1) Drinking to cope; (2) belief that their drinking patterns are not ‘problematic’; (3) clash between religious and cultural norm—glorification of drinking and perpetuation of masculinity stereotypes. However, Sikhism prohibits alcohol use; (4) stigma; (5) The games in the app was described as childish/boring, and questioned the ability to affect behavior; (6) language barriers and wordy especially for older Punjabi-Sikh community members.
2022 (Sweden)
Screening for excessive alcohol consumption in emergency departments: a nationwide assessment of emergency department physicians [16]
Workplace
Managers (193)
To describe perceived dissemination barriers of the organizational alcohol policy by managers.
Cross sectional
Semi-structured interview
Alcohol prevention program in work-place (APMat): implementation of organizational alcohol policy and skills development training for managers
Lack of time, unclear roles, organization already has a well-functioning way of working with alcohol-related issues, alcohol related issues was not prioritized, person responsible for the program no longer works for the organization, worsening finances of the organization, reduce/lack of support from management/HR personnel, unsure of the reason to the unchanged approach to working with alcohol-related issues.
2022 (USA)
Screening for excessive alcohol consumption in emergency departments: a nationwide assessment of emergency department physicians [16]
Hospital
HCW (347)
To assess current screening practices for excessive alcohol consumption, as well as perceived barriers, perceptions, and attitudes toward performing this screening among emergency department (ED) physicians.
Cross-sectional
8-item multiple choice and short-answer assessment of the alcohol screening behavior
Screening for excessive alcohol consumption
Limited time and treatment options for patients with drinking problems.
2022 (Tanzania)
Missed opportunity for alcohol use disorder screening and management in primary health care facilities in northern rural Tanzania: a cross-sectional survey [31]
Primary care
Community (1,604)
To identify the missed opportunity for detection and management of alcohol use disorder by primary health care workers.
Cross sectional
AUDIT-10
Screening and management of AUD in primary healthcare facilities
Barriers to seeking care: (1) perception that alcohol drinking problem would get better by itself; (2) concern on family members’ approval; (3) unsatisfaction with the available services; (4) logistic issues: transportation unavailability; (5) stigma by the community.
2021 (Germany)
Treating excessive consumers with brief intervention to reduce their alcohol consumption: a thankless task? [30]
Primary care
GP (188)
To determine influence of seriousness of health problem on GP’s readiness to implement brief intervention (BI) in comparison to crucial barriers such as insufficient financial reimbursement and low patient adherence.
Cross-sectional
Questionnaire (self-developed)
Brief intervention (BI)
Lower readiness in GPs for excessive alcohol consumption as compared to harmful and binge drinking. Higher GPs readiness to BI implementation when patient responded adherently. No effect found on financial reimbursement.
2021 (UK)
A mixed methods analysis evaluating an alcohol health champion community intervention: How do newly trained champions perceive and understand their training and role? [17]
Community members
AHC (93)
To explore how newly trained AHCs perceive, experience and understand their training and role and how they to embed it within their communities.
Mixed-method
AUDIT-C, pre and post training attitudinal questionnaires, post training interview
Communities in charge of alcohol (CICA): brief advice conversations, empower communities on alcohol availability
(1) Training content was considered as a lot to fit into a short space of time and course intensity may not have left enough time for AHCs to explore and evaluate information; (2) misconceptions and misunderstandings about AHC’s role; (3) physical location: setting up drop-in service felt to ‘restrict people’ to attend a particular location; (4) Other community members might be a bit ‘aggressive’ towards AHCs; (5) negotiating licensing processes as ‘full of bureaucracies’; (6) socio-cultural barrier to making complaints within a community.
2021 (USA)
Brief Alcohol Screening and Intervention for Community College Students (BASICCS): feasibility and preliminary efficacy of web-conferencing BASICCS and supporting automated text messages [18]
Community college
College students 18–29 y old (142)
To examined feasibility, acceptability, and efficacy of BASICCS delivered remotely via web-conferencing with supporting automated text messages
Web-conferencing did not indicate greater reach as compared to in-person interventions. Virtual/web-based meetings were not common place on campuses resulting reluctance to accept invitation of web-conferencing session. Some students prefer to not use web-based technology platform to disclose or discuss sensitive information, disinterest among at-risk drinkers in receiving any counselling.
2020 (UK)
Factors affecting primary care practitioners’ alcohol-related discussions with older adults: a qualitative study [19]
Primary care
HCW (35)
To examine primary care practitioners’ perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction.
Qualitative study
Semi-structured interview, FGD
Screening and brief intervention
(1) Perceptions about how receptive older people are to alcohol-related intervention: recognizing their drinking may represent a risk, perceived drinking practices to be well-established by old age, sensitive topic, potential roles of alcohol in social life, drinking to cope. (2) Processes and practicalities of addressing alcohol: raising concerns on alcohol when there is clear cut symptoms, problems integrating alcohol-related discussion. (3) Professional remit and addressing older people alcohol use: time constraint, lack of confidence, less training in alcohol intervention (e.g., dentists), reliance on referrals.
2020 (UK)
Patient experiences of alcohol specialist nurse interventions in a general hospital, and onwards care pathways [25]
Hospital
Patients (24)
To understand patient experiences of detoxification in a general hospital supported by this ASNS, as well as to compare the experiences of patients following different Pathways after detoxification.
Interview
Barriers to community-based recovery support - barriers to access further support after detoxification, taking part in peer led groups due to confidentiality issues and social anxiety.
2020 (Sweden)
Treating alcohol use disorders in primary care–a qualitative evaluation of a new innovation: the 15-method [27]
Primary care
GP, head pf unit (10)
To explore how the characteristics of an innovation, the 15-method, a stepped care model for treatment of alcohol use disorders in primary care was perceived.
Qualitative
Interview
15-Method stepped care model for AUD treatment
Lack of time, lack of skills/knowledge on alcohol screening and reluctance on asking heavy alcohol use (stigmatized topic)
2020 (Sweden)
Internet-based therapy versus face-to-face therapy for alcohol use disorder, a randomized controlled noninferiority trial [20]
AUD specialized clinic
Men and women (301; no age group reported)
To compare internet-delivered and face-to-face treatment among adult users with AUD
Two arm randomized controlled noninferiority trial with parallel design
Internet-delivered treatment and face-to-face treatment
High attrition rates in internet intervention groups might be a consequence of allowing users a fast and accessible way of signing up for participation.
2020 (UK)
“Have a little less, feel a lot better”: mixed method evaluation of an alcohol intervention [26]
Survey on populations in UK
Men aged 46–64 y; pre: 3,057 intervention, 500 control; post: 1,508 intervention, 219 control
To measure impact of HaLL campaign and determine whether the impact differed for heavier and lighter drinkers.
Mixed methods
Questionnaires: AUDIT-C, perceived susceptibility, readiness to change, beliefs about health impact of drinking alcohol, moderate drinking strategies, impact of campaign
HaLL campaign: online alcohol harm assessment tool, educational videos, posters, digital images, social media banners, radio advertisements.
Perceived lack of personal relevance (no adverse effects of alcohol) of the HaLL message reflected in low readiness to change, men’s enjoyment of drinking socially resulted in unwillingness to sacrifice this pleasure, widespread influence of habitual drinking, lack in personal resources or resilience due to multiple stressors.
2020 (Latin America: Colombia, Mexico, Peru)
Perceived appropriateness of alcohol screening and brief advice programmes in Colombia, Mexico and Peru and barriers to their implementation in primary health care-a cross-sectional survey [21]
Primary care
HCW (55)
To investigates the perceived appropriateness of the program and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico, and Peru, as part of larger implementation study (SCALA).
Cross-sectional
Online questionnaire
Alcohol screening and brief advice
(1) Heavy drinking patients; beliefs that their drinking is normal; (2) lack of on-going support for providers (assistance for clinicians); (3) difficulty of accessing referral services (professional interactions); (4) lenient laws and regulations influencing price and availability that encourage cultural tolerance to alcohol (social, political, legal factors); (5) lack of financial and nonfinancial incentives (incentives and resources), lack of necessary changes (capacity of organizational changes); (6) lack of sufficient staff for implementation center (social, political, legal factors); (7) patients’ preference not to discuss their alcohol consumption (patient’s factor); (8) lack of provider time (individual health professional’s factors)
2020 (UK)
Resilience-based alcohol education: developing an intervention, evaluating feasibility and barriers to implementation using mixed-methods [22]
Secondary school
Students aged 14–16 y (277)
To implement intervention, assess intervention effects and identify facilitators of, barriers to, fidelitous intervention delivery.
“Sweet spot” (two lesson package with lesson plans with video and other activities to enhance motivation and DRSE) intervention with ‘usual care’ (health education) alcohol education
Time constraints, pressure to prioritize other topics, and awkwardness and embarrassment arising from ongoing student-teacher relationships were all identified as barriers to effective alcohol education in general, and fidelitous delivery of the intervention in particular.
2018 (USA)
Remote alcohol monitoring to facilitate incentive-based treatment for alcohol use disorder: a randomized trial [29]
Community
Adults (40)
To developed and test the effectiveness and acceptability of a remotely delivered contingency management intervention to reduce alcohol use.
Predictability of alcohol breathalyser increased the possibility of using small amounts of alcohol undetected.
2018 (USA)
Efficacy of a web-based intervention for concerned spouses of service members and veterans with alcohol misuse [28]
Specific populations (military)
Concerned partners (312)
To evaluate a web-based intervention for military CPs concerned about their service member or veteran partner’s drinking.
RCT
PHQ-8, GAD-7, State-trait Anger Expression Inventory (STAXI-2), 3 subscales from MOS social support survey, 6-item Quality of Marriage Index, conflict subscale from the Family Environment Scale (FES)
A culture in which treatment for substance use may be judged administrative rules that require involvement of commanding officers in treatment plans, and potential recording of treatment in their personnel file.
2017 (USA)
Multilevel prevention trial of alcohol use among American Indian and white high school students in the Cherokee nation [23]
School
High school students (588 control, 208 CMCA only, 224 CONNECT only, 603 combined)
To evaluate the effectiveness of a multilevel intervention designed to prevent underage alcohol use among youths living in the Cherokee nation.
RCT
2 Standard items in the Youth Risk Behavior Surveillance System (past 30 days alcohol use and alcohol-related consequences)
Communities Mobilizing for Change on Alcohol (CMCA; a community-organizing intervention targeting alcohol access) only, CONNECT (a school-based universal screening and brief intervention) only, or a combined condition.
Due to funding restrictions, only a small number of communities per study condition.
RCT, randomized-controlled trial; AUDIT, Alcohol Use Disorders Identification Test; HR, human resource; HCW, healthcare workers; AUD, alcohol use disorder; GP, general practitioners; AHC, alcohol health champions; FGD, focus group discussion; ASNS, alcohol specialist nurse services; EuroQOL-5, Euro Quality of Life; MADRS-S, Montgomery Asberg Depression Rating Scale‐Self Rated; GAD-7, Generalized Anxiety Disorder 7-item; HaLL, “Have a little less, feel a lot better”; PHC, primary health care; SCALA, Scale up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America; DRSE, drink refusal self-efficacy; MOS, medical outcome study; CMCA, community mobilizing change on alcohol; CONNECT, a school-based universal screening and brief intervention.
References
1. Zhou Y, Zheng J, Li S, Zhou T, Zhang P, Li HB. Alcoholic beverage consumption and chronic diseases. Int J Environ Res Public Health 2016;13:522.
2. Center for Disease Control and Prevention. Alcohol use [Internet]. Center for Disease Control and Prevention 2019 [cited 2024 Mar 9]. Available from: https://www.cdc.gov/alcohol/index.htm
3. World Health Organization (WHO). Global health risks: mortality and burden of disease attributable to selected major risks. WHO; 2010.
6. Giesbrecht N, Greenfield TK. Preventing alcohol-related problems in the US through policy: media campaigns, regulatory approaches and environmental interventions. J Prim Prev 2003;24:63-104.
7. Elder RW, Lawrence B, Ferguson A, Naimi TS, Brewer RD, Chattopadhyay SK, et al. The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms. Am J Prev Med 2010;38:217-29.
11. Schotten M, El Aisati M, Meester WJ, Steiginga S, Ross CA. A brief history of Scopus: the World’s largest abstract and citation database of scientific literature. In: Cantu-Ortiz FJ, editor. Research analytics: boosting university productivity and competitiveness through scientometrics. CRC Press; 2017. p. 31-58.
12. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169:467-73.
13. Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z. JBI manual for evidence synthesis [Internet]. JBI 2024 [cited 2024 Mar 18]. Available from: https://doi.org/10.46658/JBIMES-24-01
14. Philippine T, Forsgren E, DeWitt C, Carter I, McCollough M, Taira BR. Provider perspectives on emergency department initiation of medication assisted treatment for alcohol use disorder. BMC Health Serv Res 2022;22:456.
15. Taak K, Brown J, Perski O. Exploring views on alcohol consumption and digital support for alcohol reduction in UK-based Punjabi-Sikh men: a think aloud and interview study. Drug Alcohol Rev 2020;40:231-8.
16. Uong S, Tomedi LE, Gloppen KM, Stahre M, Hindman P, Goodson VN, et al. Screening for excessive alcohol consumption in emergency departments: a nationwide assessment of emergency department physicians. J Public Health Manag Pract 2022;28:E162-9.
17. Hargreaves SC, Ure C, Burns EJ, Coffey M, Audrey S, Ardern K, et al. A mixed methods analysis evaluating an alcohol health champion community intervention: how do newly trained champions perceive and understand their training and role? Health Soc Care Community 2022;30:e2737-49.
18. Lee CM, Cadigan JM, Kilmer JR, Cronce JM, Suffoletto B, Walter T, et al. Brief Alcohol Screening and Intervention for Community College Students (BASICCS): feasibility and preliminary efficacy of web-conferencing BASICCS and supporting automated text messages. Psychol Addict Behav 2021;35:840-51.
19. Bareham BK, Stewart J, Kaner E, Hanratty B. Factors affecting primary care practitioners’ alcohol-related discussions with older adults: a qualitative study. Br J Gen Pract 2021;71:e762-71.
20. Johansson M, Sinadinovic K, Gajecki M, Lindner P, Berman AH, Hermansson U, et al. Internet-based therapy versus face-to-face therapy for alcohol use disorder, a randomized controlled non-inferiority trial. Addiction 2021;116:1088-100.
21. Kokole D, Mercken L, Jane-Llopis E, Natera Rey G, Arroyo M, Medina P, et al. Perceived appropriateness of alcohol screening and brief advice programmes in Colombia, Mexico and Peru and barriers to their implementation in primary health care: a cross-sectional survey. Prim Health Care Res Dev 2021;22:e4.
22. de Visser RO, Graber R, Abraham C, Hart A, Memon A. Resilience-based alcohol education: developing an intervention, evaluating feasibility and barriers to implementation using mixed-methods. Health Educ Res 2020;35:123-33.
23. Komro KA, Livingston MD, Wagenaar AC, Kominsky TK, Pettigrew DW, Garrett BA, et al. Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation. Am J Public Health 2017;107:453-9.
24. Grigg J, Manning V, Cheetham A, Youssef G, Hall K, Baker AL, et al. A latent class analysis of perceived barriers to help-seeking among people with alcohol use problems presenting for telephone-delivered treatment. Alcohol Alcohol 2023;58:68-75.
25. Dorey L, Lathlean J, Roderick P, Westwood G. Patient experiences of alcohol specialist nurse interventions in a general hospital, and onwards care pathways. J Adv Nurs 2021;77:1945-55.
26. Lockwood N, de Visser R, Larsen J. “Have a little less, feel a lot better”: mixed-method evaluation of an alcohol intervention. Addict Behav Rep 2020;12:100306.
27. Wallhed Finn S, Hammarberg A, Andreasson S, Jirwe M. Treating alcohol use disorders in primary care: a qualitative evaluation of a new innovation: the 15-method. Scand J Prim Health Care 2021;39:51-9.
28. Osilla KC, Trail TE, Pedersen ER, Gore KL, Tolpadi A, Rodriguez LM. Efficacy of a web-based intervention for concerned spouses of service members and veterans with alcohol misuse. J Marital Fam Ther 2018;44:292-306.
30. Fankhänel T, Panic BJ, Schwarz M, Schulz K, Frese T. Treating excessive consumers with brief intervention to reduce their alcohol consumption. Eur J Health Psychol 2021;28:131-8.
31. Mushi D, Moshiro C, Hanlon C, Francis JM, Teferra S. Missed opportunity for alcohol use disorder screening and management in primary health care facilities in northern rural Tanzania: a cross-sectional survey. Subst Abuse Treat Prev Policy 2022;17:50.
32. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011;6:42.
33. Willmott TJ, Pang B, Rundle-Thiele S. Capability, opportunity, and motivation: an across contexts empirical examination of the COM-B model. BMC Public Health 2021;21:1014.
34. Johnson M, Jackson R, Guillaume L, Meier P, Goyder E. Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Public Health (Oxf) 2011;33:412-21.
35. Yokell MA, Camargo CA, Wang NE, Delgado MK. Characteristics of United States emergency departments that routinely perform alcohol risk screening and counseling for patients presenting with drinking-related complaints. West J Emerg Med 2014;15:438-45.
36. Broffman L, Spurlock M, Dulacki K, Campbell A, Rodriguez F, Wright B, et al. Understanding treatment gaps for mental health, alcohol, and drug use in South Dakota: a qualitative study of rural perspectives. J Rural Health 2017;33:71-81.
37. May C, Nielsen AS, Bilberg R. Barriers to treatment for alcohol dependence. J Drug Alcohol Res 2019;8:236083.
38. Venegas A, Donato S, Meredith LR, Ray LA. Understanding low treatment seeking rates for alcohol use disorder: a narrative review of the literature and opportunities for improvement. Am J Drug Alcohol Abuse 2021;47:664-79.
39. Schomerus G, Lucht M, Holzinger A, Matschinger H, Carta MG, Angermeyer MC. The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol 2011;46:105-12.
40. Livingston JD, Milne T, Fang ML, Amari E. The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction 2012;107:39-50.
41. Pescosolido BA, Martin JK, Long JS, Medina TR, Phelan JC, Link BG. “A disease like any other”?: a decade of change in public reactions to schizophrenia, depression, and alcohol dependence. Am J Psychiatry 2010;167:1321-30.
42. Schomerus G, Lucht M, Holzinger A, Matschinger H, Carta MG, Angermeyer MC. The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol 2011;46:105-12.
43. Williams EC, Achtmeyer CE, Young JP, Berger D, Curran G, Bradley KA, et al. Barriers to and facilitators of alcohol use disorder pharmacotherapy in primary care: a qualitative study in five VA clinics. J Gen Intern Med 2018;33:258-67.
45. Dimova ED, Lekkas P, Maxwell K, Clemens TL, Pearce JR, Mitchell R, et al. Exploring the influence of local alcohol availability on drinking norms and practices: a qualitative scoping review. Drug Alcohol Rev 2023;42:691-703.
46. MacLean S, Moore D. ‘Hyped up’: assemblages of alcohol, excitement and violence for outer-suburban young adults in the inner-city at night. Int J Drug Policy 2014;25:378-85.
48. Allen Rose P, Erik Schuckman H, Oh SS, Park EC. Associations between gender, alcohol use and negative consequences among Korean college students: a national study. Int J Environ Res Public Health 2020;17:5192.
49. Lasimbang HB, Shoesmith W, Mohd Daud MN, Kaur N, Jin MC, Singh J, et al. Private troubles to public issue: empowering communities to reduce alcohol-related harm in Sabah, Malaysia. Health Promot Int 2017;32:122-9.
50. Lasimbang HB, Eckermann L, Shoesmith W, James S, Ellik A, Igau AE, et al. Alcohol toolkit: empowering sabah indigenous communities to reduce alcohol-related harm. Borneo J Med Sci 2019;13:11-8.
51. Robert Lourdes TG, Abd Hamid HA, Riyadzi MR, Rodzlan Hasani WS, Abdul Mutalip MH, Abdul Jabbar N, et al. Findings from a nationwide study on alcohol consumption patterns in an upper middle-income country. Int J Environ Res Public Health 2022;19:8851.
Health behaviors, lifestyle factors, and healthcare challenges in family medicine: a comprehensive review of recent evidence from Asian populations Joung Sik Son Korean Journal of Family Medicine.2025; 46(4): 215. CrossRef
Barriers to alcohol intervention program: a scoping review
Figure. 1. Articles screening process in the review.
Figure. 1.
Barriers to alcohol intervention program: a scoping review
Year (country)
Title [ref]
Setting
Participant
Objective
Study design
Tools used
Intervention
Barriers to implementation
2023 (Australia)
A latent class analysis of perceived barriers to help-seeking among people with alcohol use problems presenting for telephone-delivered treatment [24]
Community
Adults (344)
To determine the proportion of people presenting to telephone-delivered alcohol treatment who are first-time help-seekers, and explored perceived barriers to help-seeking to understand the barriers this format of treatment may help to address.
RCT
AUDIT, Time-line Follow Back measure of past month drinking patterns, Kessler Psychological Distress Scale (K10), US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) list of 15 binary indicator variables identifying perceived barriers to seeking treatment for alcohol problems.
Telephone-delivered support programs
Multiple barriers to accessing treatment were endorsed with fewer than one-third had previously accessed treatment. Latent class analysis revealed a two-class model: a “low problem recognition” class endorsed readiness-for-change and attitudinal barriers; a complex barriers class endorsed stigma, structural, attitudinal and readiness-to-change barriers.
2022 (USA)
Provider perspectives on emergency department initiation of medication assisted treatment for alcohol use disorder [14]
Hospital
HCW (25)
To identify and describe perceived barriers and facilitators to the initiation of ED-based treatment of AUD with NTX.
Qualitative study
Semi-structured interview
Initiation of ED-based treatment of AUD with NTX
(1) Capability barriers; (2) opportunity barriers (physical and social); (3) lack of resources and options for follow up: phone access; (4) logistical barriers; (5) motivational barriers
2022 (UK)
Exploring views on alcohol consumption and digital support for alcohol reduction in UK-based Punjabi-Sikh men: a think aloud and interview study [15]
Community
UK-based Punjabi-Sikh men (15)
To explore UK-based Punjabi-Sikh men’s views on: (1) alcohol consumption within the community; (2) available support for alcohol reduction; and (3) an evidence-informed alcohol reduction app.
Qualitative study
Semi-structured interviews, AUDIT questionnaire
Alcohol reduction app - drink less app
(1) Drinking to cope; (2) belief that their drinking patterns are not ‘problematic’; (3) clash between religious and cultural norm—glorification of drinking and perpetuation of masculinity stereotypes. However, Sikhism prohibits alcohol use; (4) stigma; (5) The games in the app was described as childish/boring, and questioned the ability to affect behavior; (6) language barriers and wordy especially for older Punjabi-Sikh community members.
2022 (Sweden)
Screening for excessive alcohol consumption in emergency departments: a nationwide assessment of emergency department physicians [16]
Workplace
Managers (193)
To describe perceived dissemination barriers of the organizational alcohol policy by managers.
Cross sectional
Semi-structured interview
Alcohol prevention program in work-place (APMat): implementation of organizational alcohol policy and skills development training for managers
Lack of time, unclear roles, organization already has a well-functioning way of working with alcohol-related issues, alcohol related issues was not prioritized, person responsible for the program no longer works for the organization, worsening finances of the organization, reduce/lack of support from management/HR personnel, unsure of the reason to the unchanged approach to working with alcohol-related issues.
2022 (USA)
Screening for excessive alcohol consumption in emergency departments: a nationwide assessment of emergency department physicians [16]
Hospital
HCW (347)
To assess current screening practices for excessive alcohol consumption, as well as perceived barriers, perceptions, and attitudes toward performing this screening among emergency department (ED) physicians.
Cross-sectional
8-item multiple choice and short-answer assessment of the alcohol screening behavior
Screening for excessive alcohol consumption
Limited time and treatment options for patients with drinking problems.
2022 (Tanzania)
Missed opportunity for alcohol use disorder screening and management in primary health care facilities in northern rural Tanzania: a cross-sectional survey [31]
Primary care
Community (1,604)
To identify the missed opportunity for detection and management of alcohol use disorder by primary health care workers.
Cross sectional
AUDIT-10
Screening and management of AUD in primary healthcare facilities
Barriers to seeking care: (1) perception that alcohol drinking problem would get better by itself; (2) concern on family members’ approval; (3) unsatisfaction with the available services; (4) logistic issues: transportation unavailability; (5) stigma by the community.
2021 (Germany)
Treating excessive consumers with brief intervention to reduce their alcohol consumption: a thankless task? [30]
Primary care
GP (188)
To determine influence of seriousness of health problem on GP’s readiness to implement brief intervention (BI) in comparison to crucial barriers such as insufficient financial reimbursement and low patient adherence.
Cross-sectional
Questionnaire (self-developed)
Brief intervention (BI)
Lower readiness in GPs for excessive alcohol consumption as compared to harmful and binge drinking. Higher GPs readiness to BI implementation when patient responded adherently. No effect found on financial reimbursement.
2021 (UK)
A mixed methods analysis evaluating an alcohol health champion community intervention: How do newly trained champions perceive and understand their training and role? [17]
Community members
AHC (93)
To explore how newly trained AHCs perceive, experience and understand their training and role and how they to embed it within their communities.
Mixed-method
AUDIT-C, pre and post training attitudinal questionnaires, post training interview
Communities in charge of alcohol (CICA): brief advice conversations, empower communities on alcohol availability
(1) Training content was considered as a lot to fit into a short space of time and course intensity may not have left enough time for AHCs to explore and evaluate information; (2) misconceptions and misunderstandings about AHC’s role; (3) physical location: setting up drop-in service felt to ‘restrict people’ to attend a particular location; (4) Other community members might be a bit ‘aggressive’ towards AHCs; (5) negotiating licensing processes as ‘full of bureaucracies’; (6) socio-cultural barrier to making complaints within a community.
2021 (USA)
Brief Alcohol Screening and Intervention for Community College Students (BASICCS): feasibility and preliminary efficacy of web-conferencing BASICCS and supporting automated text messages [18]
Community college
College students 18–29 y old (142)
To examined feasibility, acceptability, and efficacy of BASICCS delivered remotely via web-conferencing with supporting automated text messages
Web-conferencing did not indicate greater reach as compared to in-person interventions. Virtual/web-based meetings were not common place on campuses resulting reluctance to accept invitation of web-conferencing session. Some students prefer to not use web-based technology platform to disclose or discuss sensitive information, disinterest among at-risk drinkers in receiving any counselling.
2020 (UK)
Factors affecting primary care practitioners’ alcohol-related discussions with older adults: a qualitative study [19]
Primary care
HCW (35)
To examine primary care practitioners’ perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction.
Qualitative study
Semi-structured interview, FGD
Screening and brief intervention
(1) Perceptions about how receptive older people are to alcohol-related intervention: recognizing their drinking may represent a risk, perceived drinking practices to be well-established by old age, sensitive topic, potential roles of alcohol in social life, drinking to cope. (2) Processes and practicalities of addressing alcohol: raising concerns on alcohol when there is clear cut symptoms, problems integrating alcohol-related discussion. (3) Professional remit and addressing older people alcohol use: time constraint, lack of confidence, less training in alcohol intervention (e.g., dentists), reliance on referrals.
2020 (UK)
Patient experiences of alcohol specialist nurse interventions in a general hospital, and onwards care pathways [25]
Hospital
Patients (24)
To understand patient experiences of detoxification in a general hospital supported by this ASNS, as well as to compare the experiences of patients following different Pathways after detoxification.
Interview
Barriers to community-based recovery support - barriers to access further support after detoxification, taking part in peer led groups due to confidentiality issues and social anxiety.
2020 (Sweden)
Treating alcohol use disorders in primary care–a qualitative evaluation of a new innovation: the 15-method [27]
Primary care
GP, head pf unit (10)
To explore how the characteristics of an innovation, the 15-method, a stepped care model for treatment of alcohol use disorders in primary care was perceived.
Qualitative
Interview
15-Method stepped care model for AUD treatment
Lack of time, lack of skills/knowledge on alcohol screening and reluctance on asking heavy alcohol use (stigmatized topic)
2020 (Sweden)
Internet-based therapy versus face-to-face therapy for alcohol use disorder, a randomized controlled noninferiority trial [20]
AUD specialized clinic
Men and women (301; no age group reported)
To compare internet-delivered and face-to-face treatment among adult users with AUD
Two arm randomized controlled noninferiority trial with parallel design
Internet-delivered treatment and face-to-face treatment
High attrition rates in internet intervention groups might be a consequence of allowing users a fast and accessible way of signing up for participation.
2020 (UK)
“Have a little less, feel a lot better”: mixed method evaluation of an alcohol intervention [26]
Survey on populations in UK
Men aged 46–64 y; pre: 3,057 intervention, 500 control; post: 1,508 intervention, 219 control
To measure impact of HaLL campaign and determine whether the impact differed for heavier and lighter drinkers.
Mixed methods
Questionnaires: AUDIT-C, perceived susceptibility, readiness to change, beliefs about health impact of drinking alcohol, moderate drinking strategies, impact of campaign
HaLL campaign: online alcohol harm assessment tool, educational videos, posters, digital images, social media banners, radio advertisements.
Perceived lack of personal relevance (no adverse effects of alcohol) of the HaLL message reflected in low readiness to change, men’s enjoyment of drinking socially resulted in unwillingness to sacrifice this pleasure, widespread influence of habitual drinking, lack in personal resources or resilience due to multiple stressors.
2020 (Latin America: Colombia, Mexico, Peru)
Perceived appropriateness of alcohol screening and brief advice programmes in Colombia, Mexico and Peru and barriers to their implementation in primary health care-a cross-sectional survey [21]
Primary care
HCW (55)
To investigates the perceived appropriateness of the program and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico, and Peru, as part of larger implementation study (SCALA).
Cross-sectional
Online questionnaire
Alcohol screening and brief advice
(1) Heavy drinking patients; beliefs that their drinking is normal; (2) lack of on-going support for providers (assistance for clinicians); (3) difficulty of accessing referral services (professional interactions); (4) lenient laws and regulations influencing price and availability that encourage cultural tolerance to alcohol (social, political, legal factors); (5) lack of financial and nonfinancial incentives (incentives and resources), lack of necessary changes (capacity of organizational changes); (6) lack of sufficient staff for implementation center (social, political, legal factors); (7) patients’ preference not to discuss their alcohol consumption (patient’s factor); (8) lack of provider time (individual health professional’s factors)
2020 (UK)
Resilience-based alcohol education: developing an intervention, evaluating feasibility and barriers to implementation using mixed-methods [22]
Secondary school
Students aged 14–16 y (277)
To implement intervention, assess intervention effects and identify facilitators of, barriers to, fidelitous intervention delivery.
“Sweet spot” (two lesson package with lesson plans with video and other activities to enhance motivation and DRSE) intervention with ‘usual care’ (health education) alcohol education
Time constraints, pressure to prioritize other topics, and awkwardness and embarrassment arising from ongoing student-teacher relationships were all identified as barriers to effective alcohol education in general, and fidelitous delivery of the intervention in particular.
2018 (USA)
Remote alcohol monitoring to facilitate incentive-based treatment for alcohol use disorder: a randomized trial [29]
Community
Adults (40)
To developed and test the effectiveness and acceptability of a remotely delivered contingency management intervention to reduce alcohol use.
Predictability of alcohol breathalyser increased the possibility of using small amounts of alcohol undetected.
2018 (USA)
Efficacy of a web-based intervention for concerned spouses of service members and veterans with alcohol misuse [28]
Specific populations (military)
Concerned partners (312)
To evaluate a web-based intervention for military CPs concerned about their service member or veteran partner’s drinking.
RCT
PHQ-8, GAD-7, State-trait Anger Expression Inventory (STAXI-2), 3 subscales from MOS social support survey, 6-item Quality of Marriage Index, conflict subscale from the Family Environment Scale (FES)
A culture in which treatment for substance use may be judged administrative rules that require involvement of commanding officers in treatment plans, and potential recording of treatment in their personnel file.
2017 (USA)
Multilevel prevention trial of alcohol use among American Indian and white high school students in the Cherokee nation [23]
School
High school students (588 control, 208 CMCA only, 224 CONNECT only, 603 combined)
To evaluate the effectiveness of a multilevel intervention designed to prevent underage alcohol use among youths living in the Cherokee nation.
RCT
2 Standard items in the Youth Risk Behavior Surveillance System (past 30 days alcohol use and alcohol-related consequences)
Communities Mobilizing for Change on Alcohol (CMCA; a community-organizing intervention targeting alcohol access) only, CONNECT (a school-based universal screening and brief intervention) only, or a combined condition.
Due to funding restrictions, only a small number of communities per study condition.
Table 1. Study characteristics and barriers to the implementation of alcohol intervention
RCT, randomized-controlled trial; AUDIT, Alcohol Use Disorders Identification Test; HR, human resource; HCW, healthcare workers; AUD, alcohol use disorder; GP, general practitioners; AHC, alcohol health champions; FGD, focus group discussion; ASNS, alcohol specialist nurse services; EuroQOL-5, Euro Quality of Life; MADRS-S, Montgomery Asberg Depression Rating Scale‐Self Rated; GAD-7, Generalized Anxiety Disorder 7-item; HaLL, “Have a little less, feel a lot better”; PHC, primary health care; SCALA, Scale up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America; DRSE, drink refusal self-efficacy; MOS, medical outcome study; CMCA, community mobilizing change on alcohol; CONNECT, a school-based universal screening and brief intervention.
, Richard Avoi1*
