SECONDARY PREVENTION OF EXCESSIVE ALCOHOL-USE - ASSESSING THE PROSPECTS OF IMPLEMENTATION

Background. Alcohol risk and harm reduction is a public health approac h that goes beyond specialized treatments for alcoholism. The greatest potential for reducing alcohol risk and harm in a population depends on the extent to which health care practitioners use secondary prevent ion programmes. Objective. We aim to assess the factors that affect th e prospects of disseminating comprehensive, secondary prevention progr ammes into mainstream practice. Method. A decision balance was used to assess the prospects of practitioners implementing comprehensive prog rammes systematically. The stages-of-change model provides perspective s about behaviour change with regard to patients, practitioners and pr actice settings. Results and Conclusions. Programme implementation is extremely unlikely given the current organization of health care setti ngs. To maintain the use of such programmes, we need to change the ''u nit of leverage'' in the system: from the clinical encounter-that is, practitioners working with individual patients in a case-finding manne r-to an organizational level-that is, the appropriate use of manageria l and information systems supporting health care settings to identify at-risk patients systematically as they enter primary care and hospita l settings. With appropriate infrastructure support, practitioners wil l be able to fulfil the potential for as well as maintain the use of c omprehensive, secondary prevention programmes to reduce alcohol risk a nd harm in the population.