Alcohol screening and brief intervention: dissemination strategies for medical practice and public health

This paper introduces the concept of risky drinking and considers the poten tial of alcohol screening and brief intervention (SBI) to reduce alcohol-re lated problems in medical practice and in organized systems of health care. The research evidence behind this approach is reviewed Potential strategie s for the dissemination of SBI to systems of health care are then discussed within the context of a public health model of clinical preventive service s. There is an emerging consensus that SBI should be promoted in general he althcare settings, but further research is needed to determine the best way s to achieve widespread dissemination. In an attempt to provide an integrat ive model that is relevant to SBI, dissemination strategies are discussed f ar three target groups: (1) individual patients and practitioners; (2) heal th care settings and health systems; and (3) the communities and the genera l population. Dissemination strategies are considered from the fields of so cial change, social science, commercial marketing and education in terms of their potential for translating SBI innovations into routine clinical prac tice. One overarching strategy implicit in the approaches reviewed in this article is to embed alcohol SBI in the more general context of preventive h ealth services, the utility of which is becoming increasingly recognized as a critical supplement to more traditional clinical medicine.