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RESEARCHER SPOTLIGHT: David Brown

Alchohol Abuse Prevention Begins in Family Doctor's Office

Many people believe alcohol’s biggest burden on the health care system is associated with alcohol dependence.

Dr. David Brown is intrigued by the fact that it isn’t.

Dr. Brown, a health policy analyst who has worked with the Child & Family Research Institute and BC Mental Health and Addiction Services, stresses that most people with alcohol-related health problems are not alcoholics. Rather, individuals who binge drink create a much bigger stress on the health care system.

“Risky drinking is not only a problem because you might become dependent, but also because it leads to injury or preventable disease,” he said. “You don’t have to be a long-time user to have a car accident while under the influence.”

With a PhD in sociology concentrating in research methods, Dr. Brown says he considers himself first and foremost a methodologist. He became interested in alcohol prevention and intervention strategies during his role as Research Director with the Addictions Foundation of Manitoba (AFM). In 2003, after three years with AFM, Dr. Brown joined the Department of Family Medicine at the University of Wisconsin. There, he worked with colleague Dr. Michael Fleming on research in the area of substance misuse.

The two became co-investigators on a systematic survey of 1,000 university students who visited campus health clinics (four in the U.S. and one at the University of British Columbia) for routine primary care. The study looked at self-reported alcohol use in terms of frequency and quantity, revealing that 65 per cent of males and 52 per cent of females binge drank in the past month. These numbers reflect a serious health concern, says Dr. Brown, for many reasons.

Data analysis revealed that drinking was frequently associated with violence exposure for students, with more than one in three students reporting they were drinking when emotional violence happened, and more than half reporting they were drinking when physical violence occurred. Dr. Brown and his team are now investigating other factors that might be connected to alcohol abuse; prescription drug use, unwanted sex and depression are a few that Dr. Brown says he fears will correlate positively.

Physicians in the study conducted a brief intervention with 500 randomized students in the treatment group, while the 500 students in the control group received only printed information. The physicians asked students about their drinking habits and offered advice about ways to reduce harmful drinking and adverse consequences. In addition, two follow-up appointments were booked to talk more about the effects of risky drinking. Surveys conducted six, 12, 18 and 24 months after treatment suggest that the brief interventions were effective.

“We’re not sure yet about what the essential ingredients are in successful brief interventions,” Dr. Brown said. “Perhaps just being asked about your drinking by a concerned health professional makes the difference.”

While most students don’t go to campus clinics to talk specifically about their drinking habits, visits are often related to issues like depression, weight gain and fatigue – conditions that frequently stem from alcohol abuse. A physician has an opportunity to make a difference by simply scratching beneath the surface of a student’s problem and asking, “What are your drinking habits? How can I help?”

Even after the study’s completion, physicians from participating universities have continued to ask patients about their drinking habits. Implementation in other campus health clinics, however, has proven challenging despite the approach’s low cost.

“The public and decision-makers have the idea that help for alcohol issues only comes in the form of things like AA or rehab programs,” said Dr. Brown. “In reality, the family doctor can play a major role.”

This role, he stresses, needs to be supported by heath policy. To that end, Dr. Brown helped develop the National Treatment Strategy, advising in the area of primary care in relation to substance abuse. The strategy provides directions and recommendations to strengthen the services Canada offers those with substance use problems, aiming to close the gap between need and response.

Dr. Brown is also developing a new set of web-based continuing education materials for physicians on how to screen and provide brief interventions for alcohol abuse. Such tools are enormously important, says Dr. Brown, as alcohol causes more stress on the health care system than all illicit drugs combined – over $10 billion worth annually in Canada.

Dr. Brown is driven by research that goes against the grain of commonly accepted ideas, combining methodologies in new ways to make the best measurements possible, targeting myths about alcohol abuse and enabling people to find help for risky drinking behaviour in the familiar setting of their family doctor’s office.