Background
Individuals with alcohol problems rarely seek treatment. The barriers to seeking treatment can be divided into two overall groups: patient-related barriers and provider-related barriers. Patient-related barriers include fear of stigmatization or lack of information on available treatment options. Provider-related barriers include fear of damaging the relation to the patient or perceiving alcohol treatment as difficult. Although a combination of screening, intervention, and referral to treatment has shown to be an effective approach to handling alcohol problems in general practice, it has proven difficult to implement a systematic focus and intervention for harmful alcohol consumption in general practice overall, especially in Denmark. The reason for this is believed to be a combination of provider barriers and patient barriers.The 15-method
The 15-method was developed in Sweden and has proven to be a promising method for treating hazardous alcohol consumption and mild to moderate alcohol dependence in general practice. The Swedish population, on which the method was tested, is similar to the Danish population, and the method has been found to be acceptable by Danish general practitioners.
The method consists of three steps:
1. Increased attention to alcohol in relation to specific symptoms and reasons for contacting the general practitioner.
2. A separate consultation on alcohol habits in relation to the patient’s symptoms or health issues.
3. Treatment consisting of homework assignments, 1–3 consultations, and pharmacological treatment if relevant
The name ‘the 15-method’ refers to the duration of the consultations, 15 minutes, and to the target group for the treatment step, namely patients who score >15 points using the screening tool AUDIT (Alcohol Use Disorder Identification Test).
Results of evaluating the 15-method in Sweden and Denmark
In Sweden, a six-month follow-up of patients randomly assigned to either the 15-method in general practice or to specialist treatment found that the method was as effective for treating mild to moderate alcohol dependence in primary care as specialist treatment.
Patients treated in general practice (n=109) reduced their weekly alcohol consumption from 367 to 224 grams of ethanol by the six-month follow-up. Patients in specialist treatment (n=119) reduced their consumption from 343 to 182 grams. This reduction was not significantly different from what general practitioners achieved with the same intervention (p=0.146).
In Denmark, the method has been pilot tested in general practice. The focus of the pilot test was on the workflows surrounding the method and assessing the experiences of both patients and healthcare professionals with using the method.
The Danish pilot study found that:
1. Healthcare professionals perceived the method to be helpful in providing structure for a difficult topic.
2. The method worked well as an interdisciplinary tool.
3. The method addressed a gap in existing treatment options between primary, secondary, and municipal care.
Patients reported, among other things, that:
1. The method was patient-centered and worked well as a component in the overall understanding of health and lifestyle.
2. The method was a welcome solution that supported logistical convenience and interpersonal relationships, as well as addressing stigma.
The 15-method involves fewer and shorter sessions compared to existing and previous models used in general practice for treating alcohol-related problems. Training in the method requires only half a workday, and results from the pilot study indicate that the method can be implemented in daily clinical practice in Denmark.
15-method material
The 15-method contains the following materials (in Danish only):
For healthcare professionals:
• 15-method Manual
• Quick-Guide
For patients:
• AUDIT questionnaire form
• Logbook
• Homework assignment 1: Goals and motivation for your overall progress (Logbook, page 7)
• Homework assignment 2: Goals for the next 4 weeks (Logbook, pages 28–29)
• Homework assignment 3: Risk situations and triggers (Logbook, pages 64–69)
• Homework assignment 4: Action plan (logbook, pages 72–73)
Supplementary tools:
• Questionnaire for assessing possible dependence (ICD-10)
• Short Alcohol Dependence Questionnaire
• Alcohol Timeline Followback (TLFB)
• Questionnaire for assessing the use of other addictive substances
Educational videos
You can find educational videos for the 15-method below (in Danish; English subtitles available).
The videos illustrate consultations based on the 15-method. The 15-method builds on motivational interviewing, which is highlighted at the end of each video sequence (reflections). The video series incorporates insights from both the patient’s and the doctor’s perspectives. The videos serve as instructional material for the 15-method and offer inspiration for using motivational interviewing in general.
Video series 1: Sleep problems
Case 1, part 1
Case 1, part 2
Case 1, part 3
Case 1, part 4: Reflection with the physician
Video series 2: High blood pressure
Case 2, part 1
Case 2, part 2
Case 2: Reflection with the physician
Educational videos from Riddargatan 1 in Sweden, where the 15-method was developed, are available below. These videos include other cases and more tips for using both motivational interviewing and the 15-method. The videos below are in Swedish, but English subtitles are available.
Click here to watch the videos.
Knowledge bank
The knowledge bank contains a brief overview of the benefits of reducing one’s alcohol consumption - related to specific health conditions and symptoms. Only available in Danish.
Knowledge bank for health professionals – Benefits of reducing alcohol consumption (Danish, PDF)
Large-scale evaluation of the 15-method
The Research Unit for General Practice, Odense, and the Unit of Clinical Alcohol Research at the University of Southern Denmark are currently evaluating the 15-method on a larger scale. The project encompasses 18 general practices in the Region of Southern Denmark and aims to assess the method’s effectiveness using several parameters. One key question is whether the method can increase how often healthcare professionals talk about alcohol with their patients in general practice.
The project is funded by TrygFonden and concludes at the end of 2025.
Click here to learn more about the project.
References:
Kohn, Saxena, Levav & Saraceno, 2004
Regm, Shield, Gmel, Rhem & Frick, 2013
Saunders, Zygowicz & D’Angelo, 2006
Saunders et al., 2006
Kaner et al., 2018,
Kaner et al., 2007
Williams et al., 2018
Wallhed Finn, Hammarberg & Andreasson, 2018
Babor, Higgins-Biddle, Saunders & Monterio, 2001
Wallhed Finn et al., 2018
Wallhed Finn, 2018
Schøler, Søndergaard, Barfod & Nielsen, 2022
