The misuse of alcohol is second only to tobacco as a leading cause of preventable death in Australia,  and one in ten adults are at long-term risk of harm from their alcohol consumption [2–4]. There is good evidence that brief interventions are effective in reducing alcohol consumption and related problems, particularly in non-dependent drinkers, [5–8] and are a cost-effective technique . However, many physicians do not routinely screen or advise patients .
The first point of contact with the health system for a patient is typically the family practitioner (FP). Eighty-five per cent of the Australian population attend a family practice at least annually and people who seek help for a drinking problem are most likely to talk to an FP first [11, 12]. Therefore the opportunity exists to detect and intervene with people at risk of alcohol-related harm before complications occur and drinking patterns become entrenched.
However, FPs remain reluctant to undertake systematic screening and intervention for risky alcohol consumption . Detection rates for alcohol problems have remained low, [14, 15] despite nearly 20 years of evidence of effectiveness of early intervention and attempts at changing medical education. In recent surveys, FPs still detect or offer advice on as few as 23% of alcohol problems, similar to levels detected in the 1980's [10, 16].
FPs report that time constraints, lack of confidence, fear of intrusiveness, skepticism about achieving results, and sometimes financial disincentives, are major barriers to improved detection [13, 17, 18]. They are asked to undertake preventive medicine amidst increasing workloads and despite the conventional view of the consultation being for diagnosis and treatment of presenting problems. FPs, especially in rural areas, are already under considerable pressure due to insufficient numbers and unfavourable cost structures. More can be done to enhance the delivery of the most effective detection and intervention techniques .
The World Health Organization has been involved in a series of studies aimed at facilitating detection and brief intervention for hazardous drinking. In the second phase of this work, the WHO multi-centre trial demonstrated that as little as five minutes of advice was associated with significant reductions in drinking at 6 months follow-up . The screening and brief intervention tools were subsequently adapted for use in the routine clinical setting. In Australia these tools were packaged together in 1993 into a user-friendly kit for FPs, known as 'Drink-less' by Gomel, Saunders et al . It originally included an Australian modification of the Alcohol Use Disorders Identification Test (known as AUDIT) as well as intervention materials based on the five-minute intervention technique in the WHO collaborative trial [21, 5].
The Drink-less package provides a laminated card to guide the FP through the intervention. It describes the prevalence of excessive drinking, likely harms from drinking, likely benefits from reduced drinking and suggested approaches to control drinking. The package has been used in Australian family practice since its development. Focus group feedback from FPs who had used the package indicated it made management of alcohol problems less daunting. The Drink-less materials were updated in 2003 to include the original AUDIT questionnaire rather than the modified screening tool, and so that drinking goals suggested in the intervention better matched revised Australian guidelines. The layout was also redesigned and updated .
In this study we determine whether an interactive skills-based training session using the Drink-less package led to measurable changes in FPs' self-reported level of confidence in detecting and providing interventions for risky alcohol consumption.