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clari cation in research As Poikolainen (1999) points out, it may well be that certain kinds of OBI are effective in certain contexts, while other kinds are not and, if so, we need to know what the characteristics of successful interventions are, especially with respect to the issue of the optimal length and intensity of intervention for different categories of excessive drinker We also need more information on the longer-term effects of OBI beyond the conventional follow-up point of 1 year Fleming et al (2002) found continuing bene ts of grief intervention after 4 years but Wutzke et al (2002) in Australia reported that any such bene ts had disappeared after 10 years, suggesting the need for regular follow-up and reinforcement of OBI Another crucial issue is the extent to which the ndings of research apply to the implementation of OBI in regular, routine practice.

Portions: 8 Portion size: approximately 12 oz (360 g)

The most prominent and positive trials of OBI in the literature (eg Wallace et al, 1988; Anderson & Scott, 1992; Fleming et al, 1997) are ef cacy rather than effectiveness trials, ie they provided a test of brief interventions under optimum research conditions, rather than under real-world conditions of routine primary health care (Flay, 1986) For example, excessive drinkers entering the study were identi ed and recruited by the research team, rather than by the busy physician in the normal course of his/her practice, and this may have resulted in more motivated patients being selected for study (cf Kahan et al, 1995) Edwards & Rollnick (1997) demonstrated that subjects lost to controlled trials of OBI, due to unavailability for study or drop-out from follow-up, differed systematically from those included in ways that would probably be associated with a poorer response to intervention.

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In a project in which OBI was investigated in naturalistic general practice settings (Richmond et al, 1995), far fewer patients returned for consultation following assessment, and the bene cial effects of brief intervention, although still arguably present, were weaker than those reported in ef cacy studies More effectiveness trials of OBI are clearly needed From a clinical perspective, Rollnick, Butler & Hodgson (1997) introduced several concerns from the consulting room into the discussion of OBI and were especially critical of a simple advice-giving framework for intervention They argued that medical practitioners and nurses might not be satis ed with the evidence on which this framework is based, due to small effect sizes of intervention and to the disjunction in aims between a public health approach to alcohol problems and the practitioners over-riding interest in the welfare of the individual patient.

File transfers, voice conversations, and some other features of Windows Messenger might fail due to firewall settings that block the ports needed for those features to work. Voice conversations in Windows Messenger require that TCP and UDP ports 6901 be open. File transfers require open TCP ports 6891 through 6900. Although you need to open all 10 ports if you want to be able to transfer up to 10 files at a time. For example, you could just open port 6891 and transfer one file at a time. See 26 for information on opening ports in Windows Firewall. Even with the appropriate ports open, Messenger file transfers and voice conversations can fail just because of the different ways in which different ISPs handle the service they provide. If opening the appropriate firewall ports doesn t help with Messenger voice conversations and file transfers, check your ISP s support page or service for more information. For more technical information, see Knowledge Base article 324214 at http://support.microsoft.com/default. aspx scid=kb;en-us;324214 and the TechNet article at www.microsoft.com/technet/ prodtechnol/winxppro/deploy/worki01.mspx if you use Windows Firewall from Service Pack 2.

If true, this would create obvious barriers to the implementation of OBI in practice So too, practitioners might experience dif culty in interpreting evidence about harmful consumption when counselling their patients, especially those who may be drinking above medically recommended levels but who have not experienced any signi cant alcohol-related harm Lastly, Rollnick et al maintain that advice giving, in the sense of direct persuasion and information, is likely to be ineffective or even counterproductive and is, in any case, bedevilled by practical problems and uncertainties about putative public health gains The authors offer a number of solutions to the problems they describe, including incorporating into intervention programmes the guidance on what to do with more severely dependent drinkers that many practitioners demand and widening brief alcohol interventions to embrace other health behaviours and personal concerns in a patient-centred approach .