Alcohol in primary care: Massively simplifying the patient conversation

Around 200 health conditions are made worse by alcohol. If you’re a primary care practitioner, the overall level of alcohol consumption within your local population will be having a significant effect on the level of demand for both primary and secondary care (as well as the police, courts, and social care). Therefore, anything that reduces consumption will be a win for everyone, including you.

Many primary care practitioners will be aware of Identification and Brief Advice (IBA) for alcohol, although many of you won’t be using it: for a range of good reasons.

As we discussed with colleagues at the Addictions Professionals/RCGP Managing Additions in Primary Care conference in February 2026, many practitioners still report that the conversation about alcohol is awkward. In particular, the question of how much alcohol someone drinks, and whether or not to define this as ‘problematic’, is challenging; because it feels potentially embarrassing, stigmatising and judgemental.

Our paper at the conference proposed a massive simplification to the conversation about alcohol, and received favourable feedback from the primary care practitioners who were there.

Our proposed approach draws inspiration from the VBA+ model, advocated for patients who smoke. As you’ll already know, it’s recommended that primary care practitioners simply ask, ‘Do you smoke?’ and if the answer is ‘Yes’, they refer to proven further support that the patient can access directly themselves. This sidesteps the awkward and unnecessary question of how much they smoke.

Exactly the same can apply to alcohol. If people do drink alcohol, regardless of how much, you can refer them to the Try Dry® app. Of course, if you suspect a patient might benefit from alcohol treatment, then you should refer them to the local alcohol treatment service (see more on this below), but for everyone else who consumes alcohol, referral to the Try Dry^® app is a great solution.

Generally, for any patient you see, on any issue, you can consider simply saying, towards the end of your consultation:

“By the way, if you consume any alcohol, we’re recommending to all our patients that they use the free Try Dry^® app. Alcohol causes so many health problems but Try Dry^® is a great tool for keeping track, and if you want to, cutting back.” This avoids any sense of singling people out and gives them the freedom to decide whether they want to cut back or now.

Or you could user your surgery’s text or WhatsApp messaging service to give a recommendation twice a year to all adult patients: “If you consume any alcohol, we recommend using the free Try Dry^® app to track and, if you want, cut back. Alcohol causes so many health problems, so the less you drink, the better.” This message can even include a direct link to the app download page.

And of course, if you consume alcohol yourself, use the Try Dry^® app too. And if you do, you can let your patients know. They will be even more likely to follow your actions than your words!

• Users who use the app for six months reduce their alcohol consumption on average from 35.8 to just 5.6 units per week.
• It is entirely free to users (and is ad free). It is co-developed with its users.
• It is a fully fledged native app (not a webapp) and is available on both Google Play and Apple Store. It has been downloaded over 1 million times and has outstanding user ratings.
• It is built, designed, run by, and fully funded by the experts in alcohol behaviour change at Alcohol Change UK. As a fully independent charity, the interests of citizens are at the heart of everything that Alcohol Change UK does. We do not accept alcohol industry funding.
• It opens up access to a wider behaviour change programme involving free peer support and free expert content on cutting back on alcohol.
• It is the only app recommended by the DHSC’s new (Oct 2025) Clinical Alcohol Treatment Guidelines for use in preventing alcohol dependency.
• It is the number one alcohol accountability app, as rated by the Organisation for the Review of Care and Health Apps (Orcha), and has achieved the Orcha Assured Bronze award.
• It has been evaluated by the University of Sussex and shown to effectively reduce alcohol consumption over six months.
• Academic research into a wide range of alcohol accountability apps found that Try Dry^® contained more behaviour change techniques than any other assessed app, including the NHS Drink Free Days.

Traditionally, IBA involves first doing the AUDIT-C – the short, three question version of the Alcohol Use Disorders Identification Test (AUDIT). However, there are reasons why the AUDIT-C may in fact be unhelpful:

1. It gives questionable cut-off points. A score of ‘5’ is considered the cut-off for so-called ‘increasing risk’, where primary care practitioners are encouraged to ‘have a word’ about alcohol, but there are nine ways to score a ‘5’ and only one of these can be said to be risky alcohol consumption.
2. The AUDIT-C is generally designed for the primary care practitioner to administer, and to give the result to the patient. This disempowers the patient.
3. The AUDIT-C result only gives the patient a category, with no access to the scoring system, or information about which of the three questions they scored higher in, and might wish to address. As currently formulated, it gives much blunter results than are necessary and sacrifices sophistication and personalisation for speed.
4. It focuses on how much they consume which remains potentially awkward, judgemental and stigmatising, then puts the patient into a box and labels them. You and they both sense this.
5. It uses precious clinical time. If it delivered great benefits, then fine, but does it?

AUDIT-C is already embedded within the Try Dry^® app (called the ‘drinking risk quiz’), allowing the user to complete it in their own time in private. It allows them to see the actual scores; and the reasons for their score are explained. In particular, specific advice is given based on the make-up of that score, e.g. if your score is higher due mainly to binge drinking the app gives you difference advice than if your score is higher due mainly to everyday drinking, even if the total scores are the same. They can repeat the drinking risk quiz at regular intervals and continue to receive personalised specific advice to help reduce their risk.

You’re outsourcing the work to them and the app. And they’re feeling empowered.

You might worry about recommending the Try Dry^® app to people who are currently lighter drinkers, and who are not (yet) drinking at hazardous or harmful levels. Are these ‘false negatives’?

No! The Try Dry^® app is the ideal accountability tool for people who are already consuming fewer than 14 units a week and want to stay there. View the Try Dry^® app as a lifestyle health tool as much as a clinical tool. Think of it like Garmin or Strava for alcohol.

You might suspect that alcohol consumption is an issue for a patient if, for example, their liver blood test results indicate an issue, or they turn up possibly intoxicated, or they proactively raise concerns about alcohol in discussion with you, or they have conditions that look like they are being exacerbated by alcohol consumption.

In such cases, of course you will want to conduct AUDIT-C, or, more likely, the full AUDIT; and refer the patient to the local alcohol treatment service if needed.

We are currently planning a pilot for how the Try Dry^® app might be of significant benefit within alcohol treatment services. We’ve heard that treatment workers on the ground are already recommending it to their service users, as an accountability tool to help prevent relapse.

Sometimes, you will be wanting to ask your patient to keep an alcohol consumption diary for a week or two, and then come back and show you. While you can ask them to do this in a paper format, people remain confused about ‘units’ and the issue of conversion from drinks to units makes this problematic.

The Try Dry^® app works perfectly as a drinks diary, thanks to its powerful drinks entry module. Ask them to record their drinking for a couple of weeks in the app, and come back and show you their results. They just enter the drinks, the app converts it to units and presents it in a calendar.

You and they will now have much better data in the calendar, enhancing the quality of your discussion. And there is the significant additional advantage that you can now recommend that they carry on tracking, which they’d almost certainly never do with a paper-based drinks diary, but which they will find much easier with the Try Dry^® app. This ongoing tracking can itself generate positive behaviour change.