Can Warning Signs Training help maintain abstinence?

11 December 2005


Dr Gerald Bennett, Jackie Withers, David Higgins, James Bailey, and Lorraine Parry of Dorset HealthCare NHS Trust in Bournemouth carried out the first evaluation of this intervention in collaboration with Profes­sor Peter Thomas of Bournemouth University.

Key findings

  • During the first follow-up year 45% of the Warning Signs group and 26% of Routine Aftercare never drank heavily at all (‘heavy drinking’ being three consecutive days of drinking nine or more units of alco­hol a day). This difference was statistically significant. The Warning Signs intervention halved participants’ odds of drinking heavily.
  • For every five participants receiving the Warning Signs intervention one who would otherwise have drank heavily did not do so.
Fig 1

Never Drank Heavily During Follow-up Year

  • During this year 31% of the Warning Signs group and 17% of the Rou­tine Aftercare group never drank at all. The Warning Signs interven­tion halved participants’ odds of drinking during this time (although the difference was not statistically significant).

Never Drank At All During the Following Year

  • For every seven participants who entered Warning Signs one who would otherwise have drank did not do so. The Warning Signs group drank less often and also drank heavily less often during this year: these differences were significant.
  • The Warning Signs intervention was acceptable to service users: 96% of those eligible to join the trial did so, and those allocated to this condition attended a median of 13.5 of 15 individual sessions.
  • The differences in drinking between the two groups had disappeared by the second year follow-up, when their outcomes were similar.
  • Some 42% of all participants never drank during the 4 months prior to the two-year follow-up; 70% of all participants never drank heav­ily during those four months.
  • It would have been difficult to detect a treatment effect at the 24- month follow-up because significant numbers of those who resumed drinking stopped again during the second year, This dynamic picture could obscure any treatment effect that occurred.
  • Attending aftercare during the first month after completing day treatment was associated with better drinking outcomes during the following 11 months. Each aftercare session attended was associ­ated with 10 extra days of abstinence during the first year. These observations suggest, but cannot prove, that attending aftercare im­mediately after completing treatment caused a better outcome and should therefore be promoted.

Note: This report was funded and/or written by our predecessor organisation, the Alcohol Education Research Council (AERC).


  • The Warning Signs intervention caused reductions in heavy drinking sufficient to produce benefits to health.
  • These results justify using this intervention in similar settings to reduce the rate of resuming heavy drinking.
  • The effects are worthwhile because the participants were chosen for their history of resuming drinking after treatment and because the control group received a great deal of aftercare support and help.
  • The Warning Signs intervention achieved an effect in addition to the aftercare support. It would be valuable to replicate this single evaluation of the Warning Signs intervention in a very different set­ting, where there was less aftercare support.