Identification and Brief Advice

Tools and Techniques

Alcohol in England

• 90% of adults drink alcohol• DH lower-risk guidelines

– Men: should not regularly exceed 3-4 units/day– Women: should not regularly exceed 2-3 units/day

• 26% (around 10 million) of adults in England drink more than the Government's lower-risk guidelines

• Almost 2.6 million adults drink at higher-risk– 1.6 million men drink 50+ units/week – 1 million women drink more 35+ units/week.

Support to primary care

• DES – New registrations• Primary Care Service Framework

– Background knowledge and implementation details– Examples of practice

• Identification tools• Brief advice scripts• Care pathway• E-Learning module• Read codes• Templates for GP computer systems

Part 1

Opportunistic Case Identificationor

Screening

Point of Clarification

• Opportunistic alcohol case Identification and the

delivery of Brief Advice (IBA)

is the same as

• Screening and Brief Interventions for alcohol

misuse (SBI)

Questions

• How many Units do you drink a week?• Common questionnaires

– MAST – Michigan Alcohol Screening Test– CAGE

• Have you ever tried to Cut down on your drinking?• Have you ever felt Angered by someone talking about your drinking?• Have you ever felt Guilty about your drinking?• Have you ever had to have an “Eye opener” drink in the morning?

• World Health Organisation (WHO) developed AUDIT– Alcohol Use Disorder Identification Test – AUDIT– Measures both consumption and consequences

AUDIT – Gold Standard

Adults 16-64 visiting GP

Requesting help with alcohol problem

New Registration Other health complaint

Full ScreenAUDIT

AUDIT Score8-15

Full Assessment

Referral to Specialist Services

ExtendedBrief Advice

AUDIT Score16-20

AUDIT Score20+

AUDIT Score 0-7

Primary Care - Alcohol Care Pathway

No action

PositiveResult

NegativeResult

SASQ FAST AUDIT - C AUDIT - PCInitial Screening Tools

Brief Advice

AUDIT - C

AUDIT - PC

FAST – Fast Alcohol Screening Test

SASQ – Single Alcohol Screening Questionnaire

Adults 16-64 visiting GP

Requesting help with alcohol problem

New Registration Other health complaint

Full ScreenAUDIT

AUDIT Score8-15

Full Assessment

Referral to Specialist Services

ExtendedBrief Advice

AUDIT Score16-20

AUDIT Score20+

AUDIT Score 0-7

Primary Care - Alcohol Care Pathway

No action

PositiveResult

NegativeResult

SASQ FAST AUDIT - C AUDIT - PCInitial Screening Tools

Brief Advice

AUDIT – Gold Standard

Adults 16-64 visiting GP

Requesting help with alcohol problem

New Registration Other health complaint

Full ScreenAUDIT

AUDIT Score8-15

Full Assessment

Referral to Specialist Services

ExtendedBrief Advice

AUDIT Score16-20

AUDIT Score20+

AUDIT Score 0-7

Primary Care - Alcohol Care Pathway

No action

PositiveResult

NegativeResult

SASQ FAST AUDIT - C AUDIT - PCInitial Screening Tools

Brief Advice

Part 2

Brief Adviceor

Brief Intervention

Brief Advice

• Understanding units• Understanding risk levels• Knowing where they sit on the risk scale• Benefits of cutting down• Tips for cutting down

Understanding Units

Risk Levels

Risk Men Women

Lower Risk

No more than 3-4 units per day on a regular basis

No more than 2-3 units per day on a regular basis

Increasing Risk

4 or more units per day on a regular basis

3 or more units per day on a regular basis

Higher Risk

8 or more units per day on a regular basis or 50+ units per week

6 or more units per day on a regular basis or 35+ units per week

Where do they sit?

Male Female

Abstainers Lower Increased Higher

Risk Risk Risk

Benefits of cutting down

Physical• Reduced risk of injury• Reduced risk of high blood

pressure• Reduced risk of cancer• Reduced risks of liver disease• Reduced risks of brain damage• Sleep better• More energy• Lose weight• No hangovers• Improved memory• Better physical shape

Psychological/Social/Financial• Improved mood• Improved relationships• Reduced risks of drink driving• Save money

Tips for cutting down

• Have an alcohol-free day once or twice a week• Plan activities and tasks at those times you usually drink• When bored or stressed have a workout instead of

drinking• Explore other interests such as cinema, exercise, etc.• Avoid going to the pub after work• Have your first drink after starting to eat• Quench your thirst with non-alcohol drinks before alcohol• Avoid drinking in rounds or in large groups• Switch to low alcohol beer/lager• Avoid or limit the time spent with “heavy” drinking friends

Part 3

Brief Lifestyle Counsellingor

Extended Brief Intervention

Interactive exchange

• How important is it for you to reduce your drinking?• If you decided to reduce your drinking, how confident are

you that you would succeed?• What might be the not so good things about reducing

your drinking?• What might be the good things about reducing your

drinking?

Six-step plan

1. Identify good reasons for changing: Can you think of 2-3 good reasons?

2. Set yourself a goal to achieve change: Is this achievable?

3. Recognise difficult times or situations: When might be the hardest times?

4. Prepare for difficult times/ situations: Think of a way of dealing with hard times?

5. Find Someone to support you: Is there a family member/ friend who might help?

6. Stick to your goals – but remember, nobody’s perfect! If at first you don’t succeed, try again.

Useful Links• Primary Care Framework

http://www.primarycarecontracting.nhs.uk/204.php

• Newcastle University SBI materialshttp://www.ncl.ac.uk/ihs/news/item/?brief-interventions-alcohol-and-health-improvement

• SIPS Research Programmehttp://www.sips.iop.kcl.ac.uk/index.php

• Units Calculator and Drink Check (on-line AUDIT)http://www.units.nhs.uk/