Alcohol Screening & Brief Intervention Training GTMcClelland

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Alcohol Screening Brief Intervention Training
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The aim of the training is

• To develop skills to implement brief
  interventions with
• clients who use alcohol in a hazardous or harmful
  
• way.

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At the end of the training participants will be
able to

• Describe the potential physical, psycho-social
  legal impact of hazardous harmful alcohol use.
• Discuss the process of alcohol screening brief
  interventions.
• Identify local national key documents
  supporting the implementation of alcohol
  screening brief interventions.

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• Recognise clients displaying indicators of
  hazardous harmful alcohol use.
• Match the brief intervention to the client the
  environment.
• Implement brief interventions for hazardous
  harmful alcohol use.

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• Reflect upon the professional, interpersonal
  motivational skills required to implement brief
  interventions with a client for problematic
  alcohol use.
• Identify the range of services available to
  support clients within the broader spectrum of
  alcohol use.
• Maintain accurate records of the interventions
  undertaken.

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We are going to look at

• The conceptual framework for alcohol use/misuse
• The prevalence of alcohol misuse
• Implications of hazardous harmful use
• Case finding for hazardous harmful use
• Examples of brief interventions how to
  implement them.

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National drivers influencing the development of
alcohol screening brief interventions include..

• Alcohol Needs Assessment Research Project (DOH,
  2004)
• Alcohol Harm Reduction Strategy for England
  (P.M.S.U, 2004)
• Models of Care for Alcohol Misusers (DOH, NTA,
  2006)

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And..

• Review of the Effectiveness of Treatment for
  Alcohol Problems
• (Raistrick et al, 2006)
• Screening Intervention Programme for Sensible
  Drinking (2007)
• Safe. Sensible. Social. The next steps in the
  National Alcohol Strategy
• (H.M Government, 2007)

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The conceptual framework for alcohol use/misuse.

• Hazardous
• Harmful
• Dependent (Moderate or severe)

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Hazardous drinking

• Drinking above recommended limits
• (women, 2-3 units daily men 3-4 units
  daily).
• Use of a drug that will probably lead to harmful
  consequences for the user. The harm may include
  physical, mental and social consequences.
• Hazardous drinkers do not usually seek help
  insight will vary

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Harmful drinking

• Women drinking 6 units daily men drinking 8
  units daily regularly
• A pattern of use that is already causing physical
  or mental damage to health.
• May cause harm to other people.
• Refers to heavy drinking during pregnancy.

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Dependent drinking

• Associated with an established moderate or severe
  level of dependence upon alcohol.
• Usually characterised by health, social
  interpersonal problems.
• Associated with tolerance withdrawal symptoms.
• Treated by detoxification.

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Dependent drinking(3 or more in past 12/12)

• Strong desire to drink
• Difficult to control onset, termination level
  of use
• Withdrawal symptoms
• Evidence of tolerance
• Neglect of alternative interests
• Continued use despite evidence of harm.

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The alcohol pyramid
Severely Dependent Drinkers (lt0.1)
Moderately Dependent Drinkers (lt0.4)
Harmful Drinkers (4.1)
Hazardous Drinkers (16.3)
Low-Risk Drinkers (67.1)
Non-Drinkers (12.0)
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Alcohol use in Bradford is linked to

• 200 premature deaths annually
• 180 sexual assaults
• 3,400 cases of domestic abuse
• 70 of admissions to AE on weekends
• 7000 to 12000 children affected by parental
  alcohol misuse
• An annual cost of 135million related to alcohol.

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Alcohol and Diversity issues

• We need to place diversity in its widest context
  and recognise that race, ethnicity, sexuality,
  gender identification, disability and literacy
  are all issues that we should consider in
  ensuring that we are meeting our communitys
  needs
• (Home Office 2006)

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Health Alcohol and Diversity issues

• Age Needs of the older person often are often
  missed or overlooked
• Levels of drinking in young people are increasing
  and recommended daily benchmarks for alcohol
  consumption are based on adult drinking.
• No recommendations exist for children and young
  people and we do not yet know the long-term
  consequences of their drinking.
• Gender gender norms/expectations, complex needs
  of women e.g. mental health and domestic violence
• Race Within some communities, religious
  restrictions can lead to hidden drinking making
  seeking help problematic. Language barriers
• Social and environmental context e.g. a poor
  physical environment may increase the risk of
  accidents and a deprived social context may
  increase the risk of assault or nerve damage due
  to malnutrition.
• (Alcohol Concern Factsheets)

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Health implications of hazardous harmful
alcohol use.
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Legal implications of drinking

• Drinking driving, resulting in a 12/12 ban, or
  up to 5000 in fines or up to 6/12 in prison.
• Drinking anti-social behaviour, resulting in a
  50-80 fine for buying/drinking alcohol under 18,
  being drunk, vomiting/urinating in the street,
  harassing someone or drinking in a no alcohol
  public area.

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Case finding for hazardous harmful alcohol use
may be done by.

• Biological markers, e.g. GGT, MCV, blood alcohol
  concentration levels.
• Clinical indicators e.g. BP, tremor, duodenal
  ulcers, accidents, falls, bloodshot eyes, dilated
  facial capillaries.
• Psycho-social indicators e.g. cognitive
  impairment, mood, anxiety, insomnia, job
  relationship issues.

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The preferred option is to

• Ask the client about their drinking using a
• screening tool.
• Alcohol Use Disorder Identification Test (AUDIT)
• (This may be administered by the client or
  another
• Person takes 5 minutes to do).

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Points to remember re using AUDIT

• A non confrontational manner is best
• Do not screen if client is intoxicated/injured
• Inform the client why you are screening
• Discuss confidentiality
• Acknowledge a low score ( feedback)
• Decide who you will will not screen

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What are brief interventions?

• Those practices that aim to identify a
• real or potential alcohol problem
• motivate an individual to do something
• about it.
• (WHO, 2001)

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Examples of brief interventions

• Ask about drinking using a screening tool
• Assess amount of alcohol consumed, type,
  frequency,
• cost etc, using a unit calculator drink
  diary.
• Advise how to drink sensibly using information
  leaflet
• Assist to reduce drinking via motivation goal
  setting
• Arrange follow up, referral or signpost to
  appropriate service e.g health check.

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Motivational interviewing the most effective
form of brief intervention

• A directive, but gentle non-confrontational,
• counselling style that helps build peoples
  intrinsic
• motivation for change by exploring resolving
• Ambivalence
• (Allot, 2005)

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Principles of MI

• Express empathy
• Develop discrepancy
• Avoid arguments
• Roll with resistance
• Support self efficacy

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Basic skills MI

• Reflective listening thinking
• Ask questions to clarify
• Resolve ambivalence
• Enhance motivational statements
• Summarise

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Six elements shown to be effective in brief
interventions (Miller and Sanchez, 1993)

• F feedback, assessment evaluation of the
  problem.
• R responsibility, drinking is by choice.
• A advise, how to change drinking behaviour.
• M menu, offering alternative goals
  strategies.
• E empathy, counsellor style is important.
• S self-efficacy, instilling optimism.

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In summary, brief interventions

• Have been recommended due to an increase in
  alcohol consumption
• Provide early interventions
• May be opportunistic or targeted
• Should be used with an alcohol screening tool
• May be applied by non alcohol specialists
• May motivate dependent drinkers to enter
  treatment
• Are more effective than no intervention
• Do make a difference!

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Any questions?

• If you are interested in being trained to be a
• trainer in alcohol screening brief
• interventions, please leave your contact
• details on the sheet on the table
• Thank you.

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To book a place on theAlcohol Screening
Brief Interventions Training

• Please contact Dawn Verity, Administrator
• Joint Commissioning Team (Substance Misuse DIP)
  Bradford Airedale Teaching Primary Care Trust,
  Douglas Mill (Fourth Floor), Bowling Old Lane,
  Bradford, BD5 7JR.
• Email dawn.verity_at_bradford.nhs.uk
• Tel  [phone]