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Alcohol Identification and Brief Advice Training

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Title: Alcohol Identification and Brief Advice Training


1
Alcohol Identification and Brief Advice Training
Barnsley Social Care Workforce Development Unit
2
The aim of this training session is to give you
  • Information about alcohol units and the harm
    caused by alcohol
  • the knowledge to identify where alcohol misuse
    might be a issue in the Service Users journey
  • the tools required to assess the extent to which
    the service users alcohol use is harmful
  • the confidence to conduct a structured brief
    intervention aimed at reducing the level of the
    service users alcohol consumption

3
How much do you know about Alcohol ?
  • ?
  • ??
  • ??? Lets try a Quiz ???
  • ??
  • ?

4
Recommended Limits
  • Adult women 2-3 units per day.
  • Adult men 3-4 units per day
  • Young people under the age of 18, should normally
    drink less than adult men and women
  • Higher risk drinking is defined as regularly
    drinking over 6 units per day for women (over 35
    units per week) and over 8 units per day for men
    (over 50 units per week).

5
  • Know Your Units

6
UNIT CALCULATOR
  • Work out your alcohol units for yourself with
    this sum
  • Strength (ABV) x Volume (ml) No. of
    units
  • 1000
  • E.g. Pint of Stella 5.2 x 568
    1000 2.95 Large glass of wine 12 x
    250 1000 3.00

7
Modern Drinking Habits
  • Pubs use larger wine glasses than they did ten to
    fifteen years ago.
  • People tend to use larger glasses at home and are
    unlikely to use measures
  • Higher strength drinks are now commonplace and
    available very cheaply
  • Alcopops have revolutionized drinking for younger
    people

8
Alcohol What are the Risks
  • NUMEROUS!!!!
  • Alcohol consumption is NEVER considered to be
    completely risk free

9
Effects of Alcohol
  • Depression
  • Reduced Effectiveness of medication
  • Reduced performance at work
  • Puts individuals at risk of injury from physical
    violence
  • Weight Gain  
  • Impotence
  • Sleep disorders
  • Increased accidents/injuries
  • Alcohol Poisoning
  • Loss of consciousness
  • Cancers
  • Memory Loss
  • Dementia
  • Liver disease
  • Inflammation of the stomach/ulcers
  • Low Mood
  • Risky Behaviour
  • Increases in
  • Domestic Violence
  • Rape
  • Public Disorder
  • Violence against strangers
  • Relationship Breakdown
  • Unemployment
  • Poor/reduced performance at work or home
  • And many more

10
Health implications of hazardous harmful
alcohol use.
11
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12
ALCOHOL THE WIDER SOCIAL IMPACT
  • Alcohol misuse contributes to around 1.2 million
    incidents of violent crime
  • 200 premature deaths each year
  • 40 of Domestic Violence Cases
  • 6 of all road casualties
  • Up to 2.6 million children live with a hazardous
    drinker
  • Up to 17million working days are lost annually
    through alcohol related absences
  • 70 of AE Admissions each weekend
  • Alcohol misuse costs the NHS 2.6 billion each
    year

13
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.

14
Indicators of Alcohol Misuse
  • Gut Problems
  • Problems sleeping
  • Snoring
  • Unusual level of falls/accidents
  • Wounds that wont heal
  • Unable to lose weight
  • Social irresponsibility (promiscuity/fighting)
  • Early morning drinking
  • Bin full of bottles/cans
  • Memory problems
  • Alcohol hidden around the home
  • Lying about/hiding alcohol use
  • Relationship problems
  • Problems holding a job or keeping appointments
  • Drinking alone
  • Boasting about drinking levels

15
ALCOHOL AND YOUR JOB
  • Have you ever broached the subject of alcohol
    with a service user?
  • What response did you get?
  • Did you feel comfortable?
  • How do you feel about doing Identification and
    Brief Advice for alcohol?
  • Readiness to change will affect a service users
    response

16
MOST COMMON ALCOHOL USE QUESTIONNAIRES
  • AUDIT
  • AUDIT-C
  • FAST
  • SASQ
  • AUDIT - PC

17
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20
RISK LEVELS
  • Lower risk - drinking implies that no level of
    alcohol consumption is completely safe. The
    context can determine the level of risk, for
    example drinking and driving.
  • Increasing Risk - regularly drinking more than
    2-3 units a day for a woman and more than 3-4
    units a day for a man.
  • Higher Risk - regularly drinking more than 6
    units per day for women or more than 8 units per
    day for men. Or more than 35 units per week
    (women) and more than 50 units per week (men).
  • Binge Drinking - regularly drinking more than 6
    units for women and more than 8 units for men
    i.e. twice the daily limit on a regular basis.

21
WHO Terms
  • hazardous drinkers - those drinking above
    recognized sensible levels, but not yet
    experiencing harm.
  • Harmful drinkers - those drinking above
    sensible levels and currently experiencing harm
    (excluding dependence).
  • These terms are used by the WHO but are not
    recommended for use by the Department of Health
    because they are considered to be diagnostic

22
WHAT IS A BRIEF INTERVENTION?
  • A short, evidence-based, structured conversation
    about a health issue with a service user that
    seeks in a non-confrontational way to motivate
    and support the individual to think about and/or
    plan behaviour change
  • Its Brief! Should take 5 15 minutes.

23
AIMS OF IBA
  • To reduce the burden of alcohol related injuries
    and disease on the NHS and society
  • To inform service users of the health risks
    associated with drinking
  • To determine which service users health could be
    improved by reducing drinking
  • To encourage service users to think more
    carefully about how their drinking might
    adversely affect their client journey

24
Brief Interventions
  • Have been recommended due to an increase in
    alcohol consumption
  • Provide early interventions, not designed to deal
    with dependant drinkers
  • May be opportunistic or targeted
  • Are a structured conversation not just a
    discussion
  • Should be used with an alcohol screening tool
  • May motivate increasing or higher risk drinkers
    to change their drinking behaviour
  • Are more effective than no intervention
  • Do make a difference!

25
  • IBA ISNT
  • Specialist Counselling
  • Confrontational
  • A route to abstinence
  • A way to treat service users who are alcohol
    dependent
  • IBA IS
  • Opportunistic
  • Based on advice
  • An Intervention lasting between 5 and 15 minutes
  • Flexible with or without formal follow-up

26
Listening Skills
  • A good listener
  • Focuses and makes eye contact
  • Nods and smiles
  • Asks open questions
  • Reflects on whats been said
  • Helps the individual explore issues
  • Emphasises that responsibility lies with the
    individual
  • Allows silences
  • Uses a clear voice
  • Summarises
  • Concentrates
  • Provides structure
  • Avoids physical barriers
  • Checks and clarifies understanding
  • A poor listener
  • Interrupts or talks too much
  • Tells their own stories
  • Gives their own opinion
  • Rushes in with solutions/tries to fix
  • Gives unsolicited advice or orders
  • Doesnt admit not knowing all the answers
  • Thinks of next question without listening
  • Concentrates on the problem and not the person
  • Fidgets or fiddles
  • Looks away/looks bored/clock watches
  • Is condescending or patronisinig
  • Jumps to conclusions

27
ESSENTIAL ELEMENTS TO BRIEF INTERVENTION(FRAMES)
  • Feedback - about personal risk due to current
    drinking. Do they know how many units they drink
    and the associate risk?
  • Responsibility - rests with the individual,
    drinking is by choice and the responsibility to
    change lies with the individual.
  • Advice - on how to change drinking behaviour,
    cut down or abstain.
  • Menu give options for change, offering
    alternative goals strategies.
  • Empathy, listening reflectively without trying to
    persuade or confront self-efficacy, encourage
    optimism.
  • Self-efficacy (building confidence) an
    interviewing style that increases a persons own
    belief in their ability to change

28
Empathy
  • Empathy isnt
  • Sympathy
  • Curing or telling
  • Rescuing
  • Constant Questioning
  • Empathy is
  • Active Uninterrupted listening
  • Accepting the person
  • Challenging behaviour
  • About strengthening relationships

29
This is one unit...
For more detailed information on calculating
units see - www.units.nhs.uk/
There are times when you will be at risk even
after one or two units. For example, with
strenuous exercise, operating heavy machinery,
driving or if you are on certain medication. If
you are pregnant or trying to conceive, it is
recommended that you avoid drinking alcohol. But
if you do drink, it should be no more than 1-2
units once or twice a week and avoid getting
drunk. Your screening score suggests you are
drinking at a rate that increases your risk of
harm and you might be at risk of problems in the
future. What do you think?
How many units did you drink today?
1 very small glass of wine
1 single measure of spirits
Half pint of regular beer, lager or cider
1 small glass of sherry
1 single measure of aperitifs
(9)
...and each of these is more than one unit
3
A pint of strong/premium beer, lager or cider
Alcopop or a 275ml bottle of regular lager
A pint of regular beer, lager or cider
440ml can of regular lager or cider
440ml can of super strength lager
250ml glass of wine (12)
Bottle of wine
regular
(12)
Risk Men Women Common Effects
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 Increased relaxation Sociability Reduced risk of heart disease (for men over 40 and post menopausal women)
Increasing Risk More than 3-4 units per day on a regular basis More than 2-3 units per day on a regular basis Progressively increasing risk of Low energy Memory loss Relationship problems Depression Insomnia Impotence Injury Alcohol dependence High blood pressure Liver disease Cancer
Higher Risk More than 8 units per day on a regular basis or more than 50 units per week More than 6 units per day on a regular basis or more than 35 units per week Progressively increasing risk of Low energy Memory loss Relationship problems Depression Insomnia Impotence Injury Alcohol dependence High blood pressure Liver disease Cancer
30
  • The benefits of cutting down
  • Psychological/Social/Financial
  • Improved mood
  • Improved relationships
  • Reduced risks of drink driving
  • Save money
  • Physical
  • Sleep better
  • More energy
  • Lose weight
  • No hangovers
  • Reduced risk of injury
  • Improved memory
  • Better physical shape
  • Reduced risk of high blood pressure
  • Reduced risk of cancer
  • Reduced risks of liver disease
  • Reduced risks of brain damage

Whats everyone else like? of Adult Population
What targets should you aim for? Men Should not
regularly drink more than 34 units of alcohol a
day. Women Should not regularly drink more than
23 units a day Regularly means drinking every
day or most days of the week. You should also
take a break for 48 hours after a heavy session
to let your body recover.
  • Making your plan
  • When bored or stressed have a workout instead of
    drinking
  • Avoid going to the pub after work
  • Plan activities and tasks at those times you
    would usually drink
  • When you do drink, set yourself a limit and stick
    to it
  • Have your first drink after starting to eat
  • Quench your thirst with non-alcohol drinks before
    and in-between alcoholic drinks
  • Avoid drinking in rounds or in large groups
  • Switch to low alcohol beer/lager
  • Avoid or limit the time spent with heavy
    drinking friends

What is your personal target?
This brief advice is based on the How Much Is
Too Much? Simple Structured Advice Intervention
Tool, developed by Newcastle University and the
Drink Less materials originally developed at the
University of Sydney as part of a W.H.O.
collaborative study.
31
WHEN TO REFER SERVICE USERS
  • High Level of Alcohol Related harm
  • Where the individual is an increasing or higher
    risk drinker, who has not responded to previous
    brief intervention and advice, and who wishes to
    receive further help with their alcohol problems.
  • score of 20 or more on the full AUDIT
    questionnaire
  • Severe alcohol-related problems or risk of such
    problems, for example
  • Violence
  • Possible loss of job or family
  • Obvious signs of physical dependence, for
    example
  • Withdrawal symptoms
  • Withdrawal relief or avoidance drinking
  • Very high tolerance
  • Memory blackouts

32
Who to refer Services Users to
  • The Barnsley Treatment System
  • 9-10 Burleigh Court
  • Barnsley
  • S70 1XY
  • 01226 779066
  • 08454 561079

33
Useful Links
  • http//www.nhs.uk/livewell/alcohol/Pages/Alcoholho
    me.aspx
  • www.alcoholconcern.co.uk
  • www.drinkaware.co.uk
  • www.alcoholics-anonymous.org.uk
  • www.al-anonuk.org.uk
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