Identification and Brief Advice Tools and Techniques

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Identification and Brief AdviceTools and
Techniques
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Alcohol in England

• 85 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.

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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

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Part 1Opportunistic Case Identification orScre
ening
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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)

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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

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AUDIT Gold Standard
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Primary Care - Alcohol Care Pathway
Adults 16-64 visiting GP
Requesting help with alcohol problem
New Registration
Other health complaint
SASQ
FAST
AUDIT - C
AUDIT - PC
Initial Screening Tools
PositiveResult
NegativeResult
Full Screen AUDIT
No action
AUDIT Score 8-15 Increasing-risk
AUDIT Score 16-19 Higher-risk
AUDIT Score 20 Possible Dependence
AUDIT Score 0-7 Lower-risk
Consider Referral to Specialist Services
Extended Brief Advice
Brief Advice
Full Assessment
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AUDIT - C
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FAST Fast Alcohol Screening Test
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AUDIT - PC
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SASQ Single Alcohol Screening Questionnaire
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Primary Care - Alcohol Care Pathway
Adults 16-64 visiting GP
Requesting help with alcohol problem
New Registration
Other health complaint
SASQ
FAST
AUDIT - C
AUDIT - PC
Initial Screening Tools
PositiveResult
NegativeResult
Full Screen AUDIT
No action
AUDIT Score 8-15 Increasing-risk
AUDIT Score 16-19 Higher-risk
AUDIT Score 20 Possible Dependence
AUDIT Score 0-7 Lower-risk
Consider Referral to Specialist Services
Extended Brief Advice
Brief Advice
Full Assessment
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AUDIT Gold Standard
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Primary Care - Alcohol Care Pathway
Adults 16-64 visiting GP
Requesting help with alcohol problem
New Registration
Other health complaint
SASQ
FAST
AUDIT - C
AUDIT - PC
Initial Screening Tools
PositiveResult
NegativeResult
Full Screen AUDIT
No action
AUDIT Score 8-15 Increasing-risk
AUDIT Score 16-19 Higher-risk
AUDIT Score 20 Possible Dependence
AUDIT Score 0-7 Lower-risk
Consider Referral to Specialist Services
Extended Brief Advice
Brief Advice
Full Assessment
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Part 2Brief Advice orBrief Intervention
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FRAMES - six essential elements

• Feedback - provides feedback on the clients risk
  for alcohol problems
• Responsibility - the individual is responsible
  for change
• Advice - advises reduction or gives explicit
  direction to change
• Menu - provides a variety of options for change
• Empathy - emphasises a warm, reflective and
  understanding approach
• Self-efficacy - encourages optimism about
  changing behaviour

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Brief Advice

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

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Understanding Units
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(No Transcript)
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Risk Levels
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Where do they sit?
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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

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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

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Part 3Brief Lifestyle Counselling orExtended
Brief Intervention
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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?

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Six-step plan

• Identify good reasons for changing Can you think
  of 2-3 good reasons?
• Set yourself a goal to achieve change Is this
  achievable?
• Recognise difficult times or situations When
  might be the hardest times?
• Prepare for difficult times/ situations Think of
  a way of dealing with hard times?
• Find Someone to support you Is there a family
  member/ friend who might help?
• Stick to your goals but remember, nobodys
  perfect! If at first you dont succeed, try
  again.

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Useful Links

• IBA e-Learning module Alcohol Learning Centre
• http//www.alcohollearningcentre.org.uk/
• Primary Care Framework
• http//www.primarycarecontracting.nhs.uk/204.php
  
• SIPS Research Programme
• http//www.sips.iop.kcl.ac.uk/index.php
• Materials, Units Calculator and Drink Check
  http//www.alcoholstakeholders.nhs.uk/