Screening

1

• Screening Brief Alcohol intervention
• Level 2 session 3
• Extended brief intervention

2
Background clinical context
3
Motivational extended brief intervention

• Accords with broad principles of patient centred
  practice
• Motivational approach to behaviour change
  counselling not Motivational interviewing
• Based on Health Behaviour Change A Guide for
  Practitioners Rollnick, S., Mason, P. Butler,
  C. (1999)
• Following How Much is Too Much Level 2
• Longer 2-3 hour skill-based training session by
  Dr. Malcolm Thomas on Promoting effective
  behaviour change

4
Patient centred practice- key ingredients

• Both are experts
• disease and illness
• person in a context
• finding common ground
• mutual decision making

5
Patient presents problem

• Doctors agenda
• Symptoms
• Signs
• Investigations
• Pathophysiology

• Patients agenda
• Ideas
• Concerns
• Expectations
• Feelings

Understanding the patients unique experience of
illness
Differential diagnosis
6
Patient centred practice - active listening
patient
practitioner
What I say
What I hear
What I understand
What I mean or feel
7
assumptions

• This person ought to change
• this person wants to change
• patients health is motivation
• no changefailure
• either do or dont

• Now is the right time
• being tough is best
• I know - my advice is good
• negotiation is always best

8
Check out the assumptions

• Identify which two are the most interesting and
  discuss in groups of three or four ( 10 mins)

9
Motivational interviewing

• client-centred , directive method for enhancing
  intrinsic motivation to change by exploring and
  resolving ambivalence Miller Rollnick 2002

10
Principles of MI

• 1. Express empathy
• 2. Develop discrepancy
• 3. Avoid argumentation
• 4. Roll with resistance
• 5. Support self-efficacy

11
Behaviour change counselling

• ways of structuring a conversation which
  maximises the individuals freedom to talk and
  think about change in an atmosphere free of
  coercion and the provision of premature
  solutions Rollnick et al. 1999

12
Three broad stages in BCC

• Assessing readiness
• Weighing up pros and cons
• Determining action - moving patients on

13
Assessing Readiness
Importance Confidence Readiness
14
Importance of changing drinking
On a scale of 0 (not at all) to 10 (very important), what number would you give yourself right now? Why are you here and not higher? Or lower? What would need to happen for you to get to a higher point? How can I help you get from where you are now to a higher number?


15
Confidence about changing drinking
On a scale of 0 (not at all) to 10 (very confident), what number would you give yourself right now? Why are you here and not higher? Or lower? What would need to happen for you to get to a higher point? How can I help you get from where you are now to a higher number?


16
Weighing up the pros and cons of drinking

What are the good things?
What are the less good things?
? ? ?
? ? ?

Where does this leave you?
17
Determining action

• Identifying reasons for change
• Setting achievable goals
• Recognising difficult times/situations
• Prepare for difficult times/situations
• Finding support
• Sticking to goals

18
Discussion

• Trying out components
• Feedback
• What about patients who need more?

19

• Referral (1)
• Patients should be referred to specialist
  services who
• show a relatively high level of alcohol
  dependence or alcohol-related harm
• are harmful drinkers who have not benefited from
  brief counselling and wish to receive further
  help for their alcohol problems

20

• Referral (2)
• can be defined as score of 20 on the full AUDIT
• obvious signs of physical dependence (e.g.
  withdrawal symptoms, withdrawal relief or
  avoidance drinking, very high tolerance,
  blackouts)
• severe alcohol-related problems or risk of such
  problems (e.g. possible loss of job, family,
  etc.)
• score on recognised measure of dependence (e.g.
  10-item Leeds Dependence Questionnaire)