(Training 4 Trainers)

1. (Training 4 Trainers) Alcohol Brief Interventions Training (Trainer to insert ) Name & contact details

2. Alcohol Education & Unit Guidance – a Recap! Brief Intervention – What and Why? Screening (FAST Screening Tool) Brief Intervention Skills Alcohol Brief Intervention Session September 2018

3. Alcohol Brief Intervention Session Alcohol Education Unit Guidance Recap Pre-reading review

4. Sarah starts drinking at 4pm on Saturday; She has 2 large Vodka & Cokes (50ml, 40% abv each) and half a bottle of wine (375ml, 13.5%abv) with dinner. She then goes out with friends. Over the course of the evening she drinks 1 large glass of wine (250ml, 13% abv) and 6 bottles of Bacardi Breezer (275ml, 5%abv). No of units? Q. Approximately at what time will Sarah become alcohol free?

5. Basic Education, Information & Advice • Resources & Tools • Screening • Brief (Motivational) Intervention • Signposting • Referral • Assessment • Treatment

6. Brief Intervention – What and Why? Alcohol Brief Intervention Session

12. Important to raise clearly and be non judgemental • Compare to guidelines • Listening Skills • Interchangeable, fluid strategies, not set

14. Raising the Issue – Identifying presentations where the role of alcohol should be considered? Alcohol Brief Intervention Session

15. Raising the Issue Identifying presentations where role of alcohol should be considered

17. Screening Tools Alcohol Brief Intervention Session

24. Screening tools • Short MAST-Geriatric (SMAST-G) • 10 Questions with a focus on older people. • Plus 1 additional question: • Do you drink alcohol and take mood or mind altering drugs, • including prescription tranquilizers, prescription sleeping pills, prescription pain pills, or any illicit drugs?”

25. www.nhsghpcat.org

27. Screening Exercise Alcohol Brief Intervention Session

31. Brief Intervention Skills Alcohol Brief Intervention Session

32. MI works best when not prescribed simply by a manual or in a purely ‘technique-led’ approach The ability of the practitioner to relate to the client is far more important – not just empathy – but being ‘genuine’ with real care and compassion Some clients do not respond well to MI, they need or look for more explicit direction or already have commitment, therefore MI can be counterproductive “Listening rather than telling, evoking rather than instilling” (Bill Miller) Annual Review of Clinical Psychology Vol. 1: 91-111 (April 2005). See also “Manners Matter” (part 3) Drug & Alcohol Findings (2005) MI Techniques cautionary

33. Intervention levels

34. Key to success in any brief intervention approach is to first and foremost LISTEN to the individual’s responses to the feedback on their drinking – compared to the low risk drinking guidance • Tailor your approach based on your judgement of that response • One such way of tailoring a response is to utilise the ‘stages of change model’ which aligns brief interventions within a health behaviour change framework

35. Matching Response to Approach:

36. Matching Response to Approach Summary:

37. Open-ended questions – allow the patient / client to discuss issues from their own point of view Affirming – statements of appreciation and understanding providing positive reinforcement Reflective listening – allowing the practitioner to check on his/her understanding and to invite the patient / client to expand on any issues Summaries – useful for combining key points – demonstrating active listening and leading toward clarification and future action ‘OARS’ Practitioner-led Skills

38. Offering information – how might the patient / client benefit from cutting down on alcohol consumption? Physical and Mental Wellbeing: Improved sleep, improved memory function, reduction in anxiety and stress, more energy, fewer hangovers, lower risk of high blood pressure, losing weight, lower risk of liver disease Social and Financial:Lower risk of accident/injury, less chance of being involved in anti-social behaviours, lower risk of drink-driving, better relationships, saving money, more time for other interests, improved work relationships/prospects Advice & Information:

39. Rolling with resistance: confrontation in this scenario is unlikely to meet with any change of behaviour Eliciting change talk:if there is any positive reaction, capitalise on this by examining negative aspects of current behaviour, if there is a negative reaction look at examining first the positives or perceived advantages of current drinking Weighing up the pros and cons of change: the ‘motivational matrix’ can assist the practitioner in guiding elements of the conversation Enhancing Motivation:

40. Motivational Matrix:

41. At this stage, it is important to try and see if patient / client can suggest their own changes or steps to begin. Using good knowledge of units/calculation may be a good place to start. For example: Drinking on fewer occasions On each occasion, drinking fewer alcohol drinks Reducing the amount of alcohol in each drink Menu of Options:

42. Self efficacy is an essential part of behaviour change. Occasionally this requires examining with the patient / client A useful conceptual tool is the ‘readiness ruler’. Useful as visual aid to the process of discussing confidence. Q. “On a scale of 0 (not at all confident) to 10 (very confident indeed), how confident would you say you are now about your ability to change drinking behaviour”? Q. “Why here, and not (lower) (higher)”? Q. “Where would you like to be”? Q. “What would need to happen for you to get to a higher point”? Building Confidence:

43. Any return to prior drinking behaviours or pattern, however briefly (slip or lapse) is common, however it can provide a possible learning opportunity. The key to any relapse prevention is to carefully identify potential triggers and high-risk situations and to develop the appropriate coping strategies Coping strategies may include: Utilising assertiveness skills Managing stress Changing personal routines or circumstances where possible Coping Strategies:

44. Revisit “case studies” Maureen & James. Use Case Studies Patient Practitioner Deliver ABI as role-play and change around roles and repeat. Summary & Discussion Delivering an ABI

46. Recording an ABI • Do you have the facility to record ABIs? • Can you instigate a simple system? • Can you report back to Aberdeen City ADP on numbers of ABIs delivered on a quarterly basis.

49. LOCAL SERVICES Aberdeen: Alcohol & Drugs Action (ADA) Helpline Tel: 01224 594700/ Text: 07927 192706 (7 Days) Email: helpline@drugsaction.co.ukwww.alcoholaberdeen.org.uk Aberdeenshire: Aberdeenshire Substance use, Support, Engagement and Treatment (ASSET) Helpline: 01224 558844 Moray: Arrows Service Helpline Tel: 07812228547 Tel: 01343 610500

50. Additional supports NHS Alcohol & Units, Local Support: www.nhsgrampian.org/alcohol NHS Health Information Resources: www.nhsghpcat.org Tel: (01224) 558504 HI-NET ABI page: https://www.hi-netgrampian.org/people-networks/alcohol-and-drugs-in-grampian/alcohol-brief-interventions-resources/ Sobering Thought: http://soberingthought.co.uk/ Meet the Hendersons: http://meetthehendersons.org.uk/ Alcoholics Anonymous: www.alcoholics-anonymous.org.uk Al-Anon Family Groups: www.al-anon.org.uk Scottish Familes affected by Alcohol or Drugs (SFAD): https://www.sfad.org.uk/