Identification and Brief Advice Tools and Techniques

1. Identification and Brief AdviceTools and Techniques

2. 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.

3. 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

4. Part 1Opportunistic Case Identification orScreening

5. 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)

6. 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

7. AUDIT – Gold Standard

8. Primary Care - Alcohol Care Pathway Adults 16-64 visiting GP Requesting help with alcohol problem New Registration Other health complaint Initial Screening Tools SASQ FAST AUDIT - C AUDIT - PC PositiveResult NegativeResult Full Screen AUDIT No action AUDIT Score 20+ Possible Dependence AUDIT Score 16-19 Higher-risk AUDIT Score 8-15 Increasing-risk AUDIT Score 0-7 Lower-risk Consider Referral to Specialist Services Extended Brief Advice Brief Advice Full Assessment

9. AUDIT - C

10. FAST – Fast Alcohol Screening Test

11. AUDIT - PC

12. SASQ – Single Alcohol Screening Questionnaire

13. Primary Care - Alcohol Care Pathway Adults 16-64 visiting GP Requesting help with alcohol problem New Registration Other health complaint Initial Screening Tools SASQ FAST AUDIT - C AUDIT - PC PositiveResult NegativeResult Full Screen AUDIT No action AUDIT Score 20+ Possible Dependence AUDIT Score 16-19 Higher-risk AUDIT Score 8-15 Increasing-risk AUDIT Score 0-7 Lower-risk Consider Referral to Specialist Services Extended Brief Advice Brief Advice Full Assessment

14. AUDIT – Gold Standard

15. Primary Care - Alcohol Care Pathway Adults 16-64 visiting GP Requesting help with alcohol problem New Registration Other health complaint Initial Screening Tools SASQ FAST AUDIT - C AUDIT - PC PositiveResult NegativeResult Full Screen AUDIT No action AUDIT Score 20+ Possible Dependence AUDIT Score 16-19 Higher-risk AUDIT Score 8-15 Increasing-risk AUDIT Score 0-7 Lower-risk Consider Referral to Specialist Services Extended Brief Advice Brief Advice Full Assessment

16. Part 2Brief Advice orBrief Intervention

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

18. Understanding Units

20. Risk Levels

21. Where do they sit?

22. 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 Benefits of cutting down

23. 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

24. Part 3Brief Lifestyle Counselling orExtended Brief Intervention

25. 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?

26. 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, nobody’s perfect! If at first you don’t succeed, try again.

27. 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/