Alcohol Identification and Brief Advice Training

1. Barnsley Social Care Workforce Development Unit Alcohol Identification and Brief Advice Training

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 user’s alcohol use is harmful • the confidence to conduct a structured brief intervention aimed at reducing the level of the service user’s alcohol consumption

3. How much do you know about Alcohol ? ? ?? ??? Let’s 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. 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 …………… Effects of Alcohol

10. Health implications of hazardous &harmful alcohol use.

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 A&E 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. Gut Problems Problems sleeping Snoring Unusual level of falls/accidents Wounds that won’t 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 Indicators of Alcohol Misuse

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

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 It’s 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 IS: Opportunistic Based on advice An Intervention lasting between 5 and 15 minutes Flexible –with or without formal follow-up IBA ISN’T Specialist Counselling Confrontational A route to abstinence A way to treat service users who are alcohol dependent

26. A good listener: Focuses and makes eye contact Nods and smiles Asks open questions Reflects on what’s 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 Doesn’t 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 Listening Skills

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 - onhow 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 isn’t: Sympathy Curing or telling Rescuing Constant Questioning Empathy is: Active Uninterrupted listening Accepting the person Challenging behaviour About strengthening relationships Empathy

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%)

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 What’s everyone else like? % of Adult Population What targets should you aim for? Men Should not regularly drink more than 3–4 units of alcohol a day. Women Should not regularly drink more than 2–3 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/Alcoholhome.aspx www.alcoholconcern.co.uk www.drinkaware.co.uk www.alcoholics-anonymous.org.uk www.al-anonuk.org.uk