Transcript Alcohol Identification and Brief Advice Training

Barnsley Social Care Workforce Development Unit
Alcohol Identification and
Brief Advice Training
The aim of this training session is to give
you
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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
How much do you know about
Alcohol ?
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??? Let’s
try a Quiz ???
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Recommended Limits
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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).
Know Your Units
UNIT CALCULATOR
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Work out your alcohol units for yourself with this sum:
Strength (ABV) x Volume (ml)
1000
E.g. Pint of Stella:
Large glass of wine:
= No. of units
5.2 x 568 ÷ 1000 = 2.95
12 x 250 ÷ 1000 = 3.00
Modern Drinking Habits
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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
Alcohol – What are the Risks
 NUMEROUS!!!!
 Alcohol
consumption is
NEVER considered to be
completely risk free
Effects of Alcohol
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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
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Increases in:
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Domestic Violence
Rape
Public Disorder
Violence against strangers
Relationship Breakdown
Unemployment
Poor/reduced performance at
work or home
And many more ……………
Health implications
of hazardous &
harmful alcohol use.
ALCOHOL – THE WIDER SOCIAL IMPACT
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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
Legal implications of drinking:
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Drinking & driving, resulting in a 12/12 ban, or up to
£5000 in fines or up to 6/12 in prison.
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Drinking & anti-social behaviour, resulting in a £5080 fine for buying/drinking alcohol under 18, being
drunk, vomiting/urinating in the street, harassing
someone or drinking in a ‘no alcohol’ public area.
Indicators of Alcohol Misuse
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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
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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
ALCOHOL AND YOUR JOB
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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
MOST COMMON ALCOHOL USE QUESTIONNAIRES
AUDIT
 AUDIT-C
 FAST
 SASQ
 AUDIT - PC
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AUDIT – C
Questions
How often do you have a drink containing
alcohol?
How many units of alcohol do you drink on a
typical day when you are drinking?
How often have you had 6 or more units if
female, or 8 or more if male, on a single
occasion in the last year?
Scoring system
0
1
2
3
4
Never
Monthly
or less
2-4
times
per
month
2-3
times
per
week
4+
times
per
week
1 -2
3-4
5-6
7-8
10+
Never
Less
than
monthly
Weekly
Daily
or
almost
daily
Scoring:
A total of 5+ indicates increasing or higher risk drinking.
An overall total score of 5 or above is AUDIT -C positive.
Monthly
SCORE
Your
score
AUDIT
Questio ns
Scoring system
0
1
2
3
4
Ne ve r
Monthly
or less
2 - 4
time s
pe r
month
2 - 3
time s
pe r
wee k
4+
time s
pe r
wee k
1 -2
3 - 4
5 - 6
7 - 8
10+
How oft en have you had 6 or mo re unit s if
fe male, o r 8 or mo re if ma le, on a single
occ asion in t he last year?
Ne ve r
Less
than
monthly
Monthly
Wee kly
How oft en during t he last year have you found
t hat you were not able t o st op drinking onc e you
had st art ed?
Ne ve r
Less
than
monthly
Monthly
Wee kly
How oft en during t he last year have you failed t o
do what was norma lly expec t ed fro m you
bec ause of your drinking?
Ne ve r
Less
than
monthly
Monthly
Wee kly
How oft en during t he last year have you needed
an alc oholic drink in t he mo rning t o get yourself
going aft er a heavy drinking session?
Ne ve r
Less
than
monthly
Monthly
Wee kly
How oft en during t he last year have you had a
feeling of guilt or re mo rse aft er drinking?
Ne ve r
Less
than
monthly
Monthly
Wee kly
How oft en during t he last year have you been
unab le t o re me mbe r what happe ned t he nig ht
before bec ause you had been d rinking?
Ne ve r
Less
than
monthly
Monthly
Wee kly
How oft en do you have a drink c ont aining
alc ohol?
How many units of alcohol do you drink on a
typical day when you are drink ing?
Have you or so meb ody else been injured as a
result of your drinking ?
No
Has a re lat ive or friend, doc t or or ot her hea lt h
worker bee n c onc erned about your drinking or
suggest ed t hat you c ut down?
No
Ye s,
but not
in the
last
year
Ye s,
but not
in the
last
year
Daily
or
almost
daily
Daily
or
almost
daily
Daily
or
almost
daily
Daily
or
almost
daily
Daily
or
almost
daily
Daily
or
almost
daily
Ye s,
during
the
last
year
Ye s,
during
the
last
year
Scoring: 0 – 7 Lower ris k, 8 – 15 Inc reasing risk,
16 – 19 Hig her ris k, 20+ Poss ib le depe ndenc e
SCORE
Your
score
RISK LEVELS
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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.
WHO Terms
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hazardous drinkers - those drinking above recognized
‘sensible’ levels, but not yet experiencing harm.
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Harmful drinkers - those drinking above ‘sensible’
levels and currently experiencing harm (excluding
dependence).
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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
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.
AIMS OF IBA
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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
Brief Interventions……
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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!
IBA ISN’T
IBA IS:
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Opportunistic
Based on advice
An Intervention
lasting between 5 and
15 minutes
Flexible –with or
without formal followup
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Specialist Counselling
Confrontational
A route to abstinence
A way to treat service
users who are alcohol
dependent
Listening Skills
A good listener:
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Focuses and makes eye contact
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Nods and smiles
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Asks open questions
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Reflects on what’s been said
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Helps the individual explore issues
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Emphasises that responsibility lies with
the individual
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Allows silences
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Uses a clear voice
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Summarises
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Concentrates
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Provides structure
 Avoids physical barriers
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Checks and clarifies understanding
A poor listener:
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Interrupts or talks too much
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Tells their own stories
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Gives their own opinion
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Rushes in with solutions/tries to ‘fix’
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Gives unsolicited advice or orders
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Doesn’t admit not knowing all the
answers
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Thinks of next question without
listening
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Concentrates on the problem and not
the person
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Fidgets or fiddles
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Looks away/looks bored/clock watches
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Is condescending or patronisinig
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Jumps to conclusions
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 - on how 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 selfefficacy, encourage optimism.
Self-efficacy (building confidence) – an interviewing style that increases a
persons own belief in their ability to change
Empathy
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Empathy isn’t:
 Sympathy
 Curing
or telling
 Rescuing
 Constant Questioning
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Empathy is:
 Active
Uninterrupted
listening
 Accepting the person
 Challenging behaviour
 About strengthening
relationships
This is one unit...
1 very small
glass of
wine(9%)
Half pint of
regular
beer, lager
or cider
For more detailed information on calculating units see - www.units.nhs.uk/
1 single
measure of
spirits
1 small glass
of sherry
1 single
measure of
aperitifs
How many
units did
you drink
today?
...and each of these is more than one unit
3
A pint of
regular
“regular”
beer, lager
or cider
A pint of
“strong”/
”premium”
beer, lager
or cider
Alcopop or a
275ml bottle
of regular
lager
440ml can
of “regular”
lager or
cider
440ml can
of “super
strength”
lager
250ml glass
of wine
(12%)
Bottle of
wine
(12%)
Risk
Men
Women
Common Effects
Lower Risk
No more than
3-4 units per
day on a
regular basis
No more than
2-3 units per
day on a
regular basis
Increased relaxation
Sociability
Reduced risk of heart
disease (for men over 40 and
post menopausal women)
Increasing
Risk
More than 34 units per
day on a
regular basis
More than 2-3
units per day
on a regular
basis
Higher Risk
More than 8
units per day
on a regular
basis or more
than 50 units
per week
More than 6
units per day
on a regular
basis or more
than 35 units
per week
Progressively increasing
risk of:
Low energy
•Memory loss
•Relationship problems
Depression
Insomnia
•Impotence
•Injury
•Alcohol dependence
•High blood pressure
•Liver disease
•Cancer
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?
The benefits of cutting down
What’s everyone else like?
% of Adult Population
Population by Risk Category
70.0%
60.0%
50.0%
40.0%
Male
Female
30.0%
20.0%
10.0%
What targets should you aim for?
0.0%
Abstaining Low er risk
Making your plan
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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
Increasing
risk
Higher risk
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
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.
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.
WHEN TO REFER SERVICE USERS
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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:
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Withdrawal symptoms
Withdrawal relief or avoidance drinking
Very high tolerance
Memory blackouts
Who to refer Services Users to:
The Barnsley Treatment System
9-10 Burleigh Court
Barnsley
S70 1XY
01226 779066
08454 561079
Useful Links
http://www.nhs.uk/livewell/alcohol/Pages/A
lcoholhome.aspx
 www.alcoholconcern.co.uk
 www.drinkaware.co.uk
 www.alcoholics-anonymous.org.uk
 www.al-anonuk.org.uk
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