Transcript Using this template - National Institute for Health and

Alcohol-use disorders:
preventing harmful drinking
Workshop on putting NICE guidance
into practice
2nd. Edition – August 2011
NICE public health guidance 24
What this presentation covers
Background
Policy recommendations
Pre-training quiz
Practice recommendations
Post-training quiz
Discussion & other NICE resources
Background
Alcohol is attributable for:
• 14,982 deaths in England (2005)
• 500,000 recorded crimes (England)
• up to 35% of attendances at hospital emergency
departments (2003)
24% of adults drink a hazardous or harmful amount
Recommendations for policy
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lunchtime session]
Recommendations 1 to 3 cover:
• price
• availability
• marketing
Policy: price
• Consider introducing a minimum price per unit
• Regularly review the minimum price per unit
• Regularly review alcohol duties
Policy: availability
Consider revising licensing legislation to ensure:
• links between the availability of alcohol and alcoholrelated harm are taken into account when licence
applications are considered
• immediate sanctions can be imposed on premises in
breach of their licence
• health bodies are ‘responsible authorities’
Policy: marketing
Consider a review of the advertising codes – to ensure:
• limits set by Advertising Standards Authority for the
proportion of the audience under age 18 are
appropriate
• children and young people are adequately protected
where alcohol advertising is permitted
• a stringent regulatory system covers all alcohol
marketing, particularly via new media
Policy: costs & savings
Recommendation
Sector affected
Minimum price per
Health (full effect)
unit of alcohol - £0.40
Total
Potential savings
£ millions
80.3
Crime
6.8
Employee
absenteeism
13.2
100.3
Recommendations for practice
• Organisational issues
• Children and young people aged 10 to 15
• Young people aged 16 and 17 years
• Adults
Organisational issues:
licensing
• Map alcohol-related problems before developing
or reviewing a licensing policy
• In ‘saturated’ areas adopt a ‘cumulative impact’ policy
• Identify and take action against premises making
illegal sales
• Ensure sanctions are fully applied
Organisational issues:
resources for screening
and brief interventions
• Prioritise alcohol-use disorder prevention as an
’invest to save’ measure
• Conduct a local joint alcohol needs assessment
• Include screening and brief interventions in
commissioning plans
• Provide resources for tier 2, 3 and 4 alcohol services to
accommodate a likely increase in referrals
Quiz time
Children and young people
aged 10 to 15 years
• Routinely assess their ability to consent to treatment
• Obtain a detailed history of their alcohol use
• Use professional judgement to decide what action
to take
• Consider referral to CAMHS, social care or young
people’s alcohol services, if there is risk of harm
• Tailor discussions to age and ability
Young people aged 16 and 17:
screening
• Complete a validated alcohol screening questionnaire
such as AUDIT
• Focus on groups at increased risk of alcohol-related
harm
• Tailor discussions to age and ability
• Routinely assess their ability to consent to treatment
Screening
AUDIT – C
For people aged 16 years and over
Scoring: A total of 5+ indicates increasing or higher risk drinking.
Young people aged 16 and 17:
extended brief interventions
• Ask their permission to arrange an extended brief
intervention with a trained member of staff
• Provide information on local specialist addiction
services to those who do not respond well to
discussion but who want further help
• Assess the physical and mental health of those who
are actively seeking help, or refer them for appropriate
treatment and care
Group work: screening
Adults: screening
Conduct alcohol screening as part of routine NHS
practice. If universal screening is not feasible focus
on those:
•
•
•
•
with relevant physical or mental health conditions
who have been assaulted
at risk of self-harm
who regularly experience accidents or minor
traumas
• who regularly attend GUM clinics or repeatedly
seek emergency contraception
Adults: screening
Non-NHS professionals should focus on groups
at increased risk of harm from alcohol and people who
have alcohol-related problems.
For example those:





at risk of self-harm
involved in crime or other anti-social behaviour
who have been assaulted
at risk of domestic abuse
whose children are involved with child safeguarding
agencies
 with drug problems
Adults: screening
• Ensure discussions are sensitive to the person’s culture
and faith and tailored to their needs
• Complete a validated alcohol questionnaire
• Do not offer simple brief advice to anyone who may be
dependent on alcohol
• Biochemical measures should not be used as a
matter of routine for screening
Adults: brief advice
Offer a session of structured brief advice on alcohol
Use a recognised resource based on FRAMES
principles
Where there is an ongoing client relationship,
routinely monitor progress
Group work: brief advice
1 very small
glass of
wine(9%)
Half pint of
regular
beer, lager
or cider
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
(12.5%)
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
What’s everyone else like?
% of Adult Population
Abstainers
Lower
risk
Making your plan
•
•
•
•
•
•
•
•
•
Increasing Higher
risk
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
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 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.
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.
Adults: extended
brief interventions
Adults who have not responded to brief structured
advice should be:
• offered an extended brief intervention to help
address their alcohol use
• followed up and assessed
Referral
Consider referring for specialist treatment if they:
• show signs of moderate or severe alcohol-dependence
• have failed to benefit from structured brief advice and
an extended brief intervention and still want help
• show signs of severe alcohol-related impairment
or have a related co-morbid condition
Quiz time
Discussion
Who leads our local joint alcohol needs assessment?
When were our local alcohol care pathways last
reviewed?
How can we incorporate alcohol screening within routine
appointments?
What are the challenges involved in delivering
brief interventions within routine practice?
NHS Evidence
Visit NHS Evidence for
the best available
evidence on all
aspects of harmful
alcohol use
Click here to go to
the NHS Evidence
website
Find out more
Visit www.nice.org.uk/guidance/PH24 for the:
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•
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•
•
guidance
quick reference guide
business case
training plan
audit support
self-assessment tool
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