Screening and Brief Alcohol Intervention

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• Screening and Brief Alcohol Intervention
• Level 1 Session 2 Training
• Simple Structured Advice

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Linking screening to brief intervention

• Start with reference to the patients screening
  score or consumption level
• Avoid labelling the patient
• Ask the patient how they feel about their
  screening score/consumption level
• Highlight that screening scores indicate
  potential increased risk or harm.

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Examples

• You appear to be drinking at a rate that
  increases your risk of harm. What do you think?
• The way in which you are drinking may be having
  an impact on your health. What do you think?
• Your score on this screening tool suggests that
  you might be at risk of problems in the future.
  What do you think?
• Screening suggests that if you keep going as you
  are, youre increasing the chance of problems in
  the future. What do you think?

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But - not all patients are the same
Alcohol may not be at the top of their agenda
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Stage of Change brief intervention

• Precontemplation (unaware/unready)
• intervention unlikely to succeed, give
  information about risks
• Contemplation (aware/ambivalent)
• offer advice /or motivational work to move
  patient along
• Preparation (planning)
• set date, make plans, be specific, anticipate
  difficulties
• Action (ready to go)
• encourage, support, offer to follow-up
• Maintenance (keeping it up)
• reinforce success, advise on managing
  slips/relapse prevention

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Level of risk brief intervention

• Low Risk - Brief congratulatory, positive
  reinforcement. Possibly unit awareness work.
• Hazardous drinkers Simple structured advice and
  offer of further support (level 1 BI)
• Harmful drinkers Simple structured advice
  (level 1 BI) and offer Motivational intervention
  (level 2 BI)
• Dependent drinking Referral on to specialist
  services

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Balancing patients stage risk factors
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What generally happens now?
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Example 1 - avoid
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Example 2 - evade
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Example 3 - dictate
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Level 1 brief intervention

• Simple structured advice
• Delivered in 1-2 minutes
• Following How Much is Too Much protocol (level
  1)
• Offer of future follow-up/further discussion
• Very practical - common sense content
• Clinicians already use many of the elements

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• Broad approach FRAMES
• Feedback (personalised)
• Responsibility (with patient)
• Advice (clear, practical)
• Menu (variety of options)
• Empathy (warm, reflective)
• Self-efficacy (boosts confidence)

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Discussion

• Essential elements
• Most useful bits
• When, where and by whom
• Resources
• What if patients want more?

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Level 2 brief intervention - Behaviour Change
counselling

• Motivationally enhanced, lifestyle intervention
  not MI
• Based on brief counselling on Rollnick, S.,
  Mason, P. Butler, C. (1999) Health Behaviour
  Change A Guide for Practitioners
• Following How much is Too Much level 2
• Longer 2-3 hour skill-based training - Promoting
  effective behaviour change by Dr Malcolm Thomas