Alcohol Identification and Brief Advice Training

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Alcohol Identification and Brief Advice Training
Barnsley Social Care Workforce Development Unit
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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 users alcohol use is harmful
• the confidence to conduct a structured brief
  intervention aimed at reducing the level of the
  service users alcohol consumption

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How much do you know about Alcohol ?

• ?
• ??
• ??? Lets try a Quiz ???
• ??
• ?

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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).

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• Know Your Units

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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

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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

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Alcohol What are the Risks

• NUMEROUS!!!!
• Alcohol consumption is NEVER considered to be
  completely risk free

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Effects of Alcohol

• 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

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Health implications of hazardous harmful
alcohol use.
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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 AE Admissions each weekend
• Alcohol misuse costs the NHS 2.6 billion each
  year

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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.

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Indicators of Alcohol Misuse

• Gut Problems
• Problems sleeping
• Snoring
• Unusual level of falls/accidents
• Wounds that wont 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

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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

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MOST COMMON ALCOHOL USE QUESTIONNAIRES

• AUDIT
• AUDIT-C
• FAST
• SASQ
• AUDIT - PC

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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.

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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

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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
• Its Brief! Should take 5 15 minutes.

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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

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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!

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• IBA ISNT
• Specialist Counselling
• Confrontational
• A route to abstinence
• A way to treat service users who are alcohol
  dependent

• IBA IS
• Opportunistic
• Based on advice
• An Intervention lasting between 5 and 15 minutes
• Flexible with or without formal follow-up

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Listening Skills

• A good listener
• Focuses and makes eye contact
• Nods and smiles
• Asks open questions
• Reflects on whats 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
• Doesnt 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

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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 self-efficacy, encourage
  optimism.
• Self-efficacy (building confidence) an
  interviewing style that increases a persons own
  belief in their ability to change

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Empathy

• Empathy isnt
• Sympathy
• Curing or telling
• Rescuing
• Constant Questioning

• Empathy is
• Active Uninterrupted listening
• Accepting the person
• Challenging behaviour
• About strengthening relationships

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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
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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)
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 3-4 units per day on a regular basis More than 2-3 units per day on a regular basis Progressively increasing risk of Low energy Memory loss Relationship problems Depression Insomnia Impotence Injury Alcohol dependence High blood pressure Liver disease Cancer
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
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• 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

Whats everyone else like? of Adult Population
What targets should you aim for? Men Should not
regularly drink more than 34 units of alcohol a
day. Women Should not regularly drink more than
23 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.
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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

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Who to refer Services Users to

• The Barnsley Treatment System
• 9-10 Burleigh Court
• Barnsley
• S70 1XY
• 01226 779066
• 08454 561079

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Useful Links

• http//www.nhs.uk/livewell/alcohol/Pages/Alcoholho
  me.aspx
• www.alcoholconcern.co.uk
• www.drinkaware.co.uk
• www.alcoholics-anonymous.org.uk
• www.al-anonuk.org.uk