Iain%20Armstrong%20Improving%20Health%20and%20Wellbeing%20UK

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Iain ArmstrongImproving Health and Wellbeing UK
Alcohol IBA Effective in Primary Care will it
work in Social Work?

• Reducing the costs from alcoholrelated harm

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Risk Levels
Risk Men Women
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
Increasing Risk 4 or more units per day on a regular basis 3 or more units per day on a regular basis
Higher Risk 8 or more units per day on a regular basis or 50 units per week 6 or more units per day on a regular basis or 35 units per week
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Drinking categories
26.3m 62.5
6.6m15.8
6.9m16.5
60
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6.9m16.5
1.6m3.8
2.2m 5.2
Source General Household Survey 2009 mid-2009
population estimates (ONS) Adult Psychiatric
Morbidity Survey 2007
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Cost to the NHS

• 7 of all hospital admissions
• In 2009/10 there were around 1.1 million alcohol
  related hospital admissions
• an increase of 12 compared with 2008/9.
• Up to 35 of all AE attendance and ambulance
  costs may be alcohol-related
• Up to 70 of AE attendances at peak times on the
  weekends (between midnight and 5am) may be
  alcohol-related
• Alcohol misuse is calculated to cost the health
  service 2.7bn per annum

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Alcohol accounts for

• Between 15,000 and 22,000 premature deaths
  annually in England and Wales each year
• Nearly 5,000 (3.5) cancer deaths per annum are
  attributable to alcohol
• Cancers of the oral cavity and pharynx, larynx,
  oesophagus and liver
• Suggestive but inconclusive data for role in
  rectal and breast cancer
• A severe risk of cardiovascular disease
• 1,200 associated deaths per year due to
  haemorrhagic stroke
• 10 of deaths due to hypertension
• Liver Cirrhosis is now the 5th most common cause
  of death and continues to rise
• The top 4 conditions HD, CVD, Chronic Lung
  Disease and Cancer deaths are all falling.
• Alcohol accounts for 58 of all Liver Disease
• 4,500 deaths, a 90 increase over the past decade

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Crime-related Impact from alcohol

• 986,000 violent incidents in England and Wales in
  2009/10, where the victim believed the offender
  to be under the influence of alcohol (50 of all
  violent crimes) (Flatley et al., 2010)
• Nearly half of all offences of criminal damage
  are alcohol-related
• alcohol is implicated in domestic violence,
  sexual assaults, burglary, theft robbery and
  murder (Prime Ministers Strategy Unit, 2003)
• In 2008 estimated 13,020 reported road casualties
  (6 of all road casualties) occurred when someone
  was driving whilst over legal limit.
• The provisional number of people estimated to
  have been killed in drink-drive accidents was 430
  in 2008 (17 of all road fatalities) (Department
  of Transport, 2009)
• Approximately two thirds of male prisoners and
  over a third of female prisoners are hazardous or
  harmful drinkers and up to 70 of probation
  clients are hazardous or harmful drinkers
  (Singleton, et al., 1998)

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Risks
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QOF Registers
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What Can Social Workers Do?

• Identify those at risk
• Deliver Brief Advice to those drinking at
  increasing and higher risk
• Refer Dependent Drinkers to Specialist Services

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Identification
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Point of Clarification

• Opportunistic alcohol case Identification and the
  delivery of Brief Advice (IBA)
• is the same as
• Screening and Brief Interventions for alcohol
  misuse (SBI)

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Alcohol Identification

• Alcohol risk levels can be quickly ascertained
  using a simple screening tool

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AUDIT Gold Standard
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AUDIT Gold Standard

• Developed by WHO
• Validated screening tool
• High specificity (94)
• High sensitivity (92)
• Adapted version for the UK
• Various shortened adaptations for pre-screening
• More accurate and economical than most
  bio-chemical tests

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Brief Advice (or Brief Intervention)
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FRAMES - six essential elements

• Feedback - provides feedback on the clients risk
  for alcohol problems
• Responsibility - the individual is responsible
  for change
• Advice - advises reduction or gives explicit
  direction to change
• Menu - provides a variety of options for change
• Empathy - emphasises a warm, reflective and
  understanding approach
• Self-efficacy - encourages optimism about
  changing behaviour

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Brief Advice

• The recommended brief intervention is 5 minutes
  of advice developed by the WHO
• In the UK, the University of Newcastle had
  refined this into a programme called How Much Is
  Too Much?
• Content
• Understanding units
• Understanding risk levels
• Knowing where they sit on the risk scale
• Benefits of cutting down
• Tips for cutting down

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Benefits of cutting down

• Physical
• Reduced risk of injury
• Reduced risk of high blood pressure
• Reduced risk of cancer
• Reduced risks of liver disease
• Reduced risks of brain damage
• Sleep better
• More energy
• Lose weight
• No hangovers
• Improved memory
• Better physical shape

• Psychological/Social/Financial
• Improved mood
• Improved relationships
• Reduced risks of drink driving
• Save money

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Tips for cutting down

• Have an alcohol-free day once or twice a week
• Plan activities and tasks at those times you
  usually drink
• When bored or stressed have a workout instead of
  drinking
• Explore other interests such as cinema, exercise,
  etc.
• Avoid going to the pub after work
• Have your first drink after starting to eat
• Quench your thirst with non-alcohol drinks before
  alcohol
• Avoid drinking in rounds or in large groups
• Switch to low alcohol beer/lager
• Avoid or limit the time spent with heavy
  drinking friends

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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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IBA - Evidence
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Evidence for IBA

• There is a very large body of research evidence
• 56 controlled trials (Moyer et al., 2002) all
  have shown the value of IBA
• A recent Cochrane Collaboration review (Kaner et
  al., 2007) shows substantial evidence for IBA
  effectiveness
• For every eight people who receive simple alcohol
  advice, one will reduce their drinking to within
  lower-risk levels (Moyer et al., 2002)
• This compares favourably with smoking where only
  one in twenty will act on the advice given
  (Silagy Stead, 2003)

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Barriers

• Staffing and staff attitudes
• Dont have time
• Not my job
• Uncomfortable commenting on patients personal
  life
• To close to home
• Dont feel trained to intervene
• Dont believe it will do any good
• Focus on dependence

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Mitigation

• Not my job
• Every contact counts
• reduces problems caused by alcohol
• Training
• Less is more
• E-learning

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Can IBA be effective in non-health settings?

• The SIPS study recently published findings of
  three randomised control trials on IBA using
  various screening tools, levels of intervention
  and in three different settings.
• Primary Care
• AE
• Probation

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Can IBA be effective in non-health settings?

• In probation
• Training crucial
• Alcohol Health Worker support crucial
• Senior management buy in crucial
• But IBA can be equally effective in a non-health
  setting if adequately supported and delivered by
  well trained practitioners

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Useful Links

• IBA e-Learning module Alcohol Learning Centre
• http//www.alcohollearningcentre.org.uk/
• NICE guidance
• http//guidance.nice.org.uk/PH24
• http//guidance.nice.org.uk/CG115
• Primary Care Framework
• http//www.pcc.nhs.uk/alcohol
• SIPS Research Programme
• http//www.sips.iop.kcl.ac.uk/index.php
• Materials, Units Calculator and Drink Check
  http//www.nhs.uk/LiveWell/Alcohol/Pages/
• Alcoholhome.aspx

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