Alcohol Identification and Brief Advice Training

Barnsley Social Care Workforce Development Unit

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

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

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

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

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

Alcohol – What are the Risks

NUMEROUS!!!!

Alcohol consumption is NEVER considered to be completely risk free

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 ……………

Health implications of hazardous &harmful alcohol use.

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 A&E Admissions each weekend Alcohol misuse costs the NHS £ 2.6 billion each year

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.

Indicators of Alcohol Misuse

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

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

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

AUDIT – C

Questions Scoring system Your

score 0 1 2 3 4

How often do you have a drink containing alcohol?

Never Monthly or less

2 - 4 times per

month

2 - 3 times per

week

4+ times per

week

How many units of alcohol do you drink on a typical day when you are drinking?

1 -2 3 - 4 5 - 6 7 - 8 10+

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?

Never Less than

monthly 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.

SCORE

AUDIT

Questions Scoring system Your

score 0 1 2 3 4

How often do you have a drink containing alcohol?

Never Monthly or less

2 - 4 times per

month

2 - 3 times per

week

4+ times per

week

How many units of alcohol do you drink on a typical day when you are drinking?

1 -2 3 - 4 5 - 6 7 - 8 10+

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?

Never Less than

monthly Monthly Weekly

Daily or

almost daily

How often during the last year have you found that you were not able to stop drinking once you had started?

Never Less than

monthly Monthly Weekly

Daily or

almost daily

How often during the last year have you failed to do what was normally expected from you because of your drinking?

Never Less than

monthly Monthly Weekly

Daily or

almost daily

How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?

Never Less than

monthly Monthly Weekly

Daily or

almost daily

How often during the last year have you had a feeling of guilt or remorse after drinking?

Never Less than

monthly Monthly Weekly

Daily or

almost daily

How often during the last year have you been unable to remember what happened the night before because you had been drinking?

Never Less than

monthly Monthly Weekly

Daily or

almost daily

Have you or somebody else been injured as a result of your drinking?

No

Yes, but not in the last year

Yes, during

the last year

Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?

No

Yes, but not in the last year

Yes, during

the last year

Scoring: 0 – 7 Lower risk, 8 – 15 I ncreasing risk,

16 – 19 Higher risk, 20+ Possible dependence

SCORE

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.

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

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

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……

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 IS:

Opportunistic Based on advice An Intervention

lasting between 5 and 15 minutes

Flexible –with or without formal follow-up

IBA ISN’T

Specialist Counselling Confrontational A route to abstinence A way to treat service

users who are alcohol dependent

Listening Skills

A good listener: Focuses and makes eye contact Nods and smiles Asks open questions Reflects on what’s 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 Doesn’t 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

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

Empathy

Empathy isn’t: Sympathy Curing or telling Rescuing Constant Questioning

Empathy is: Active Uninterrupted

listening Accepting the person Challenging behaviour About strengthening

relationships

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?

This is one unit...

Half pint of regular

beer, lager or cider

1 very small glass of

wine

1 single measure of

spirits

1 small glass of sherry

1 single measure of

aperitifs

How many units did you drink

today?

A pint of 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

...and each of these is more than one unit

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 relaxationSociabilityReduced 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 problemsDepressionInsomnia•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

(9%)

“regular”

3

(12%)

For more detailed information on calculating units see - www.units.nhs.uk/

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

The benefits of cutting downPsychological/Social/Financial•Improved mood•Improved relationships•Reduced risks of drink driving•Save moneyPhysical•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?MenShould not regularly drink more than 3–4 units of alcohol a day. WomenShould 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.

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.

What’s everyone else like?

% of Adult Population

What is your personal target?

Population by Risk Category

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Abstaining Lower risk Increasingrisk

Higher risk

Male

Female

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

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/Alcoholhome.aspx

www.alcoholconcern.co.uk www.drinkaware.co.uk www.alcoholics-anonymous.org.uk www.al-anonuk.org.uk