Brief Alcohol Advice and Screening

1. Brief Alcohol Advice and Screening Ellie Gordon

2. Aims of session • To introduce the idea of screening and brief alcohol advice • To address the issue of stigma in relation to patient's with alcohol issues. • To equip staff with skills to deliver screening and brief alcohol interventions • To outline available referral and treatment pathways

3. why should we do this? • The view of the government is that everyone accessing primary care should be offered this form of intervention. • Why? • Alcohol misuse costs ? • Treatment saves ? To the health care system alone • Early treatment can reduce the life of alcohol issues by ? Years

4. Health costs of alcohol misuse/or all the bad staff that alcohol does! • Peripheral neuropathy • Gastritis • Bloating • Muscle wastage • Accidents • Paranoia • Anxiety • Depression • Etc. etc. etc. etc.

5. Health gains of treatment • Reducing alcohol intake early is associated with ? • Reduction of harm • Reduced risk of developing some long term health conditions • Reduced financial burden to health care system • Increased quality of life

6. What has stopped me asking about alcohol before ? • Exercise –small groups • Feedback • Nerves • I’ve never done this before • Who do I ask? • Who don’t I ask?

7. What is involved in screening for alcohol? • Different elements • Questionnaire • AUDIT • Short ten item questionnaire

8. Exercise • The delivery of any questionnaire is eased by familiarity – so we will ask you to split into pairs and try asking your partner the AUDIT questions. • After 5? Minutes swop over • Then we will reconvene and feedback.

9. More screening • Blood test –LFT’s • The results of these blood tests form an integral part of brief advice feedback –more later. • Semi structured interview • Manual based prompts • Basic communication skills

10. Do I only ask these people?

11. So now who do I ask? • Unfortunately patient’s with an alcohol problem don’t wear a sign. • Alcohol affects all people in all areas of society • Blanket screening can help to reduce the risk of stigma • It also increases the likelihood of identifying hazardous and harmful alcohol use.

12. How can I fit this into a busy clinic? • By including alcohol screening as a core element of treatment • By normalising this intervention • The AUDIT tool can be given out as a self completion questionnaire • By linking the symptoms the patient presents with to alcohol • e.g. hypertension may be linked to excessive alcohol intake

13. I’ve asked and now what? • Offer brief advice • Feedback • Responsibility • Advice • Menu • Empathy • Self efficacy

14. Health Care • Brief • Opportunistic • Tailored to patient need • ‘Bite size’ pieces of information • Always within own sphere of competency • If in doubt ask for help!

15. Hazardous drinkers • Characterised by binge drinking, regular excessive alcohol intake often linked to accidents and injuries • Advice around recommended units • Making the links between level of alcohol intake and drinking • Information about the short and long term ill effects of drinking at this level • Looking at other forms of positive reinforcement

16. Harmful drinkers • Characterised by • Use feedback from liver function tests as an objective indicator of harms caused by alcohol. • Information about the short and long term ill effects of drinking at this level. • Discuss how current ill health is linked to alcohol intake • Help the patient to realise that reduction in alcohol intake will lead to a reduction in symptoms of ill health

17. Dependent drinkers • Any patient who attends and is identified as suffering with a dependent alcohol problem will require specialist interventions. • Referral pathways