Screening and Brief Alcohol Intervention

Level 1; Session 2 Training

Simple Structured Advice

Linking screening to brief intervention

• Start with reference to the patient’s 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.

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, you’re increasing the chance of problems in the future. What do you think?

But - not all patients are the same

Alcohol may not be at the top of their agenda

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

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

Balancing patients’ stage & risk factors

Case finding

Negative screenCongratulate, check awareness

Positive ScreenPossible dependence

Assess further, refer on

Assess interest/motivation

No interest – offer PILKeep door open for future

Interest/ hazardous drinkerSimple structured advice

Interest/ harmful drinkermotivational counselling

What generally happens now?

Example 1 - avoid

Example 2 - evade

Example 3 - dictate

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

Broad approach – FRAMES

•Feedback (personalised)

•Responsibility (with patient)

•Advice (clear, practical)

•Menu (variety of options)

•Empathy (warm, reflective)

•Self-efficacy (boosts confidence)

Discussion

• Essential elements

• Most useful bits

• When, where and by whom

• Resources

• What if patients want more?

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