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 screen Congratulate, check awareness Positive Screen Assess interest/motivation No interest – offer PIL Keep door open for future Interest/ hazardous drinker Simple structured advice Interest/ harmful drinker motivational counselling Possible dependence Assess further, refer on

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