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Early identification and brief advice

It is estimated that of the £3.5bn cost to the NHS from alcohol harm each year, only a small percentage is spent on identifying and treating alcohol misuse.[1]

Evidence shows that services which enable you to identify hazardous and harmful drinking, through brief interventions or early treatment, can help prevent the health risks associated with alcohol misuse.[2]

The cost of alcohol to UK society is £21bn, with £11bn attributed to alcohol-related crimes and a further £7bn to lost productivity (unemployment and sickness).[3] Ultimately, early identification will reduce the strain on the health services and other areas of society. Figure 2 shows that:

 


 

Early identification involves the administration of a short questionnaire about current drinking behaviour. This is followed by advice and information, appropriate to the drinker and the context. It does not require extensive training, and can be delivered in a variety of settings, including primary care via GPs, community settings such as schools, job centers and pharmacies, via social care services, in accident and emergency settings, and in the workplace.

Depending on the setting and time available, a variety of tools can be used to deliver interventions and brief advice. These include:

  • Alcohol Use Disorders Identification Test [AUDIT] which is considered the “gold standard” of identification tests. This consists of ten alcohol identification questions and was developed by the World Health Organisation [WHO].[4]
  • AUDIT-Consumption [AUDIT-C], an abbreviated version of the above for when time is more limited.[5]
  • Fast Alcohol Screening Test [FAST], a four-item initial screening test taken from AUDIT. It was developed for busy clinical settings as a two-stage initial screening test that is quick to administer since >50% of patients are identified by using just the first question.
  • Paddington Alcohol Test [PAT].
  • Single Alcohol Screening Questionnaire [SASQ].

Alcohol Concern provide a variety of tools for early identification as mentioned above. These include:[6]

  • A Unit Calculator, this helps create an understanding around how many units of alcohol you should consume in a day. It also allows you to calculate unit information of the drink you are currently consuming.
  • Alcohol Concern’s new ‘Dry January’ app that is available on IOS and android that allows you to keep track of your drinking and how much money you are saving. The app also provides you with regular articles and tips to guide you to drink in moderation. It also lets you record the drink you consumed as you can choose from 95,000 different alcoholic beverages.
  • A service directory can be used for support around a range of alcohol problems. You can search services that are in local area for help and advice.

Identification and Brief Advice (IBA) has potential to prevent and reduce alcohol-related harms. It involves attempting to identify risky drinking and provides advice to those who need it, with the goal of encouraging heavy drinkers to reduce their consumption. This strategy can provide a positive impact, helping to reduce alcohol-related hospital admissions and service response pressures across the NHS. However, Dr Matthew Andrews from the Safe Sociable London Partnership has lamented the lack of strategic approach to rolling out IBA in England. He wrote in a recent Alcohol IBA blogpost that: “In the last two national strategies IBA has been noted, but with little strategy for implementation.”[7]

According to the blog, ‘IBA direct’ was taken to the public in South London over a three-day period and was found to be highly effective in engaging people and delivering a brief intervention.[8] Branded The London Challenge, the project involved a number of ambassadors trained to engage with the public and deliver IBA.

The project was developed by Resonant, a specialist behaviour change agency commissioned by NHS Lambeth to deliver the activity in a way which would engage at-risk drinkers in their twenties as an identified target group.[9] Rod Watson, a senior project manager (Alcohol) for The Health Innovation Network, made the following key observations about the project:[10]

  • IBA direct is practical and acceptable at being delivered in a public setting by people who are non-healthcare professionals
  • 402 people received IBA over the course of 3 days
  • A small follow up of the sample of 402 people who received IBA direct showed a reduction in AUDIT scores
  • Respondents found the setting to be suitable and would take part in the service in a public setting again.

This project therefore highlights the potential for delivering ‘IBA direct’ in public spaces. Resonant also found that the target group who answered the alcohol question and later went on to receive ‘brief advice’ would do so if it was “engaging and non-judgemental.”[11]

The National Institute of Health and Clinical Excellence (NICE) defines a brief intervention for hazardous and harmful drinkers as:

  • A session of structured brief advice on alcohol for adults who have been identified via screening as drinking a hazardous or harmful amount, and/or
  • An extended brief intervention for adults who have not responded to structured brief advice or who may benefit from an extended brief intervention for other reasons. This could take the form of motivational interviewing or motivational-enhancement therapy.[12]

Patients who do not respond to brief advice, or who experience alcohol dependence are referred to specialist treatment services for more intensive interventions.

 

Next: Alcohol specialist treatment services


[1] Babor, Thomas F., Higgins-Biddle, John C., Saunders, John B., Monteiro, Maristela G (2001)., ‘Alcohol Use Disorders Identification Test [AUDIT]’, The World Health Organisation [WHO]

<http://www.who.int/substance_abuse/activities/sbi/en/>

[2] Alcohol Learning Centre, ‘AUDIT-Consumption [AUDIT-C]’ <http://www.alcohollearningcentre.org.uk/Topics/Browse/BriefAdvice/?parent=4444&child=4898>

[3] Alcohol Concern, ‘Apps and tools’ <https://www.alcoholconcern.org.uk/Pages/Category/apps-and-tools>

[4] Alcohol IBA Blog (February 2017), ‘What’s our strategy for IBA?’ <https://alcoholiba.com/2017/02/08/whats-our-strategy-for-iba/>

[5] Alcohol IBA Blog (December 2015), ‘IBA direct evaluation shoes people welcome IBA in public’  <https://alcoholiba.com/2015/12/21/iba-direct-evaluation-shows-people-welcome-iba-in-public/>

[6] Resonant, <http://resonant.agency/>

[7] Alcohol IBA Blog, ‘IBA direct evaluation shoes people welcome IBA in public’

[8] Alcohol IBA Blog, ‘IBA direct evaluation shoes people welcome IBA in public’

[9] National Institute for Health and Care Excellence [NICE] (August 2011), ‘Services for the identification and treatment of hazardous drinking, harmful drinking and alcohol dependence in children, young people and adults’ <http://bit.ly/2wtcTbu>

[10] Public Health England (October 2014), ‘Alcohol Treatment in England 2013-14’ <http://www.nta.nhs.uk/uploads/adult-alcohol-statistics-2013-14-commentary.pdf>

[11] Department of Health (February 2010), ‘Signs for Improvement: Commissioning interventions to reduce alcohol-related harm’

<http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_102813>

[12] Public Health England (January 2016), ‘Health matters: harmful drinking and alcohol dependence’ <http://bit.ly/2uFNgC5>