Screening and brief advice tools An introduction Deryn Bishop

NICE alcohol use disorders PH24 Quality statement Health and social care staff opportunistically carry out screening and brief interventions for hazardous and harmful drinking as an integral part of practice Using a validated screening tool followed by structured brief advice

Introducing AUDIT Alcohol Use Disorders Identification Test Helps identify excessive drinking, dependence and some consequences of harmful drinking Used in the non-treatment seeking population Can be self administered or used by non- health professionals The Gold standard tool

AUDIT Score 8 – 15 Increasing Risk AUDIT Score Higher Risk No Action AUDIT Score 0 – 7 Lower Risk AUDIT Score 20+ Possible Dependence Full Assessment for physical dependence. Not Dependent Extended brief interventions Severe Dependence requiring In Pt Detoxification Dependent not requiring In Pt Detoxification Brief Advice Higher Risk drinkers Full AUDIT Assessment Positive Pre-Screen Eg MSASQ, FAST or Audit C

FAST…a shortened AUDIT A 2 stage procedure: ask the more detailed questions only if required FAST will indicate if the individual is possibly drinking at increasing or higher risk levels FAST will NOT determine dependency Brief Rapid Flexible Effective A positive score means a Full AUDIT should be conducted

Questions Scoring system Your score 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 MonthlyWeekly Daily or almost daily Only answer the following questions if the answer above is Never (0), Monthly (1) or Less than monthly (2). Stop here if the answer is Weekly (3) or Daily (4). 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 MonthlyWeekly 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 MonthlyWeekly Daily or almost daily 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 FAST Score 3 or 4 on Q1 = Fast Positive. Stop here Overall score 3 or more on all 4 Qs = Fast Positive

Audit C Score >5 = audit C positive

Brief advice Too short for major change but long enough to get people thinking Structured brief advice uses evidence based behaviour change techniques to accelerate change thinking Must be used alongside empathic communication skills

Brief Advice tool

Brief Advice Delivery Structure 1.Start with general information regarding drinking that increases risk of harm. 2.Give the person an opportunity to consider what this means to them. 3.Show the person how their drinking compares with the general population. 4.Go through the benefits of reducing drinking. 5.Look at strategies for reducing drinking. 6.Discuss the sensible drinking targets they should aim for. “Your drinking at the moment places you at an increased level of risk … some of the effects of drinking at this level could be…” “ How do you feel about this?”

Take the leaflet with you and have a think about what we have discussed. If you want some further support then we can signpost you to our local services. If you want some further support then we can signpost you to our local services.