1. Identification and Brief Advice Tools and Techniques

2. Alcohol in England 90% of adults drink alcohol DH recommended guidelines –Men: should not regularly exceed 3-4 units/day –Women: should not regularly exceed 2-3 units/day 26% - around 10 million adults in England drink more than the Government's recommended guidelines Almost 2.6 million adults drink at "high risk“ –1.6 million men drink 50+ units/week –1 million women drink more 35+ units/week.

3. Part 1 Opportunistic Case Identification or Screening

4. Point of Clarification Opportunistic alcohol case Identification and the delivery of Brief Advice (IBA) is the same as Screening and Brief Interventions for alcohol misuse (SBI)

5. Questions How many Units do you drink a week? Common questionnaires –MAST – Michigan Alcohol Screening Test –CAGE Have you ever tried to Cut down on your drinking? Have you ever felt Angered by someone talking about your drinking? Have you ever felt G uilty about your drinking? Have you ever had to have an “Eye opener” drink in the morning? World Health Organisation (WHO) developed AUDIT –Alcohol Use Disorder Identification Test – AUDIT –Measures both consumption and consequences

6. AUDIT – Gold Standard

7. Adults 18-64 visiting GP New Registration Other health complaint Requesting help with alcohol problem Initial Screen AUDIT Score 8-15 Full Screen AUDIT Full Assessment Referral to Specialist Services Extended Brief Advice AUDIT Score 16-20 AUDIT Score 20+ AUDIT Score 0-7 Brief Advice Primary Care - Alcohol Care Pathway No action Positive Neg SASQ FAST AUDIT – C AUDIT -PC

8. AUDIT - C

9. AUDIT - PC

10. FAST – Fast Alcohol Screening Test

11. SASQ – Single Alcohol Screening Questionnaire

12. Adults 18-64 visiting GP New Registration Other health complaint Requesting help with alcohol problem Initial Screen AUDIT Score 8-15 Full Screen AUDIT Full Assessment Referral to Specialist Services Extended Brief Advice AUDIT Score 16-20 AUDIT Score 20+ AUDIT Score 0-7 Brief Advice Primary Care - Alcohol Care Pathway No action Positive Neg SASQ FAST AUDIT – C AUDIT -PC

13. AUDIT – Gold Standard

14. Adults 18-64 visiting GP New Registration Other health complaint Requesting help with alcohol problem Initial Screen AUDIT Score 8-15 Full Screen AUDIT Full Assessment Referral to Specialist Services Extended Brief Advice AUDIT Score 16-20 AUDIT Score 20+ AUDIT Score 0-7 Brief Advice Primary Care - Alcohol Care Pathway No action Positive Neg SASQ FAST AUDIT – C AUDIT -PC

15. Part 2 Brief Advice or Brief Intervention

16. Brief Advice Understanding units Understanding risk levels Knowing where they sit on the risk scale Benefits of cutting down Making a plan

17. Understanding Units

19. Risk Levels RiskMenWomen Lower Risk No more than 3-4 units per day on a regular basis No more than 2-3 units per day on a regular basis Increasing Risk 4 or more units per day on a regular basis 3 or more units per day on a regular basis High Risk8 or more units per day on a regular basis or 50+ units per week 6 or more units per day on a regular basis or 35+ units per week

20. Where do they sit? Male Female Abstainers Lower Increased Higher Risk Risk Risk

21. Benefits of cutting down Physical Reduced risk of injury Reduced risk of high blood pressure Reduced risk of cancer Reduced risks of liver disease Reduced risks of brain damage Sleep better More energy Lose weight No hangovers Improved memory Better physical shape Psychological/Social/Financial Improved mood Improved relationships Reduced risks of drink driving Save money

22. Making a plan Plan activities and tasks at those times you usually drink When bored or stressed have a workout instead of drinking Explore other interests such as cinema, exercise, etc. Avoid going to the pub after work Have your first drink after starting to eat Quench your thirst with non-alcohol drinks before alcohol Avoid drinking in rounds or in large groups Switch to low alcohol beer/lager Take smaller sips Avoid or limit the time spent with “heavy” drinking friends

23. Part 3 Brief Lifestyle Counselling or Extended Brief Intervention

24. Interactive exchange How important is it for you to reduce your drinking behaviour? If you decided to reduce your drinking, how confident are you that you would succeed? What might be the not so good things about reducing your drinking? What might be the good things about reducing your drinking?

25. Six-step plan 1.Identify good reasons for changing: Can you think of 2-3 good reasons? 2.Set yourself a goal to achieve change: Is this achievable? 3.Recognise difficult times or situations: When might be the hardest times? 4.Prepare for difficult times/ situations: Think of a way of dealing with hard times? 5.Find Someone to support you: Is there a family member/ friend who might help? 6.Remember, nobody’s perfect! If at first you don’t succeed, try again.

26. Useful Links Primary Care Framework http://www.primarycarecontracting.nhs.uk/204.php Newcastle University SBI materials http://www.ncl.ac.uk/ihs/news/item/?brief-interventions-alcohol- and-health-improvement SIPS Research Programme http://www.sips.iop.kcl.ac.uk/index.php Units Calculator and Drink Check (on-line AUDIT) http://www.units.nhs.uk/