1. Prepared by J. Mabbutt & C. Maynard NaMO September 2008 5: Opportunistic Intervention

2. During the session, nurses & midwives will become more aware of how to provide effective opportunistic interventions with patients assessed as at risk of harm from drug & alcohol use By the end of the session nurses will have practiced using the AUDIT alcohol assessment tool and have a good understanding of standard drinks & recommended levels of alcohol use By the end of the session nurses & midwives will have an increased knowledge & skills regarding opportunistic interventions 5: Opportunistic Intervention Objectives

3.  Undertaken in a few minutes & can be supported by written information & self-help strategies  Talking with people at a critical moment (e.g. in hospital) is effective in educating & preventing further problems & complications (Heather et al. 1996)  Pregnancy & around the time of birth also provide useful opportunities for appropriate interventions if drugs &/or alcohol are an issue  Generally used for those using drugs or alcohol at low to medium levels 5: Opportunistic Intervention (OI) (1)

4.  OI has been previously known as Early Intervention (EI) & Brief Intervention (BI)  EI is aimed before harm is cause by drug use & a BI at any stage in someone’s drug & alcohol use  OI is a combination of these terms  It identifies & encourages nurses & midwives to take opportunities to intervene in someone’s drug & alcohol use whether it is early on in their use & even if the intervention is just a phone number, pamphlet, 5 or 10 minutes of health education 5: Opportunistic Intervention (2)

5.  Opportunistic interventions are not as likely to be effective for those who experience chronic relapsing dependence or a co-morbid mental health condition  This group usually requires supportive care and longer-term expert treatment  This section outlines briefly the concept of opportunistic intervention and when it may or may not be appropriate  Also refer to the Handouts in the Guidelines especially the AUDIT & ASSIST 5: Opportunistic Intervention (3)

6.  Carrying out a comprehensive substance use assessment allows the nurse or midwife to identify whether the person is using substances in ways that may become damaging in the future  Opportunistic interventions can be done at any time during contact with a person who is being assessed for substance use  Providing relevant, easy-to-understand information such as self-help materials or handouts may help to motivate a person to seek further help 5: General Principles of Opportunistic intervention

7. Not everyone responds favorably to an OI for example:  If there are signs & symptoms of serious physical illness from substance use a physician needs to further assess the patient  People who are dependent need comprehensive general & mental health screening, specialist assessment & treatment.  People who feel powerless or have concurrent health & social problems require more intensive counselling, intervention & support than is possible in an OI 5: Unsuitable candidates for opportunistic intervention

8.  Ask all patients if they use psychoactive drugs (both licit and illicit)  Assess the patients’ willingness to alter their pattern of use (if appropriate)  Advise all patients of potential harms associated with their particular pattern of use  Assist patients in accordance with their readiness to change  Arrange for the next consultation or referral 5: A framework to conduct an BI/OI The 5 ‘A’s of Brief Intervention From Commonwealth Government /NCETA 2004 – GP Trainers Illicit Drug Issues CD Rom

9.  Feedback personal risk or impairment  Emphasise personal Responsibility for change  Provide clear Advice on how to change  Offer a Menu of alternative change options  Use therapeutic Empathy as a counselling style  Enhance client Self-efficacy or optimism 5: A framework to conduct an BI/OI Key Principles of FRAMES From Commonwealth Government /NCETA 2004 – GP Trainers Illicit Drug Issues CD Rom

10.  When staff are pressed for time, self-help approaches have been shown to be effective with mild to moderate levels of alcohol or other drug use  Self-help maybe a pamphlet or booklet targeted to alcohol or specific to the drug they are using  There is also a range of written resources, books, & a range of material on the internet  For more information see the Treatment Options Presentation 10 5: Self-help interventions

11.  If injecting advise on using clean needles & equipment each time & not to share any equipment  Arrange & encourage Hepatitis B immunisation/Hepatitis C screening & possible HIV testing if injecting  Discourage use of drugs alone, to decrease risk of accidental overdose, ‘look after each other’  Discourage use of a combination of drugs, these can lead to an increased risk of overdose or risky behaviour  Keep hydrated with water, not over hydrated, if using stimulant drugs & engaging in prolonged physical activity causing dehydration (dancing) 5: Some specific information/advice for drug users to use in OI

12. Person using at harmful or dependent levels Assessment Person using at low risk levels Person using at hazardous levels Give health information, if required Opportunistic intervention, education and health information and follow-up Referral to specialist services or consultancy staff Possible referral to specialist services or consultancy staff 5: Figure 5.1: Intervention flowchart

13. From Commonwealth Government /NCETA 2004 – GP Trainers Illicit Drug Issues CD Rom

14.  80% of Australians aged 15 years and over  46% males and 32% of females drink above the recommended low risk levels at least once a month  One third of males and one quarter of females in their 20’s drink at risky or high levels for short term harm at least once per month  There are increasing concerns regarding the impact of violence relating to alcohol intoxication and the culture of binge drinking especially in the younger population 5: Who drinks alcohol?

15. 5: A Standard Drink? From Commonwealth Government /NCETA 2004 – GP Trainers Illicit Drug Issues CD Rom

16. 5: Standard Drinks

18. Light beer 1 std drink= Ordinary beer 1 std drink= Wine 1 std drink= Spirits 1 std drink= port/ sherry 1 std drink= 1 schooner=1 middie=1 glass=1 nip=1 glass= 425ml285ml100ml30ml60ml 2.7% Alc./Vol4.9% Alc./Vol12% Alc./Vol40% Alc./Vol20% Alc./Vol 5: Appendix 9.1: Standard Drinks

19. 5: Alcohol consumption in Australia by percentage male vs female

20. GenderLow Risk (Standard Drinks) Risky (Standard Drinks) High Risk (Standard Drinks) Males On any one day Up to 6 on any one day, no more than 3 days per week 7-10 on any one day 11 or more on any one day Females On any one day Up to 4 on any one day, no more than 3 days per week. 5-6 on any one day7 or more on any one day Australian Alcohol Guidelines: Health Risks and Benefits, The National Health and Medical Research Council (NH&MRC) 2001 # NH&MRC Guidelines are under review in 2008 5: Appendix 9.2: Risk of harm in the short term

21. Low Risk (Standard Drinks) Risky (Standard Drinks) High Risk (Standard Drinks) Males DailyUp to 4 per day5-6 per day7 or more per day Overall weekly level Up to 28 per week29-42 per week43 or more per week Females DailyUp to 2 per day3-4 per day5 or more per day Overall weekly level Up to 14 per week15-28 per week29 or more per week Australian Alcohol Guidelines: Health Risks and Benefits, The National Health and Medical Research Council (NH&MRC) # NH&MRC Guidelines are under review in 2008 5: Appendix 9.3: Risk of harm in the long term

22. Show either of the videos below from the CIWAR-Ar CD-ROM and discuss  E3 Early detection of people at risk (alcohol) (9.04 min) – this does not demonstrate the use of the AUDIT  E4 Quantifying an alcohol history & brief intervention using the AUDIT & Drinkless Resource (6.18 min) 5: Opportunistic intervention Quantifying an alcohol history and using the AUDIT

23.  Handout and ask participants to complete the AUDIT  Participants score it and keep their score to themselves  Discuss what the score means with the following slide and reflecting on the video (if E4 is shown) 5: Opportunistic intervention AUDIT – see handout

24. Questions 1–3Quantity and frequency of alcohol use Questions 4–6Possible dependence on alcohol Questions 7–10Alcohol-related problems AUDIT Scores:Hazardous levels8–12 Harmful levels >13 Chronic health problems related to harmful patterns of drinking may be evident within about three years The items measure: 5: What Does AUDIT Measure? From Commonwealth Government /NCETA 2004 – GP Trainers Illicit Drug Issues CD Rom

25.  Use either scenario 1 or 2 in A5 to:  Either read out to participants and have them use the AUDIT to create a score  Or use the scenarios for the participants to break into twos, and have them conduct the AUDIT on each other (or just one of them if time is limited).  Then discuss with the group afterwards.  Time 5 minutes per scenario and 5 minutes for discussion RPA Education Unit CSAHS – Powell, Keen & Brown 1994 5: Opportunistic intervention AUDIT – Activity No 5