1. Alcohol Identification and Brief Advice Training
Barnsley Social Care Workforce Development Unit
Alcohol Identification and Brief Advice Training

2. The aim of this training session is to give you
Information about alcohol units and the harm caused by alcohol
the knowledge to identify where alcohol misuse might be a issue in the Service Users journey
the tools required to assess the extent to which the service user’s alcohol use is harmful
the confidence to conduct a structured brief intervention aimed at reducing the level of the service user’s alcohol consumption

3. How much do you know about Alcohol ???
??? Let’s try a Quiz ???

4. Recommended Limits Adult women 2-3 units per day.
Adult men 3-4 units per day
Young people under the age of 18, should normally drink less than adult men and women
Higher risk drinking is defined as regularly drinking over 6 units per day for women (over 35 units per week) and over 8 units per day for men (over 50 units per week).

5. Know Your Units

6. Strength (ABV) x Volume (ml) = No. of units
UNIT CALCULATOR
Work out your alcohol units for yourself with this sum:
Strength (ABV) x Volume (ml) = No. of units
1000
E.g. Pint of Stella: x 568 ÷ = Large glass of wine: x 250 ÷ = 3.00

7. Modern Drinking Habits
Pubs use larger wine glasses than they did ten to fifteen years ago.
People tend to use larger glasses at home and are unlikely to use measures
Higher strength drinks are now commonplace and available very cheaply
Alcopops have revolutionized drinking for younger people

8. Alcohol – What are the Risks
NUMEROUS!!!!
Alcohol consumption is NEVER considered to be completely risk free

9. Effects of Alcohol Increases in: And many more …………… Depression
Reduced Effectiveness of medication
Reduced performance at work
Puts individuals at risk of injury from physical violence
Weight Gain  
Impotence
Sleep disorders
Increased accidents/injuries
Alcohol Poisoning
Loss of consciousness
Cancers
Memory Loss
Dementia
Liver disease
Inflammation of the stomach/ulcers
Low Mood
Risky Behaviour
Increases in:
Domestic Violence
Rape
Public Disorder
Violence against strangers
Relationship Breakdown
Unemployment
Poor/reduced performance at work or home
And many more ……………

10. Health implications of hazardous & harmful alcohol use.

12. ALCOHOL – THE WIDER SOCIAL IMPACT
Alcohol misuse contributes to around 1.2 million incidents of violent crime
200 premature deaths each year
40% of Domestic Violence Cases
6% of all road casualties
Up to 2.6 million children live with a hazardous drinker
Up to 17million working days are lost annually through alcohol related absences
70% of A&E Admissions each weekend
Alcohol misuse costs the NHS £ 2.6 billion each year

13. Legal implications of drinking:
Drinking & driving, resulting in a 12/12 ban, or up to £5000 in fines or up to 6/12 in prison.
Drinking & anti-social behaviour, resulting in a £50-80 fine for buying/drinking alcohol under 18, being drunk, vomiting/urinating in the street, harassing someone or drinking in a ‘no alcohol’ public area.

14. Indicators of Alcohol Misuse
Gut Problems
Problems sleeping
Snoring
Unusual level of falls/accidents
Wounds that won’t heal
Unable to lose weight
Social irresponsibility (promiscuity/fighting)
Early morning drinking
Bin full of bottles/cans
Memory problems
Alcohol ‘hidden’ around the home
Lying about/hiding alcohol use
Relationship problems
Problems holding a job or keeping appointments
Drinking alone
Boasting about drinking levels

15. ALCOHOL AND YOUR JOB
Have you ever broached the subject of alcohol with a service user?
What response did you get?
Did you feel comfortable?
How do you feel about doing Identification and Brief Advice for alcohol?
Readiness to change will affect a service users response

16. MOST COMMON ALCOHOL USE QUESTIONNAIRES
AUDIT
AUDIT-C
FAST
SASQ
AUDIT - PC

20. RISK LEVELS
Lower risk - drinking implies that no level of alcohol consumption is completely safe. The context can determine the level of risk, for example drinking and driving.
Increasing Risk - regularly drinking more than 2-3 units a day for a woman and more than 3-4 units a day for a man.
Higher Risk - regularly drinking more than 6 units per day for women or more than 8 units per day for men. Or more than 35 units per week (women) and more than 50 units per week (men).
Binge Drinking - regularly drinking more than 6 units for women and more than 8 units for men i.e. twice the daily limit on a regular basis.

21. WHO Terms
hazardous drinkers - those drinking above recognized ‘sensible’ levels, but not yet experiencing harm.
Harmful drinkers - those drinking above ‘sensible’ levels and currently experiencing harm (excluding dependence).
These terms are used by the WHO but are not recommended for use by the Department of Health because they are considered to be diagnostic

22. WHAT IS A BRIEF INTERVENTION?
A short, evidence-based, structured conversation about a health issue with a service user that seeks in a non-confrontational way to motivate and support the individual to think about and/or plan behaviour change
It’s Brief! Should take 5 – 15 minutes.

23. AIMS OF IBA
To reduce the burden of alcohol related injuries and disease on the NHS and society
To inform service users of the health risks associated with drinking
To determine which service users health could be improved by reducing drinking
To encourage service users to think more carefully about how their drinking might adversely affect their client journey

24. Brief Interventions……
Have been recommended due to an increase in alcohol consumption
Provide early interventions, not designed to deal with dependant drinkers
May be opportunistic or targeted
Are a structured conversation – not just a discussion
Should be used with an alcohol screening tool
May motivate increasing or higher risk drinkers to change their drinking behaviour
Are more effective than no intervention
Do make a difference!

25. IBA IS:
Opportunistic
Based on advice
An Intervention lasting between 5 and 15 minutes
Flexible –with or without formal follow-up
IBA ISN’T
Specialist Counselling
Confrontational
A route to abstinence
A way to treat service users who are alcohol dependent

26. Listening Skills A good listener: Focuses and makes eye contact
Nods and smiles
Asks open questions
Reflects on what’s been said
Helps the individual explore issues
Emphasises that responsibility lies with the individual
Allows silences
Uses a clear voice
Summarises
Concentrates
Provides structure
Avoids physical barriers
Checks and clarifies understanding
A poor listener:
Interrupts or talks too much
Tells their own stories
Gives their own opinion
Rushes in with solutions/tries to ‘fix’
Gives unsolicited advice or orders
Doesn’t admit not knowing all the answers
Thinks of next question without listening
Concentrates on the problem and not the person
Fidgets or fiddles
Looks away/looks bored/clock watches
Is condescending or patronisinig
Jumps to conclusions

27. ESSENTIAL ELEMENTS TO BRIEF INTERVENTION (FRAMES)
Feedback - about personal risk due to current drinking. Do they know how many units they drink and the associate risk?
Responsibility - rests with the individual, drinking is by choice and the responsibility to change lies with the individual.
Advice - on how to change drinking behaviour, cut down or abstain.
Menu – give options for change, offering alternative goals & strategies.
Empathy, listening reflectively without trying to persuade or confront self-efficacy, encourage optimism.
Self-efficacy (building confidence) – an interviewing style that increases a persons own belief in their ability to change

28. Empathy Empathy isn’t: Empathy is: Sympathy Curing or telling Rescuing
Constant Questioning
Empathy is:
Active Uninterrupted listening
Accepting the person
Challenging behaviour
About strengthening relationships

29. ...and each of these is more than one unit
This is one unit...
For more detailed information on calculating units see -
There are times when you will be at risk even after one or two units. For example, with strenuous exercise, operating heavy machinery, driving or if you are on certain medication.
If you are pregnant or trying to conceive, it is recommended that you avoid drinking alcohol. But if you do drink, it should be no more than 1-2 units once or twice a week and avoid getting drunk.
Your screening score suggests you are drinking at a rate that increases your risk of harm and you might be at risk of problems in the future.
What do you think?
How many units did you drink today?
Half pint of regular beer, lager or cider
1 very small glass of wine
1 single measure of spirits
1 small glass of sherry
1 single measure of aperitifs
(9%)
...and each of these is more than one unit 3
A pint of regular beer, lager or cider
A pint of “strong”/ ”premium” beer, lager or cider
Alcopop or a 275ml bottle of regular lager
440ml can of “regular” lager or cider
440ml can of “super strength” lager
250ml glass of wine (12%)
Bottle of wine
“regular”
(12%)
Risk
Men
Women
Common Effects
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
Increased relaxation
Sociability
Reduced risk of heart disease (for men over 40 and post menopausal women)
Increasing Risk
More than 3-4 units per day on a regular basis
More than 2-3 units per day on a regular basis
Progressively increasing risk of:
Low energy
Memory loss
Relationship problems
Depression
Insomnia
•Impotence
•Injury
Alcohol dependence
•High blood pressure
•Liver disease
•Cancer
Higher Risk
More than 8 units per day on a regular basis or more than 50 units per week
More than 6 units per day on a regular basis or more than 35 units per week

30. What is your personal target?
The benefits of cutting down
Psychological/Social/Financial
Improved mood
Improved relationships
Reduced risks of drink driving
Save money
Physical
Sleep better
More energy
Lose weight
No hangovers
Reduced risk of injury
Improved memory
Better physical shape
Reduced risk of high blood pressure
Reduced risk of cancer
Reduced risks of liver disease
Reduced risks of brain damage
What’s everyone else like?
% of Adult Population
What targets should you aim for?
Men
Should not regularly drink more than 3–4 units of alcohol a day.
Women
Should not regularly drink more than 2–3 units a day
‘Regularly’ means drinking every day or most days of the week.
You should also take a break for 48 hours after a heavy session to let your body recover.
Making your plan
When bored or stressed have a workout instead of drinking
Avoid going to the pub after work
Plan activities and tasks at those times you would usually drink
When you do drink, set yourself a limit and stick to it
Have your first drink after starting to eat
Quench your thirst with non-alcohol drinks before and in-between alcoholic drinks
Avoid drinking in rounds or in large groups
Switch to low alcohol beer/lager
Avoid or limit the time spent with “heavy” drinking friends
What is your personal target?
This brief advice is based on the “How Much Is Too Much?” Simple Structured Advice Intervention Tool, developed by Newcastle University and the Drink Less materials originally developed at the University of Sydney as part of a W.H.O. collaborative study.

31. WHEN TO REFER SERVICE USERS
High Level of Alcohol Related harm
Where the individual is an increasing or higher risk drinker, who has not responded to previous brief intervention and advice, and who wishes to receive further help with their alcohol problems.
score of 20 or more on the full AUDIT questionnaire
Severe alcohol-related problems or risk of such problems, for example:
Violence
Possible loss of job or family
Obvious signs of physical dependence, for example:
Withdrawal symptoms
Withdrawal relief or avoidance drinking
Very high tolerance
Memory blackouts

32. Who to refer Services Users to:
The Barnsley Treatment System
9-10 Burleigh Court
Barnsley
S70 1XY

33. Useful Links http://www.nhs.uk/livewell/alcohol/Pages/Alcoholhome.aspx