1. Opportunity to intervene?
Firstly, the appropriate timing to carry out the intervention is important – the physical setting and emotional setting needs to be right e.g. approach the subject with sensitivity in a quiet, confidential area of the workplace.
Furthermore, significant events or transition points in people’s lives present an important opportunity for intervening at some or all of the levels, because it is then that people often review their own behaviour and contact services. Typical transition points include: leaving school, entering the workforce, becoming a parent, becoming unemployed, retirement and bereavement. (top)
2. Raising the issue
Raise health issues in a friendly, non-threatening manner which uses indirect questions to start with.
Q: We are raising awareness of recommended drinking levels for alcohol – would you like any advice or help with this?
Q: Have you seen out promotion/advertisement for a healthy lifestyle consultation?
Doing brief interventions requires good communication skills. It is important to:
- listen to what people say
- notice what they do not say
- watch what they do
- think about their situation
- think about what you know about them
- talk with them in a way which is not threatening
- avoid giving a lecture about health behaviour
A warm, reflective, and understanding style of delivering brief intervention is more effective than an aggressive, confrontational, or coercive style. Miller and Rollnick found that when they used an empathetic style, individuals' drinking was reduced by 77 percent, as opposed to 55 percent when a confrontational approach was used. (top)
3. Why Screen for Alcohol Misuse
Brief alcohol interventions, as short as five minutes, have been shown to be effective in reducing alcohol consumption within primary care settings (Poikolainen, 1999; Wilk et al., 1997). Furthermore, due to an over-reliance on physical symptoms to detect alcohol misuse, screening questionnaires have been demonstrated to be the most effective method of detecting alcohol misuse.
Therefore, an Alcohol Quiz is included within the ‘Alcohol’ leaflet and is a replica of the ‘Fast’ Screening Questionnaire.
‘Fast’ Screening Questionnaire - The purpose of the ‘FAST’ questionnaire is to assess alcohol misuse through routine screening in a variety of contexts, although this will not be possible with individuals who are in pain, distressed or have other obvious cognitive limitations; or individuals who are intoxicated.
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4. Example of a completed alcohol quiz
Initially, let the individual know the information is being collected in order to help them and that it is confidential.
Administration of the quiz is a very straightforward procedure, but it is advisable to administer the quiz in conditions where distractions are kept to a minimum. The quiz can either be self-completed or administered by the staff member. In the case of self-completion, a staff member should be available to address any problems and should check that all questions have been answered. Individuals should be asked to circle the appropriate response for each question. If more than one response has been made for an individual question, staff should clarify the correct response with the individual. (top)
Example of a completed FAST screening test (click here)
5. How to score the Alcohol Quiz
Scoring is quick and can be completed with just a glance at the pattern of responses:
Stage 1
The first stage only involves question 1.
If the response to question 1 is Never then the patient is not misusing alcohol.
If the response to question 1 is Weekly or Daily or almost daily then the patient is a hazardous, harmful or dependent drinker.
Over 50% of people will be classified using just this one question.
Only consider questions 2, 3 and 4 if the response to question 1 is Less than monthly or Monthly
Stage 2
If the response to question 1 is Less than monthly or Monthly then each of the four questions is scored 0 to 4.
These are then added together, resulting in a total score between 0 and 16.
The person is misusing alcohol if the total score for all four questions is 3 or more.
In summary:
The minimum score is 0
The maximum score is 16
The score for hazardous drinking is 3 or more. (top)
Score questions 1, 2 and 3 as follows: |
Score question 4 as follows: |
Never = 0
Less than monthly = 1
Monthly = 2
Weekly = 3
Daily or almost daily = 4 |
No = 0
Yes, on one occasion = 2
Yes, on more than one occasion = 4 |
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Using the completed test, from before, you can see below how the individual scored 8, meaning they are a hazardous drinker.
Stage one – The response is Monthly (score 2), so move onto stage two.
Stage two –
Question 2 – Monthly – Score 2
Question 3 – Monthly – Score 2
Question 4 – Yes, on one occasion – Score 2
Total score = 8 |
6. Discussing the Alcohol Quiz
Ask the individual how theyfeel about their score OR begin a discussion using the following;
Your score suggests you might be at risk of problems in the future. What do you think?
You appear to be drinking at a rate that increases your risk of harm. What do you think?
Do they have all the information they need to decide what to do for the best? Follow on to talk about recommended sensible drinking limits and benefits of cutting down. (top)
7. Recommendations
Individuals vary in how they process alcohol, for example by gender and body weight, but the general recommendations for drinking alcohol are:
MEN – should not regularly drink more than 3-4 units a day.
WOMEN – should not regularly drink more then 2-3 units a day.
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Diagram of units per drink (click here)
8. What are the benefits of cutting down?
Physical
The possibility that you will die of liver disease will be dramatically reduced (12 times less likely).
Reduced risk of stomach and pancreas disorders
Reduced risk of sexual problems
Reduced risk of muscle and heart muscle disease
Reduced risk of high blood pressure
Reduced risk of damage to nervous tissue
Reduced risk of injury
Reduced risk of cancers (particularly mouth, gullet, liver, colon and breast)
Lose weight (alcohol is high in calories)
Reduced risk of brain damage
Sleep better
More energy
No hangovers
Improved memory
Better physical shape
FOR WOMEN: There will be less chance that you will have an unplanned pregnancy.
FOR WOMEN: There will be less chance that you will damage your unborn child |
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Psychological/Social/Financial
Improved mood
Less hassle from family
Reduced risk of drink driving
Save money
Reduced risk of anxiety and depression
You will live longer- probably between five and ten years.
You will be happier
Your relationships will improve
You will stay younger for longer
You will achieve more in your life
There will be a greater chance that you will survive to a healthy old age without premature damage to your brain
You will be better at your job
Other people will respect you
You will be less likely to get into trouble with the police |
Diagram showing effects of High-Risk Drinking (click here)
WHO 2001; Brief Intervention for hazardous and harmful drinking
9. Stages of change model – Are they ready to change?
Brief interventions can help instigate a natural process, from pre-contemplation, to contemplation to action. The Stages of change model is a useful tool to describe the process that people will go through en route to health behaviour change.
Follow the link to the stages of change model in relation to carrying out and a brief intervention around alcohol.
However, are they ready to commit to change?
As well as exploring readiness, it’s useful to explore the importance of changing by using a question such as:
How important is it for you to cutback on drinking? If 0 was ‘not important’ and 10 was ‘very important’, what number would you give yourself?
Also, explore the individual’s confidence in changing to a healthier lifestyle by using a question such as:
If you decided right now to cutback on drinking, how confident do you feel about succeeding with this? If 0 was ‘not confident’ and 10 was ‘very confident’, what number would you give yourself?
The response to the above questions will help you understand exactly what someone feels about change. Follow the link to some useful questions which can help you further Explore Importance and Build Confidence. (top)
Diagram showing Stages of Change and explanation (click here)
Useful Questions (click here)
10. Top tips for sensible drinking
- Don’t binge drink.
- Consider drinking a non-alcoholic drink to quench your thirst before having alcohol.
- Alternate non-alcoholic drinks with alcoholic ones.
- Pace yourself – enjoy a drink slowly. Set yourself a limit and stick to it.
- Try to eat when you drink, as it helps you to drink less.
- Reduce the number of days when you drink more than 1-2 units.
- Go out to the pub or club later in the evening.
- Resist pressure from people who encourage you to drink more – it’s your health you are looking after!
- Avoid salty snacks when drinking alcohol
- Avoid drinking in rounds or in large groups
- Switch to low alcohol beer/lager
- Take smaller sips
- Plan activities and tasks at those times you usually drink
- When bored or stressed have a workout instead of drinking
- Explore interests – cinema, exercise etc
- Avoid going to the pub after work
- Avoid or limit the time spent with ‘heavy’ drinking friends
- Avoid ‘top-ups’ so you can keep track of your units.
- Decide how many units you want to drink in an evening – and stick with it. (top)
11. Making a SMART Plan
If the individual appears ready to change, make use of the ‘tips’ section within the leaflet and allow the individual to decide upon some goals which will work for them, allow the individual to take the lead.
The ‘Planning for Change’ tool in the leaflet has a section where goals can be set; remember to assist the individual in making the goals SMART –
Specific - vague terms are not useful and can easily be confusing.
Measurable - how will you know if the goal has been achieved?
Achievable - don't set impossibly high targets for yourself.
Realistic - you know yourself, what can you actually do?
Time-limited - set a period in which this will be achieved.
If the individual doesn't succeed at their goal, they need to examine why not, re-frame the goal and then try again. If they do succeed, it is important to acknowledge it. Rewarding themselves with an appropriate treat, such as going to see a favourite film, buying a new CD, perhaps, or going for a swim is important, they deserve it! (top)
12. Links to Local and National Support
Where to get more information....
Locally
AddactionCada - (01872) 263001 www.addaction.org.uk/OurworkservicesSW.html
Your local GP surgery
Nationally
Drinkline - 0800 917 8282 (open 24 hours)
National Drugs Helplice - 0800 77 66 00
Alcoholics Anonymous - 0845 769 7555
NHS Direct - 0845 4647
Useful websites for more information
Worried about your drinking? (Alcohol Concern) www.alcoholconcern.org.uk/servlets/wrapper/worried_about.jsp
Think about Drink (Health Promotion, England)
www.wrecked.co.uk
Alcoholics Anonymous (AA)
www.alcoholics-anonymous.org.uk
Binge Drinking (Alcohol Concern)
http://www.alcoholconcern.org.uk/files/20031212_114408_Binge%20drinking%20update%20%202003.pdf
Alcohol Misuse (Department of Health)
www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Alcoholmisuse/index.htm
Find out if you’re drinking too much (Alcohol Concern)
www.downyourdrink.org.uk
Drinkaware
www.drinkaware.co.uk
13. Leaflet available for ordering or downloading
To download leaflet (click here)
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