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Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide
April 2016
Regan Jules-Macquet
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 1 of 30
CJCP © 2016 Creative Commons
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0
International License.
Telephone:
021 685 2659
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 2 of 30
TABLE OF CONTENTS
TABLE OF CONTENTS ........................................................................................................................................ 2
TABLE OF FIGURES ........................................................................................................................................... 4
INTRODUCTION ............................................................................................................................................... 5
ABOUT THE CJCP .............................................................................................................................................. 5
INTRODUCTION TO THE TRAINING GUIDE........................................................................................................ 6
TRAINING OVERVIEW ............................................................................................................................................... 6
TRAINING OUTCOMES .............................................................................................................................................. 7
TRAINING OUTLINE .................................................................................................................................................. 7
FACILITATOR’S INSTRUCTIONS ......................................................................................................................... 9
USING THIS MANUAL ............................................................................................................................................... 9
EQUIPMENT & RESOURCES ....................................................................................................................................... 9
ICE-BREAKERS AND ENERGIZERS .............................................................................................................................. 10
FACILITATING LEARNING ......................................................................................................................................... 10
SESSION 1: INTRODUCTION ........................................................................................................................... 11
WELCOME TO THE TRAINING .................................................................................................................................. 11
HOUSEKEEPING MATTERS ....................................................................................................................................... 11
TRAINING EXPECTATIONS ........................................................................................................................................ 11
TRAINING OVERVIEW ............................................................................................................................................. 11
SESSION 2: BACKGROUND ............................................................................................................................. 12
INTRODUCTION ..................................................................................................................................................... 12
THE AUDIT TOOL ................................................................................................................................................... 12
DEFINITIONS......................................................................................................................................................... 13
EVIDENCE OF BENEFITS (BRIEF) ............................................................................................................................... 14
APPLICABILITY ....................................................................................................................................................... 15
REFLECTION AND REVIEW ....................................................................................................................................... 15
SESSION 3: CONTEXT...................................................................................................................................... 16
INTRODUCTION ..................................................................................................................................................... 16
THE SOUTH AFRICAN CONTEXT ................................................................................................................................ 16
EFFECTS OF ALCOHOL CONSUMPTION ON INDIVIDUALS, FAMILIES AND COMMUNITIES ...................................................... 16
THE DRINKER’S PYRAMID ........................................................................................................................................ 18
MODEL OF BEHAVIOUR CHANGE (BRIEF) ................................................................................................................... 19
REFLECTION AND REVIEW ....................................................................................................................................... 23
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 3 of 30
SESSION 4: THE AUDIT TOOL .......................................................................................................................... 24
INTRODUCTION ..................................................................................................................................................... 24
THE TOOL ............................................................................................................................................................ 24
OPTIONS FOR USAGE ............................................................................................................................................. 24
STRUCTURE AND COMPONENTS ............................................................................................................................... 24
SCORING AND INTERPRETATION OF THE SCORING ....................................................................................................... 25
REFLECTION AND REVIEW ....................................................................................................................................... 25
SESSION 5: INTERVENTIONS FOR ZONE 1 DRINKERS ...................................................................................... 26
INTRODUCTION ..................................................................................................................................................... 26
SUITABLE INTERVENTIONS ....................................................................................................................................... 26
A GUIDE TO LOW-RISK DRINKING HANDOUT ............................................................................................................. 26
HOW TO PREVENT ALCOHOL-RELATED PROBLEMS BROCHURE ....................................................................................... 26
REFLECTION AND REVIEW ....................................................................................................................................... 26
SESSION 6: INTERVENTIONS FOR ZONE 2 DRINKERS ...................................................................................... 27
INTRODUCTION ..................................................................................................................................................... 27
REFLECTION AND REVIEW ....................................................................................................................................... 27
SESSION 7: INTERVENTIONS FOR ZONE 3 DRINKERS ...................................................................................... 28
INTRODUCTION ..................................................................................................................................................... 28
EXISTING MATERIALS ............................................................................................................................................. 28
REFLECTION AND REVIEW ....................................................................................................................................... 28
SESSION 8: INTERVENTIONS FOR ZONE 4 DRINKERS ...................................................................................... 28
INTRODUCTION ..................................................................................................................................................... 28
REFLECTION AND REVIEW ....................................................................................................................................... 28
SESSION 9: SUMMARY & REFLECTION ........................................................................................................... 29
INTRODUCTION ..................................................................................................................................................... 29
SUMMARY OF LEARNING ........................................................................................................................................ 29
EVALUATION ........................................................................................................................................................ 29
CLOSURE ............................................................................................................................................................. 29
BIBLIOGRAPHY ............................................................................................................................................... 30
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 4 of 30
TABLE OF FIGURES
FIGURE 1: HARMS CAUSED BY ALCOHOL CONSUMPTION .................................................................................................. 17
FIGURE 2: THE DRINKERS' PYRAMID .............................................................................................................................. 19
FIGURE 3: MODEL OF BEHAVIOUR CHANGE .................................................................................................................... 20
FIGURE 4: STAGES OF BEHAVIOURAL CHANGE ................................................................................................................. 20
FIGURE 5: THE STAGES OF CHANGE AND ASSOCIATED BRIEF INTERVENTION ELEMENTS ........................................................... 23
FIGURE 6: INTERVIEW VERSUS SELF-REPORT AUDIT ........................................................................................................ 24
FIGURE 7: AUDIT DOMAINS AND ITEM CONTENT ........................................................................................................... 24
FIGURE 8: AUDIT SCORING GRID ................................................................................................................................. 25
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 5 of 30
Brief Introduction to the World Health
Organisation’s AUDIT Tool: A Trainer’s Guide
INTRODUCTION
This guide provides instructions and content to trainers conducting training on integrating the World
Health Organisation’s Alcohol Use Disorders Identification Test (AUDIT) into service delivery
ABOUT THE CJCP
The CJCP is a South African research NGO working in the field of violence prevention and safety, in
South Africa and the region, with a particular focus on children and youth. The organisation has
extensive experience in the field of child protection and safety; child and youth victimization; online
child protection, risks and opportunities; and school violence. The organisation works both nationally
in South Africa, and regionally, and consults internationally.
Since its establishment in 2005, the CJCP has worked with a number of National and Provincial
government departments in South Africa, including the Departments of Basic Education,
Communications and Social Development, as well as the Presidency, to formulate evidence-based
policy on issues of child safety, both online and offline, and to develop appropriate implementation
frameworks and mechanisms for national and provincial policies and strategies. The organisation has
also worked with a number of regional governments and international agencies on issues of violence
against children, child safety and protection, and specifically child online safety. Specific examples
include the current development of a child online safety strategy for UNICEF Namibia, development
of a National Schools Safety Framework in 2014/15, and the development of a Children’s
Empowerment and ICT strategy with the South African Department of Communications. Further, the
CJCP is the South African implementation partner of Global Kids Online, an international extension of
the EU Kids Online project, in partnership with UNICEF Office of Research at Innocenti, and the London
School of Economics and Political Sciences (LSE). The CJCP is also leading a team of experts
undertaking a child online protection scoping and mapping study in five countries in the MENA region:
Tunisia, Algeria, Morocco, Egypt and Jordan; is providing technical assistance to UNICEF Namibia and
the Namibian University of Technology in exploratory research into child online protection and ICT
opportunities in Namibia; and is undertaking a scoping exercise on child online protection in Uganda.
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 6 of 30
The organisation has extensive experience in conducting both large scale epidemiological studies on
violence relating to children, best evidenced through the National Optimus Foundation Study on Child
Abuse, Violence and Neglect, a study of 10,000 children and adolescents; as well as smaller scale
qualitative and policy-oriented studies, including a comprehensive desktop study on violence against
children, undertaken for UNICEF South Africa and the national Department of Social Development, in
2011.
The organisation also designs and delivers intervention and training material for both government and
civil society, and regularly presents research on children and online safety at national and international
fora. The organisation has undertaken work in South Africa, the Democratic Republic of Congo,
Mozambique, Namibia, Kenya, South Sudan and Ethiopia.
INTRODUCTION TO THE TRAINING GUIDE
TRAINING OVERVIEW
This guide provides instructions and content to trainers conducting training on integrating the World
Health Organisation’s Alcohol Use Disorders Identification Test (AUDIT) into service delivery. The
World Health Organisation’s AUDIT is a simple screening tool that has been extensively tested for
validity and reliability. The tool is in the public domain, as are the guides and manuals used to support
its use. This guide is to be used with the following documents:
1. Babor, T., Higgins-Biddle, J., Saunders, J., & Monteiro, M. (2001). AUDIT: The Alcohol Use
Disorders Identification Test: Guidelines for Use in Primary Care.
2. World Health Organisation. (2001). Brief Intervention for Hazardous and Harmful Drinking:
A Manual for Use in Primary Care. Geneva: World Health Organisation.
This training is designed to equip service providers with the necessary skills and knowledge to use the
AUDIT as an integral part of their screening, intervention planning and case management processes.
This training is suitable for the following practitioners:
1. Educators
2. Child and youth care workers
3. Social workers
4. Social Auxiliary Workers
5. Lay counsellors
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 7 of 30
TRAINING OUTCOMES
Outcome Description
Able to apply a basic model of behaviour change to case management
Able to apply the risk matching principle to intervention planning and case management
Able to select and use a range of tools and methods to assist clients in managing low to moderate
risk alcohol consumption
Able to use the Alcohol Use Disorders Identification Test (AUDIT) with clients
Knowledge of the definitions and relevance of the concepts of hazardous alcohol consumption
and alcohol dependence
Knowledge of the effects of hazardous alcohol consumption and alcohol dependence on the
individual, family and community
Knowledge of the risk matching principle and its application in work with clients
TRAINING OUTLINE
Session Topic Sub-Topics
1. Introduction Welcome to the training
Meet the facilitators
Housekeeping matters
Training expectations
Training overview
2. Background Definition of hazardous alcohol consumption
Definition of alcohol dependence
The AUDIT Tool
Evidence of benefits (brief)
Applicability
3. Context The South African context
Effects of hazardous alcohol consumption on individuals, families and communities
The Drinker’s Pyramid
Model of behaviour change (brief)
4. The AUDIT Tool
Options for usage
Structure
Components
Scoring and interpretation of the scoring
5. Interventions for Zone 1 Drinkers
Suitable interventions
6. Interventions for Zone 2 Drinkers
Suitable interventions
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 8 of 30
Session Topic Sub-Topics
7. Interventions for Zone 3 Drinkers
Suitable interventions
8. Interventions for Zone 4
What to do
9. Summary and Reflection
Summary of learning
Reflection
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 9 of 30
FACILITATOR’S INSTRUCTIONS
The following is recommended:
1. Two facilitators for groups than exceed 10 people
2. The facilitators must :
a. Have at least 2-3 years of facilitation experience
USING THIS MANUAL
This training has been developed to be as cost effective as possible. Other than refreshments, a venue
and the equipment and resources listed below, no additional costs are necessary.
The worksheets for the training are also available in a handbook on the CJCP website for download in
order to facilitate making copies. Each training participant receives his or her own handbook to keep.
This guide provides instructions and content to trainers conducting training on integrating the World
Health Organisation’s AUDIT Tool into service delivery. This guide is to be used with the following
documents:
3. Babor, T., Higgins-Biddle, J., Saunders, J., & Monteiro, M. (2001). AUDIT: The Alcohol Use
Disorders Identification Test: Guidelines for Use in Primary Care.
4. World Health Organisation. (2001). Brief Intervention for Hazardous and Harmful Drinking:
A Manual for Use in Primary Care. Geneva: World Health Organisation.
The facilitator must have their own copy and have studied the above three manuals.
EQUIPMENT & RESOURCES
The following items are required to facilitate this training:
1. Attendance register
2. Flipchart stand
3. Flipchart paper (at least 1 full pack)
4. Flipchart pens (at least 8)
5. Prestik
6. Copies of the following handouts (one for each person):
a. Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary Care
b. The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 10 of 30
ICE-BREAKERS AND ENERGIZERS
Ice-breakers and energizers are not included in the content of this training manual. Feel free to
introduce them at any point of the training programme. CJCP has developed a games, ice-breakers
and energizers manual that is available for download.
FACILITATING LEARNING
This training programme contains several activities that support the overall learning experience. It is
important that the facilitators extract as much learning as possible form these activities. This can be
done by closing each activity with a brief facilitated discussion by asking these questions:
What did you learn from this activity?
What was difficult about this activity?
How will you use what you learnt from this activity in your work?
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 11 of 30
SESSION 1: INTRODUCTION
WELCOME TO THE TRAINING
1. Welcome the trainees to the training workshop
2. Introduce the trainers for the workshop
3. Implement an introductory activity to assist the trainees with meeting one another
HOUSEKEEPING MATTERS
1. Hand out the attendance register and ask each person to fill in their details
2. Point out the location of the toilets
3. Give the times of the usual breaks, such as tea and lunch, as well as the time the programme
will end on this day.
4. Ask people to switch off their cell phones
5. Hand out copies of the workbook
TRAINING EXPECTATIONS
1. Explain to the group that they will now reflect on and discuss their expectations for the
training
2. Put up two pieces of flipchart paper on opposite walls
3. Write the following:
a. “My Expectations” on one paper
b. “My Fears / Concerns” on the second paper
4. Explain that the group will now write their expectations on the appropriate piece of
flipchart paper
5. If they find someone has already written what they wanted to, they can think of another
expectation or concern, if they like.
6. They should try not to repeat what is on the paper.
7. Hand out flipchart pens and pieces of blank paper to the group
8. When people have written their input, they must stick it on the relevant flipchart paper.
9. Give 5-8 minutes for this.
10. When the activity is finished, work through the expectations and explain whether or not
the training programme will address these expectations
11. Work through the fears / concerns paper, and discuss each one in terms of how it can be
addressed during the course of the training.
TRAINING OVERVIEW
1. Explain to the group that they will now look at an overview of the training programme.
2. Take the group through the training overview in their workbooks
3. When you have finished, ask the group if they have any questions about the training
programme structure.
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 12 of 30
4. When there are no further questions, move on to the next session.
SESSION 2: BACKGROUND
INTRODUCTION
1. Provide the group with a brief overview of the content of this session.
THE AUDIT TOOL
1. Handout the following handouts to the group:
a. Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary
Care
b. The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care
2. Explain to the group that they will first look at the history and context of the tool which forms
the basis for the training.
3. Explain that the Audit Tool stands for “Alcohol Use Disorders Identification Test”.
4. It is a test developed by the World Health Organisation for use as a screening tool.
5. Overtime, it was found that using the tool acted as an intervention itself, and today the
screening tool is used as a brief intervention.
6. Explain the following:
a. Brief interventions have become increasingly important components of programme
work because they are:
i. Effective
ii. Efficient
iii. Inexpensive
b. Brief interventions are intended to be slotted in between primary or early prevention,
on the one hand, and intensive treatment services on the other.
c. Brief interventions are an effective and efficient method of promoting health and
disease prevention within an entire population.
7. The Audit tool is intended to respond the three levels of risk:
a. Hazardous drinking
b. Harmful drinking
c. Alcohol dependence
8. The Audit tool is used:
a. As a brief intervention
b. As a screening tool that identifies which people can be referred to other more
intensive services, if need be
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 13 of 30
DEFINITIONS
1. Explain to the group that they will engage in an activity that focuses on defining the three
levels of risk-related alcohol consumption
2. Divide the group into 3-4 teams
3. Provide each team with flipchart paper and pens
4. Inform each team that they must develop a definition of each of the following risk levels:
a. Hazardous drinking
b. Harmful drinking
c. Alcohol dependence
5. Give the group 15 minutes.
6. Have each team present their definitions to the larger group
7. When this activity is complete, take the group through the following definitions from the
WHO:
Hazardous
Drinking
Hazardous drinking is a pattern of alcohol consumption that increases the risk
of harmful consequences for the user or others. Hazardous drinking patterns are
of public health significance despite the absence of any current disorder in the
individual user.
Harmful
Drinking
Harmful drinking refers to alcohol consumption that results in consequences to
physical and mental health. Some would also consider social consequences
among the harms caused by alcohol
Alcohol
Dependence
Alcohol dependence syndrome is a cluster of cognitive, behavioural, and
physiological symptoms.
A diagnosis of dependence should only be made if three or more of the following
have been experienced or exhibited at some time in the previous twelve months:
A strong desire or sense of compulsion to drink
Difficulties in controlling drinking in
Terms of onset, termination, or levels of use;
A physiological withdrawal state when alcohol use has ceased or been
reduced, or use of alcohol to relieve or avoid withdrawal symptoms
Pg. 5 of Audit Guidelines
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 14 of 30
evidence of tolerance, such that increased doses of alcohol are required
to achieve effects originally produced by lower doses;
Progressive neglect of alternative pleasures or interests because of
alcohol use;
Continued use despite clear evidence of harmful consequences.
EVIDENCE OF BENEFITS (BRIEF)
1. Explain to the group that the Audit tool has been reviewed for effectiveness and the following
has been found:
a. The AUDIT was developed and evaluated over a period of two decades
b. It has been found to provide an accurate measure of risk across:
i. Gender
ii. Age, and
iii. Cultures
c. The AUDIT was validated on primary health care people in six countries1
d. It is the only screening test specifically designed for international use
e. It is consistent with ICD-10 definitions of alcohol dependence and harmful alcohol use
2
f. A systematic review of the literature has concluded that the AUDIT is the best
screening instrument for the whole range of alcohol problems in primary care, as
compared to other questionnaires such as the CAGE and the MAST.
a. In comparison to other screening tests, the AUDIT has been found to perform equally
well or at a higher degree of accuracy,
b. Since the AUDIT User’s Manual was first published in 198930, the test has fulfilled
many of the expectations that inspired its development. Its reliability and validity have
been established in research conducted in a variety of settings and in many different
nations.
c. It has been translated into many languages, including Turkish, Greek, Hindi, German,
Dutch, Polish, Japanese, French, Portuguese, Spanish, Danish, and Flemish, Bulgarian,
Chinese, Italian, and Nigerian dialects.
1 Norway, Australia, Kenya, Bulgaria, Mexico, and the United States of America. 2 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO).
Pg. 10 of Audit Guidelines
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 15 of 30
APPLICABILITY
1. Explain to the group that they will now look briefly at the kinds of people who may use the
AUDIT tool
2. The AUDIT tool can be used by any of the following as a brief screening and intervention tool
in any intervention setting:
a. Health care workers
b. Social workers
c. Social auxiliary workers
d. Development workers
e. Child and youth care workers
f. Lay counsellors
REFLECTION AND REVIEW
1. Ask the following questions
o What did you learn from this session?
o What was difficult about this session?
o How will you use what you learnt from this session in your work?
Pg. 9 of Audit Guidelines
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 16 of 30
SESSION 3: CONTEXT
INTRODUCTION
1. Provide the group with a brief overview of the content of this session.
THE SOUTH AFRICAN CONTEXT
1. Explain to the group that they will now look at the state of alcohol consumption in South Africa
a. The prevalence of alcohol use disorders amongst South African males is 10%, and for
women it is 1.5%
b. The prevalence of alcohol dependence amongst South African males is 4.2%, and
amongst women it is 0.7%
c. 52.2% of road traffic accidents involving males are caused by alcohol-related factors.
The same statistics for females is 11.6%
d. 47.7 % of deaths of males resulting from road traffic accidents are caused by alcohol
consumption. For female deaths, it is 16.2%.
e. Average alcohol consumption (litres per person per annum) in South Africa for both
genders is 11 litres. For males it is 18.4 litres and for females it is 4.2 litres. The
average for the rest of Africa is 6 litres per person per annum. 3
2. Summarise the above stats by having a general discussion using the following questions:
a. Do you think alcohol consumption is a problem in South Africa?
b. Are South African men and women affected in the same way?
c. What do you think contributes to these differences?
d. Do South Africans consume more alcohol, on average, than other African countries?
e. Why do you think this is the case?
EFFECTS OF ALCOHOL CONSUMPTION ON INDIVIDUALS, FAMILIES AND COMMUNITIES
1. Explain to the group that they will now look at the effects of alcohol consumption on
individuals families and communities
2. Divide the group into three teams
3. Give each team flipchart paper and pens
4. Allocate the topics to the following teams:
a. Team 1: Individuals
b. Team 2: Families
3 (WHO, 2014)
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 17 of 30
c. Team 3: Communities
5. Have each group brainstorm the effects of alcohol consumption on their topic
6. Remind them that they are focusing specifically on s alcohol consumption. Refer them to the
definitions reviewed in the previous session
7. Give them 15 minutes for this activity
8. Have each team present their findings to the larger group
9. When this activity has been completed, review the following content with the group
Figure 1: Harms Caused by Alcohol Consumption 4
4 (WHO, 2014)
Level Harms
Individual Neuropsychiatric conditions: o Alcohol use disorders o Epilepsy is another disease o Depression or anxiety disorders
Gastrointestinal diseases: o Liver cirrhosis o Pancreatitis (both acute and chronic)
Cancers: o Alcohol consumption has been identified as carcinogenic for
the following cancer categories Cancer of the mouth Nasopharynx Other pharynx and oropharynx Laryngeal cancer Oesophageal cancer Colon and rectum cancer Liver cancer Female breast cancer.
Intentional injuries: o Alcohol consumption, especially heavy drinking, has been
causally linked to suicide and violence
Unintentional injuries: o Almost all categories of unintentional injuries are impacted
by alcohol consumption. The effect is strongly linked to the alcohol concentration in the blood and the resulting effects on psychomotor abilities. Higher levels of alcohol consumption create an exponential increase in risk
Cardiovascular diseases: o Alcohol consumption has detrimental effects on
hypertension, atrial fibrillation and haemorrhagic stroke, regardless of the drinking pattern
Foetal alcohol syndrome (FAS) and preterm birth complications
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 18 of 30
THE DRINKER’S PYRAMID
1. Explain to the group that they will now look at what is called “The Drinker’s Pyramid
2. This is a diagram of the whole population, divided into categories of how they consume
alcohol
3. Refer the group to the diagram below.
Diabetes mellitus: a dual relationship exists, whereby a low-risk pattern of drinking may be beneficial while heavy drinking is detrimental
Infectious diseases: Harmful use of alcohol weakens the immune system thus enabling development of pneumonia and tuberculosis.
Family Injury to other individuals can be intentional, e.g., assault or homicide, or unintentional, e.g., a traffic crash, workplace accident or scalding of a child.
Neglect or abuse can affect, for example, a child, a partner or a person in the drinker’s care.
Default on social role can involve the drinker’s role as a family member, as a friend and/or as a worker.
Property damage can involve damage, for example, to clothing, a car or a building.
Toxic effects on other individuals include most notably foetal alcohol syndrome (FAS) and preterm birth complications
Loss of amenity or peace of mind can influence family members (including children), friends, co-workers and strangers, who may, for example, be kept awake or frightened by the actions of the drinker.
Community High costs of: o Hospitalizations o Ambulatory care o Nursing home care o Prescription medicines o Home health care
Damage to property from vehicle crashes
Arrests for being “drunk and disorderly”
Increased crime
Lost productivity due to absenteeism
Unemployment
Decreased output
Reduced earnings potential
Lost working years due to premature pension or death
Alcohol-attributable loss in workforce productivity can affect the economic viability of an entire community
Pg. 33 of Brief Intervention
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 19 of 30
Figure 2: The Drinkers' Pyramid
1. Ask the group to interpret what the pyramid means
2. When the group has finished discussing the meaning of the pyramid, summarise the
discussion as follows:
a. The majority of people do not drink alcohol
b. There are more low risk drinkers that high risk drinkers
c. People who have alcohol dependence are the smallest group.
d. The top two groups are the smallest of the four. Despite this, they cause the most
harm to others.
3. Ask the group why they think it would be useful to be able to differentiate between these four
groups, and be able to place someone in the correct category.
MODEL OF BEHAVIOUR CHANGE (BRIEF)
1. Explain to the group that they will now briefly review a simple model of behaviour change.
2. Ask the group why they think it is important to study a model of behaviour change.
3. Refer the group to the below diagram.
Probably alcohol dependence
High risk drinkers
Low risk drinkers
Abstainers
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 20 of 30
Figure 3: Model of Behaviour Change
4. Explain the content and structure of the above diagram with reference to the guide below.
Figure 4: Stages of behavioural Change 5
Stages of Behavioural
Change
Description of Stage
Pre-contemplation People in
this stage are:
Not necessarily thinking about changing their substance use;
Focused on the positive aspects of their substance use;
Unlikely to have any concerns about their use of psychoactive
substances;
May show resistance to talking about their substance use;
Unlikely to know or accept that their substance use is problematic;
Unlikely to respond to direct advice to change their behaviour but
may be receptive to information about the risks associated with
their level and pattern of substance use (if approached
appropriately).
Contemplation People in this stage are:
Thinking about cutting down or stopping substance use;
Ambivalent about their substance use when they may be able to see
both the good things and the ‘less good things’ about their
substance use;
Likely to have some awareness of the problems associated with
substance use and may be weighing up the advantages and
disadvantages of their current substance use pattern;
5 (Humeniuk, et al., 2010)
Pre-contemplation
Contemplation Preparation Action Maintenance
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 21 of 30
Stages of Behavioural
Change
Description of Stage
Likely to respond to information about their substance related risks,
advice to cut down or engage in discussion about their substance
use (if approached appropriately).
Preparation People in the preparation stage are:
Intending to take action;
May vocalise their intentions to others;
Making small changes in their substance use behaviour;
Re-evaluating their current behaviour and considering what
different behaviour could offer them;
Becoming more confident and ready to change their behaviour;
Considering the options available to them;
Setting dates and determining strategies to assist change.
Action People in the action stage:
Have made the decision that their use of substances needs to
change;
Have commenced cutting down or stopping;
Are actively doing something about changing their behaviour;
Have cut down or stopped completely;
Are likely to continue to feel somewhat ambivalent about their
substance use and to need encouragement and support to maintain
their decision.
Maintenance People in the maintenance stage are:
Attempting to maintain the behaviour changes that have been
made;
Working to prevent relapse (the risk of relapse decreases with
time);
Focusing attention on high risk situations and the strategies for
managing these;
Best equipped when they develop strategies for avoiding situations
where they are at risk of relapse;
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 22 of 30
Stages of Behavioural
Change
Description of Stage
Are more likely to remain abstinent if they receive reward, support
and affirmation.
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 23 of 30
THE STAGES OF CHANGE AND ASSOCIATED BRIEF INTERVENTION ELEMENTS
Figure 5: The Stages of Change and Associated Brief Intervention Elements
Stage Definition Brief Intervention Elements to be Emphasised
Pre-contemplation
The hazardous or harmful drinker is
not considering change in the near
future, and may not be aware of the
actual or potential health
consequences of continued drinking
at this level.
Feedback about the results of the
screening, and Information about
the hazards of drinking
Contemplation The drinker may be aware of alcohol-
related consequences but is
ambivalent about changing
Emphasize the benefits of changing,
give information about alcohol
problems, the risks of delaying, and
discuss how to choose a goal
Preparation The drinker has already decided to
change and plans to take action.
Discuss how to choose a goal, and
give advice and encouragement
Action The drinker has begun to cut down or
stop drinking, but change has not
become a permanent feature
Review advice, give encouragement
Maintenance The drinker has achieved moderate
drinking or abstinence on a relatively
permanent basis
Give encouragement
REFLECTION AND REVIEW
2. Ask the following questions
o What did you learn from this session?
o What was difficult about this session?
o How will you use what you learnt from this session in your work?
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 24 of 30
SESSION 4: THE AUDIT TOOL
INTRODUCTION
1. Provide the group with a brief overview of the content of this session.
THE TOOL
1. Explain to the group that they will now study the AUDIT tool
2. Refer to the AUDIT interview tool handout and read through the tool as a group
OPTIONS FOR USAGE
1. Explain to the group that there are two ways to use the AUDIT tool: a. As a self-report questionnaire (AUDIT self-report) b. As an administered interview (AUDIT interview)
2. Explain that they will now look briefly at the pros and cons of each option. 3. Refer the group to the table below 4. Explain to the group that the tool will normally take between 2-4 minutes to complete
Figure 6: Interview versus Self-Report AUDIT
Advantages of Different Approaches to AUDIT Administration
Self-Report Questionnaire Interview
Takes less time
Easy to administer
Suitable for computer administration and scoring
May produce more accurate results
Allows clarification of ambiguous answers
Can be administered to people with low literacy levels
Allows seamless feedback to people and initiation of brief advice
STRUCTURE AND COMPONENTS
1. Explain to the group that they will now start exploring the AUDIT tool in detail 2. Refer the group to the diagram below
Figure 7: AUDIT Domains and Item Content
Domains Question
Number
Item Content
Hazardous
alcohol use
1
2
3
Frequency of drinking
Typical quantity
Frequency of heavy drinking
Pg. 16 of AUDIT Guidelines
Pg. 11 of AUDIT Guidelines
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 25 of 30
Domains Question
Number
Item Content
Dependence
symptoms
4
5
6
Impaired control over drinking
Increased salience (conspicuousness) of drinking
Morning drinking
Harmful alcohol
use
7
8
9
10
Guilt after drinking
Blackouts
Alcohol-related injuries
Others concerns about drinking
SCORING AND INTERPRETATION OF THE SCORING
1. Explain to the group that they will now review how to score the AUDIT. 2. The score for each item is the number of the answer the person has given 3. The score for each item is added up to produce a total for all 10 questions. 4. Refer the group to the grid below
Figure 8: AUDIT Scoring Grid
AUDIT SCORE
AUDIT Zones Intervention Type
0 – 7 Zone 1 Alcohol education
8 -15 Zone 2 Advice
16 – 19 Zone 3 Advice Brief counselling
Continued monitoring
20 - 40 Zone 4 Referral to specialist for diagnostic evaluation and treatment
REFLECTION AND REVIEW
3. Ask the following questions
o What did you learn from this session?
o What was difficult about this session?
o How will you use what you learnt from this session in your work?
Pg. 22 of AUDIT Guidelines
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 26 of 30
SESSION 5: INTERVENTIONS FOR ZONE 1 DRINKERS
INTRODUCTION
1. Provide the group with a brief overview of the content of this session.
SUITABLE INTERVENTIONS
1. Explain to the group that they will now review the basics of suitable interventions for
abstainers and low risk drinkers
A GUIDE TO LOW-RISK DRINKING HANDOUT
1. Take the group through appendix A page 32-37 of the Brief Intervention manual.
HOW TO PREVENT ALCOHOL-RELATED PROBLEMS BROCHURE
1. Take the group through appendix B page 38-46 of the Brief Intervention manual.
REFLECTION AND REVIEW
4. Ask the following questions
o What did you learn from this session?
o What was difficult about this session?
o How will you use what you learnt from this session in your work?
Pg. 14-16 of Brief Intervention
Pg. 32 – 37 of Brief Intervention
Pg. 38 - 46 of Brief Intervention
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 27 of 30
SESSION 6: INTERVENTIONS FOR ZONE 2 DRINKERS
INTRODUCTION
1. Explain to the group that appendix A and B of the Brief Interventions Manual also form part
of the Zone 2 interventions.
2. In addition to these two tools, the following information should be used to guide zone 2
interventions
3. Take the group through the content below.
REFLECTION AND REVIEW
5. Ask the following questions
o What did you learn from this session?
o What was difficult about this session?
o How will you use what you learnt from this session in your work?
Pg. 17- 22 of Brief Intervention
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 28 of 30
SESSION 7: INTERVENTIONS FOR ZONE 3 DRINKERS
INTRODUCTION
1. Provide the group with a brief overview of the content of this session.
EXISTING MATERIALS
1. Explain to the group that appendix A and B of the Brief Interventions Manual also form part
of the Zone 3 interventions.
2. In addition to these two tools, the following information should be used to guide zone 3
interventions
3. Take the group through the content below.
REFLECTION AND REVIEW
6. Ask the following questions
o What did you learn from this session?
o What was difficult about this session?
o How will you use what you learnt from this session in your work?
SESSION 8: INTERVENTIONS FOR ZONE 4 DRINKERS
INTRODUCTION
1. Provide the group with a brief overview of the content of this session.
2. Take the group through the content below.
REFLECTION AND REVIEW
7. Ask the following questions
o What did you learn from this session?
o What was difficult about this session?
o How will you use what you learnt from this session in your work?
Pg. 23 - 26 of Brief Intervention
Pg. 27 - 29 of Brief Intervention
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 29 of 30
SESSION 9: SUMMARY & REFLECTION
INTRODUCTION
1. Provide the group with a brief overview of the content of this session.
SUMMARY OF LEARNING
1. Explain to the group that they will now review and summarise what they have learnt in the
training workshop.
2. Divide the group into 4 teams
3. Allocate flipchart paper and pens to each team
4. Have each team work as a group and develop a brief outline of what they have learnt in the
workshop that they can use in their work
5. Give 20 minutes for this activity
6. Have each team present their findings to the larger group (5 mins each)
EVALUATION
1. Explain to the group that they will now evaluate the training workshop
2. Hand out evaluation forms
3. Give 10 minutes for this activity
4. Collect the complete evaluation forms.
CLOSURE
1. Thank the group for their attention and participation
2. If certificates are issued as part of the workshop, explain when these certificates will be
available and how they will be distributed
3. Close the programme
Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 30 of 30
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