Ellie Gordon

Aims of session To introduce the idea of screening and brief

alcohol advice To address the issue of stigma in relation to

patient's with alcohol issues. To equip staff with skills to deliver screening

and brief alcohol interventionsTo outline available referral and treatment

pathways

why should we do this? The view of the government is that everyone

accessing primary care should be offered this form of intervention.

Why?Alcohol misuse costs ?Treatment saves ? To the health care system

aloneEarly treatment can reduce the life of alcohol

issues by ? Years

Health costs of alcohol misuse/or all the bad staff that alcohol does! Peripheral neuropathyGastritis BloatingMuscle wastage Accidents ParanoiaAnxiety Depression Etc. etc. etc. etc.

Health gains of treatment Reducing alcohol intake early is associated

with ? Reduction of harm Reduced risk of developing some long term

health conditions Reduced financial burden to health care

system Increased quality of life

What has stopped me asking about alcohol before ? Exercise –small groups Feedback Nerves I’ve never done this before Who do I ask?Who don’t I ask?

What is involved in screening for alcohol? Different elements Questionnaire AUDIT Short ten item questionnaire

Exercise The delivery of any questionnaire is eased by

familiarity – so we will ask you to split into pairs and try asking your partner the AUDIT questions.

After 5? Minutes swop overThen we will reconvene and feedback.

More screening Blood test –LFT’s The results of these blood tests form an

integral part of brief advice feedback –more later.

Semi structured interviewManual based prompts Basic communication skills

So now who do I ask? Unfortunately patient’s with an alcohol

problem don’t wear a sign. Alcohol affects all people in all areas of

society Blanket screening can help to reduce the risk

of stigma It also increases the likelihood of identifying

hazardous and harmful alcohol use.

How can I fit this into a busy clinic? By including alcohol screening as a core

element of treatment By normalising this interventionThe AUDIT tool can be given out as a self

completion questionnaireBy linking the symptoms the patient presents

with to alcohole.g. hypertension may be linked to excessive

alcohol intake

I’ve asked and now what? Offer brief advice Feedback ResponsibilityAdviceMenuEmpathy Self efficacy

Health Care Brief OpportunisticTailored to patient need ‘Bite size’ pieces of informationAlways within own sphere of competency If in doubt ask for help!

Hazardous drinkersCharacterised by binge drinking, regular

excessive alcohol intake often linked to accidents and injuries

Advice around recommended units Making the links between level of alcohol

intake and drinking Information about the short and long term

ill effects of drinking at this level Looking at other forms of positive

reinforcement

Harmful drinkers Characterised by Use feedback from liver function tests as an

objective indicator of harms caused by alcohol.

Information about the short and long term ill effects of drinking at this level.

Discuss how current ill health is linked to alcohol intake

Help the patient to realise that reduction in alcohol intake will lead to a reduction in symptoms of ill health

Dependent drinkers Any patient who attends and is identified as

suffering with a dependent alcohol problem will require specialist interventions.

Referral pathways