Screening and intervening of Alcohol misuse

Question 1

What does 1 unit of alcohol look like?

Answer 1

218ml of cider (1/4 pint)
75ml wine
1 shot of spirit
250ml beer (1/4pint)

Question 2

What is definition of hazardous drinking?

Answer 2

• Risks for problems are likely

Question 3

Definition of harmful drinking?

Answer 3

• Problems associated with alcohol are actually present

Question 4

Definition of dependent drinking?

Answer 4

• Alcohol is needed to function

Question 5

What is the SIGN Guideline no 74 for The management of harmful drinking and alcohol dependence in primary care?

Answer 5

• '’GPs and other primary health care professionals should opportunistically identify hazardous and harmful drinkers and deliver a brief (10 minute) intervention”

Question 6

What is the definition of Screening?

Answer 6

• Purpose is to identify people who need more comprehensive assessment for substance misuse disorders
• Uncovers indicators of serious substance-related problems among adolescents
• Covers general areas in clients life that pertain to substance use without making involved diagnosis or assessment

Question 7

Why should we screen in the healthcare setting?

Answer 7

• Alcohol related mortality and morbidity is high
• Lot of morbidity related to medical and dental effects

Question 8

What skills are required for a screen?

Answer 8

• A basic working knowledge of drug / alcohol issues
• Awareness of signs for potential problems
• Training in interviewing techniques
• Ability to listen to the views of the patient
• Report writing skills
• Awareness of services available
• Recognition of confidentiality issues

Question 9

Why are screening tools useful?

Answer 9

• Basically questionnaires
• They are very effective in detecting hazardous drinking and alcohol dependence
• They are short, easily administered and easily scored
• They can be used by a wide range of professions
• They can be used opportunistically

Question 10

What are some specific screening tools used for alcohol disorders?

Answer 10

• AUDIT-the Gold Standard
• PAT-used in A&E
• FAST-the most practical
• CAGE-not suitable for young people
• POSIT-good but 139 questions
• CRAFFT-specifically for adolescents

Question 11

What is the CAGE screening tool?

Answer 11

• 1984
• Yes, Sometimes or Often to 2 or more may indicate alcohol problem
• Have you ever felt you ought to Cut down on your drinking?
• Do you get Annoyed at criticism of your drinking?
• Do you ever feel Guilty about your drinking?
• Do you ever take an Early morning drink first thing in the morning to get the day started or eliminate the shakes?

Question 12

What is the FAST questionaire?

Answer 12

• Each question is scored 0-4
• Patient is FAST positive if the total score for all questions is > 3
• May only need to ask the first question

Question 13

What is the AUDIT screening tool?

Answer 13

• Alcohol use disorders identification test
• 0-6 WOMEN non-hazardous
• 0-7 MEN non-hazardous
• 7-13 WOMEN hazardous drinking
• 8-15 MEN hazardous drinking
• 14-20 WOMEN harmful drinking
• 16-19 MEN harmful drinking
• > 20 possibly dependent drinking

Question 14

How to know if drinkers are amenable to brief intervention?

Answer 14

• Hazardous drinking-at risk of developing a problems due to alcohol are Amenable to brief intervention
• Harmful drinking-problems due to alcohol are evident are Amenable to brief intervention
• Dependent drinking-displays symptoms of dependence on alcohol are NOT amenable to brief intervention

Question 15

What can a teachable moment be?

Answer 15

• Time when people may be more receptive to change
• May be After witnessing someone else being injured
• May be After experiencing other negative consequences of drinking
• May be Need to be able to relate the adverse event to drinking.

Question 16

What is the readiness to change ruler?

Answer 16

• A brief intervention will be most effective if the person receiving it is ready to change
• Can use readiness to change ruler to tell if they ae

Question 17

What is the cycle of change Prochaska and Diclemente 1998?

Answer 17

• Precontemplative
• Contemplative
• Preparation
• Action
• Maintenance
• Relapse
• Cycle loops

Question 18

What are some examples of patient statements for each stage of change?

Answer 18

• Precontemplation: ‘What problem? There’s no need to change. My friends drink more than me.’
• Contemplation: ‘I hear what you are saying. I know it is bad for me, but I enjoy drinking.’
• Preparation: ‘I am going to cut down after new year/next week’
• Action: ‘I have cut down my drinking.’
• Maintenance: ‘I‘ve only been drinking once a week for the last 6 months and have had no more than two drinks on that night’

Question 19

What are brief motivational interventions?

Answer 19

• Behaviour change style of counselling
• Non judgmental
• Typically lasts between 5 and 20 minutes
• Suitable as an opportunistic intervention for patients whose main reason for contact is not their drinking behaviour i.e. dental patients
• Pioneered by Miller and Rollnick, (1991) who see BMI as not a technique, but as way of being with people
• Patient encouraged to recognise ambivalence between their actual and ideal behaviour and that the responsibility of change rests with them

Question 20

How does FRAMES; A framework for BMI work?

Answer 20

• Feedback is given to patient about behaviour
• Responsibility for change is placed on the patient
• Advice to change is given by practitioner
• Menu of self-directed change options/treatment is offered
• Empathic style using warmth, respect and understanding
• Self-efficacy is engendered to encourage change