Alcohol misuse and brief Intervention Flashcards
What are the damage to health from alcohol use?
Stroke alcohol related brain damage withdrawal symptoms heart disease/irregular heart beat high blood pressure liver disease/cancer Depression/anxiety and suicide Cancer of the mouth, throat, oesophagus or larynx breast cancer in women harm to unborn babies colorectal cancer
What are the oral implications from alcohol use?
Irritation of the gum, tongue and oral tissues.
Poor healing after dental surgery
Poor dental health habits
Increase in tooth decay
Poor compliance in home care to obtain good oral health
Increases risk toward periodontal (gum) disease
Smoking and drinking are risk factors for higher incidence of periodontal disease and oral cancer.
Why don’t DCP’s carry out alcohol screen?
Shepherd et al (2010)
had low confidence to talk to patients, they understood the impacts from alcohol misuse on oral and general health
poor knowledge reduced their willingness to talk to patients about alcohol
Felt it would disrupt the dentists-patient relationship, felt embarrassment and did not see the relevance to the clinical situation
What did Miller et al (2006) find?
patients thought that dentists should give alcohol: 75% were in favour
if trained, dental professionals could identify alcohol levels in patients
Using an identification tool found 1 in 4 patients had positive screening for heavy alcohol use.
DBOH tool Kit
Professional intervention for all patient:
ASK: establish and record if the patient is drinking above low risk (recommended) levels
ADVISE: offer brief advice to those drinking above recommended levels
ACT: Refer/ signpost high risk drinkers to their GP or local alcohol support services
DBOH tool Kit- Guidelines for alcohol consumption
All adults
“you are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a lower level if you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more”
DBOH tool Kit- Guidelines for alcohol consumption
Young people
“young people under the age of 18, should normally drink less than adult men and women”
DBOH tool Kit- Guidelines for alcohol consumption
Pregnant women
“If you are pregnant or planning a pregnancy. the safest approach is not to drink alcohol at all, to keep risks to your baby minimum
Drinking in pregnancy can lead to long term harm to the baby, with more you drink the greater the risk.
The risk of harm to the baby is likely to be low if a women has drunk only a small amounts of alcohol before she knew she was pregnant or during pregnancy”
Definition of drinking riks?
Abstainer: No alcohol
Lower risk: no more than 14 units per week with at least 2 free alcohol days per week
Why identify problem drinking and offer brief advice ?
its been shown to be useful in helping people cut down
often a person may be unaware that they are drinking to much
a simple intivatentin, brief advice may motivate a person to drink less
drinking less is likely to have a positive impact on the person’s general health and well being
Audit-C
what does it stand for?
what is it used for?
Alcohol use disorder identification test
is a quick way of detecting hazardous drinking by arriving at a score
The Scores
0-4
patient is at a lower risk of harm from alcohol and they should be congratulated
The Scores
5-9
the frequency and pattern of alcohol consumption may be associated with any problems they may be experiencing. get the person to think about the possible consequences of their drinking on aspects of their (and others) lives
The Scores
10+
Above the recommended safe levels of drinking. direct the patient to their local GP (or an alcohol service if they provide support to patients (alcohol concern has details of local services). Give the patient feedback on the risks alcohol use above the recommended safe limits and give leaflets to support this
Assessing interest and motivation
Long term change maintenance Action Make a decision Contemplation pre-contemplation lapse re-lapse
What to Say when……..
Pre-contemplation (unaware/unready)
” If you need help in the future here is a card with some useful information”
What to Say when……..
Contemplation (aware/Ambivalent)
“Now might be a good time to make some changes, here is a card with contact information for a service that could help, its free and anonymous”
What to Say when……..
Make a decision
” you should give your local service a call today”
What to Say when……..
Action (ready to go)
” Brilliant, well done, keep me informed how things are going”
What to Say when……..
Maintenance (keeping it up)
“you’re doing really well”
Risk a status and brief intervention
A score of 0-4
can be considered low risk, give positive reinforcement and sate the 14 unit rule
Risk a status and brief intervention
A score of 5-7
suggests the person is drinking at a level which could be considered hazardous. give simple structred advice, offer further support where appropriate
Risk a status and brief intervention
A score of 8-10
Suggests the person is drinking at a level which could be harmful. give simple structured advice and signpost using the card
Risk a status and brief intervention
A score of 10+
may suggest the person is a dependent drinker. These patients should be referred/signposted to GP or specialist services using the signposting card
Very Brief Intervention
Delivered in 30 seconds
Ask
Cards
Notes
Brief Intervention structure- FRAMES
FEEDBACK- (personalised) RESPONSIBILITY- (With patient) ADVICE- (Clear and practical) MENU- (variety of options) EMPATHY- (Warm and reflective) SELF-EFFICACY- (boosts confidence)
FEEDBACK
provide patients with feedback on their risks for alcohol problems based on such factors as their current drinking patterns; problem indicators, such as laboratory test results; and any medical consequences of their drinking. For example, a physician may tell a patient that his or her drinking may be contributing to a current medical problem, such as hypertension, or may increase the risk for certain health problems
RESPONSIBILITY
Perceived personal control has been recognized to motivate behaviour change. Therefore, brief intervention commonly emphasizes the patient’s responsibility and choice for reducing drinking (e.g., 8). For example, a doctor or nurse may tell patients that “No one can make you change or make you decide to change. What you do about your drinking is up to you.”
ADVICE
In some types of brief intervention, professionals give patients explicit advice to reduce or stop drinking. While expressing concern about the patient’s current drinking and the related health risks, the physician may discuss guidelines for “low-risk” drinking.
MENU
offer patients a variety of strategies from which to choose. These may include setting a specific limit on alcohol consumption; learning to recognize the antecedents of drinking and developing skills to avoid drinking in high-risk situations; planning ahead to limit drinking; pacing one’s drinking (e.g., sipping, measuring, diluting, and spacing drinks); and learning to cope with the everyday problems that may lead to drinking.
give their patients self-help materials to present such strategies and to help them carry these strategies out. Self-help materials often include drinking diaries to help patients monitor their abstinent days and the number of drinks consumed on drinking days, record instances when they are tempted to drink or experience social pressure to drink, and note the alternatives to drinking that they use.
When working with alcohol-dependent patients, abstinence, rather than reduced drinking, is the goal of brief intervention.
EMPATHY
A warm, reflective, and understanding style of delivering brief intervention is more effective than an aggressive, confrontational, or coercive style.Use an empathetic counselling style, patients’ drinking was reduced by 77 percent, as opposed to 55 percent when a confrontational approach was used.
SELF-EFFICACY
Health professionals delivering brief intervention commonly encourage patients to rely on their own resources to bring about change and to be optimistic about their ability to change their drinking behaviour. Brief intervention often includes motivation-enhancing techniques (e.g., eliciting and reinforcing self-motivating statements, such as “I am worried about my drinking and want to cut back,” and emphasizing the patient’s strengths) to encourage patients to develop, implement, and commit to plans to stop drinking.
