Alcohol misuse and brief Intervention

Question 1

What are the damage to health from alcohol use?

Answer 1

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

Question 2

What are the oral implications from alcohol use?

Answer 2

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.

Question 3

Why don’t DCP’s carry out alcohol screen?

Shepherd et al (2010)

Answer 3

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

Question 4

What did Miller et al (2006) find?

Answer 4

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.

Question 5

DBOH tool Kit

Professional intervention for all patient:

Answer 5

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

Question 6

DBOH tool Kit- Guidelines for alcohol consumption

All adults

Answer 6

“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”

Question 7

DBOH tool Kit- Guidelines for alcohol consumption

Young people

Answer 7

“young people under the age of 18, should normally drink less than adult men and women”

Question 8

DBOH tool Kit- Guidelines for alcohol consumption

Pregnant women

Answer 8

“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”

Question 9

Definition of drinking riks?

Answer 9

Abstainer: No alcohol

Lower risk: no more than 14 units per week with at least 2 free alcohol days per week

Question 10

Why identify problem drinking and offer brief advice ?

Answer 10

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

Question 11

Audit-C
what does it stand for?
what is it used for?

Answer 11

Alcohol use disorder identification test

is a quick way of detecting hazardous drinking by arriving at a score

Question 12

The Scores

0-4

Answer 12

patient is at a lower risk of harm from alcohol and they should be congratulated

Question 13

The Scores

5-9

Answer 13

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

Question 14

The Scores

10+

Answer 14

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

Question 15

Assessing interest and motivation

Answer 15

Long term change
maintenance       
Action
Make a decision
Contemplation
pre-contemplation
lapse
re-lapse

Question 16

What to Say when……..

Pre-contemplation (unaware/unready)

Answer 16

” If you need help in the future here is a card with some useful information”

Question 17

What to Say when……..

Contemplation (aware/Ambivalent)

Answer 17

“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”

Question 18

What to Say when……..

Make a decision

Answer 18

” you should give your local service a call today”

Question 19

What to Say when……..

Action (ready to go)

Answer 19

” Brilliant, well done, keep me informed how things are going”

Question 20

What to Say when……..

Maintenance (keeping it up)

Answer 20

“you’re doing really well”

Question 21

Risk a status and brief intervention

A score of 0-4

Answer 21

can be considered low risk, give positive reinforcement and sate the 14 unit rule

Question 22

Risk a status and brief intervention

A score of 5-7

Answer 22

suggests the person is drinking at a level which could be considered hazardous. give simple structred advice, offer further support where appropriate

Question 23

Risk a status and brief intervention

A score of 8-10

Answer 23

Suggests the person is drinking at a level which could be harmful. give simple structured advice and signpost using the card

Question 24

Risk a status and brief intervention

A score of 10+

Answer 24

may suggest the person is a dependent drinker. These patients should be referred/signposted to GP or specialist services using the signposting card

Question 25

Very Brief Intervention

Answer 25

Delivered in 30 seconds
Ask
Cards
Notes

Question 26

Brief Intervention structure- FRAMES

Answer 26

FEEDBACK- (personalised)
RESPONSIBILITY- (With patient)
ADVICE- (Clear and practical)
MENU- (variety of options)
EMPATHY- (Warm and reflective)
SELF-EFFICACY- (boosts confidence)

Question 27

FEEDBACK

Answer 27

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

Question 28

RESPONSIBILITY

Answer 28

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.”

Question 29

ADVICE

Answer 29

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.

Question 30

MENU

Answer 30

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.

Question 31

EMPATHY

Answer 31

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.

Question 32

SELF-EFFICACY

Answer 32

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.