Brief Interventions

Question 1

What is a brief intervention?

Answer 1

Brief Interventions = collective term for giving advice to help change harmful behaviors​

Question 2

When is a brief intervention given?

Answer 2

Typically given whenever the opportunity arises​

Referred to as ‘a teachable moment’/’making every contact count’

Question 3

What is the structure of a brief intervention?

Answer 3

1. Identify behavioural risk factor​
2. Explain how best to change high risk behaviour​
3. Signpost how to obtain help​

Question 4

What does VBA stand for?

Answer 4

Very Brief Advice

Question 5

What is VBA?

Answer 5

VBA = a form of advice designed for busy clinicians to be used opportunistically in less than 30s in almost any consultation​

Question 6

What are some benefits of VBA?

Answer 6

Improves patient health in long term​

Reduces financial strain on NHS​

Can make patient feel like they are being seen as a whole person​

Helps doctor-patient relationship​

Cheap + simple to implement​

Can exist in both hospital and non-hospital settings​

Don’t need a background in public health to receive training​

Can be easily tailored to fit different needs​

Question 7

What are some risks of VBA?

Answer 7

Patient may get offended​

Risk of worsening behaviours​

Practitioners may be resistant causing inconsistencies in MECC​

Can be seen as a burden on practitioners​

Requires more training​

Needs continuous follow-up/support services​

May have differing cultural assumptions about the role of health professionals (treat vs prevent)​

Question 8

What are the questions on the Audit-C?

Answer 8

How often do you have a drink containing alcohol?

How many units of alcohol do you drink on a typical day when you are drinking?

How often have you had 6 more (female) or 8 or more (male) on a single occasion in the last year?

Question 9

What is the maximum score for each question on the Audit-C?

Answer 9

4

Question 10

What does a score of 1-4 on the Audit-C mean?

Answer 10

1-4 = low risk (sensible drinking)

Question 11

What does a score of 5-7 on the Audit-C mean?

Answer 11

5-7 = increasing risk (hazardous drinking)​

Question 12

What does a score of 8-10 on the Audit-C mean?

Answer 12

8-10 = higher risk (harmful drinking)

Question 13

What does a score of 11-12 on the Audit-C mean?

Answer 13

11-12 = potentially addicted/dependent

Question 14

Why do people smoke?

Answer 14

Inhaled nicotine from tobacco smoke is as/more addictive than heroin or cocaine​

Also habit/boredom/stress/social/taste/weight control

Question 15

Explain the psychobiology of nicotine addiction?

Answer 15

Has the highest binding affinity to 𝛼4𝛽2 nicotinic receptors​

Main mediators for nicotine addiction in the Ventral Tegmental Area (VTA) of the midbrain​

Inhaled nicotine reaches receptors in 7-10 seconds​

Triggers release of dopamine​

Regular smoking also increases no. of these receptors by 3 or 4 times​

Receptor changes are long term – more likely to relapse​

Question 16

When is nicotine addiction treatment most effective?

Answer 16

when good quality support + evidence based treatments​

Question 17

What behavioural support can be offered for those with nicotine addiction?

Answer 17

Reduce smoking motivation, increase cessation motivation, help cope with cravings, ensure effective medication use​

Trained advisors: nurses, HCAs, pharmacists, specialist advisors​

4-6 appointments over 6-12 weeks​

Question 18

What medicines can be offered for those with nicotine addiction?

Answer 18

NRTs ​
- skin patches/gum/lozenges/inhaler/oral spray/nasal spray/oral film​

Bupropion – non-nicotine tablet ​
- modifies dopamine levels and noradrenergic activity (decreases cravings and withdrawal symptoms)​

Varenicline – partial nicotine agonist ​
- part stimulating – decreased craving + withdrawal, part blocking – reduced reward from smoking​

Question 19

What 3 things to consider when offering support/medication for treatment of nic addiction?

Answer 19

Consider all three for any patient​

What works for someone may not work for someone else​

Allows patient to choose​

If quit attempts fail – know there are other options​

Question 20

Give a VBA for smoking cessation.

Answer 20

Ask –establish and record status​

Advise – on how to stop​

Act – offer support + treatment​

Don’t push them to stop if they are not ready ​

Question 21

Give a VBA for physical activity.

Answer 21

Ask + screen for activity​ - Scot-PASQ​

Advise​ - Signposting​, need reinforcing yearly​

Act​ - Remember that barriers are multifactorial!​

Question 22

Do you give VBA for alcohol missue?

Answer 22

No - IBA, identification and BA

Question 23

Give IBA for alcohol misuse.

Answer 23

Identification – who is at risk?​
AUDIT-C screening tool​

Brief advice – cutting down​
    MI skills​
    Implementation intentions (what, where, when, how)​

Support – self help/referral​
Mostly self help with a follow-up​
Refer to specialist if addicted​