Brief Interventions

Question 1

what are brief interventions?

Answer 1

collective term for giving advice to help change harmful behaviours (typically opportunistic)

Question 2

how to structure brief interventions

Answer 2

identify behavioural risk factor
explain how best to change high risk behaviour
signpost how to obtain help

Question 3

what is VBA?

Answer 3

very brief advice, form of advice designed for busy clinicians to be used opportunistically in less than 30s

Question 4

what are the benefits of VBA?

Answer 4

improves long term patient health
reduces cost to NHS
can make patient feel like they are being seen as a whole person
cheap + simple
can exist in hospital and non-hospital settings
don’t need a background in public health to receive training
can be easy tailored to fit different needs

Question 5

what are the risks of VBA?

Answer 5

patient may get offended
risk of worsening behaviours
practitioners may be resistant causing inconsistencies in MECC
can be seen as a burden
requires more training
needs continuous follow up/support services
may have differing cultural assumptions about role of health workers

Question 6

what questions in the audit-c are used to assess alcohol use?

Answer 6

how often do you have a drink containing alcohol?
how many units do you drink on a typical day?
how often have you had 6/8 (F/M) units on a single occasion in the last year?

Question 7

score meaning of audit-c in terms of alcohol use

Answer 7

1-4 = low risk (sensible drinking)
5-7 = increasing risk (hazardous drinking)
8-10 = higher risk (harmful drinking)
11-12 = potentially addicted/dependent

Question 8

is inhaled nicotine from tobacco as addictive as heroine or cocaine?

Answer 8

yes

Question 9

why do some people smoke?

Answer 9

habit
boredom
stress
social
taste
weight control

Question 10

explain the psychobiology of nicotine addiction

Answer 10

highest binding affinity to alpha4beta2 nicotinic receptors, main mediators in ventral tegmental area of midbrain
triggers release of dopamine
regular smoking increases no of receptors by x3 or x4
receptor changes are long term

Question 11

what do receptor changes mean in terms of relapse?

Answer 11

more likely to relapse

Question 12

when is nicotine addiction treatment most effective?

Answer 12

with good quality support and evidence based treatments

Question 13

list treatments for nicotine addiction

Answer 13

behavioural support

medications

Question 14

behavioural support for nicotine addiction

Answer 14

reduce smoking motivation
increase cessation motivation
help cope with cravings
ensure effective medication use
4-6 appointments over 6-12 weeks

Question 15

list medications to treat nicotine addiction

Answer 15

NRT
bupropion
varenicline

Question 16

NRT

Answer 16

skin patches
gum
lozenges
inhaler
oral spray
nasal spray
oral film

Question 17

buproprion

Answer 17

non-nicotine agonist, modifies dopamine level and noradrenergic activity (decreases cravings and withdrawal symptoms)

Question 18

varenicline

Answer 18

partial nicotine agonist, part stimulating > decreased craving + withdrawal, part blocking > reduced reward from smoking

Question 19

cons of advice to stop smoking

Answer 19

-ve message
nagging
conflict + denial
takes longer
frustrating

Question 20

how to apply VBA to smoking cessation

Answer 20

ask - establish and record status
advise - how to stop
act - offer support + treatment
don’t push them to stop if they are not ready

Question 21

how to apply VBA to physical activity

Answer 21

ask - screen for activity (Scot-PASQ)
advise - signposting, need reinforcing yearly
act
remember that barriers are multifactorial

Question 22

how to apply IBA to alcohol misuse

Answer 22

identification - who is at risk? AUDIT-C screening tool
brief advice - cutting down, MI skills, implementation intentions
support - self help, referral