One of the key characteristics of IBA, and brief intervention in general, is that it is ‘opportunistic’. IBA is delivered by someone who makes use of a chance to ask about alcohol use when the patient or contact is not seeking help or advice around their alcohol. IBA is truly a brief intervention – an opportunity to initiate a risky drinker to think about their alcohol use when they would not have otherwise done so.
But after recently doing IBA with, wait for it… a stranger on a train, I was left asking myself “have I taken this too far?”. Of course they weren’t a complete stranger when I asked them if they wanted to look at their own alcohol use. It came about after I’d got chatting with them (during a long delay) and told them about what I’d been doing (IBA training) and why. Interestingly they agreed, scored as drinking at a risky level and were willing to discuss some of the good and not so good things about their drinking. Along with some light-hearted chat and joking – understandable given the situation – they identified some benefits to cutting down. I closed it by handing over a leaflet with more information on ways to cut down, and we moved back to the more usual topics of light conversation had amongst relative strangers.
So, how do I feel about what happened? We know IBA works very well in Primary Care settings. We are learning more about its role in A&E settings, Criminal Justice environments and other health or community based settings. But how far outside of these ‘common sense’ settings should we go? At an individual level, asides from a lack of evidence, should there be any limits to who and where we can offer to do IBA? A recent post suggested we can use an ethical framework to assess how far we can extend IBA, rather than focusing on research to prove it will work. I think this makes good sense and I believe if IBA can be done, the setting may be less important that the individual’s consent and the IBA delivery skills.
I’ve always suggested that IBA should ideally be in a confidential environment. But if someone is comfortable to discuss their alcohol use in more public places then why should we neglect them of the opportunity to make a more informed decision about their drinking? Of course I’m not suggesting we all try IBA with every person you get chatting to on a train, but there are some real opportunities to do IBA in ‘creative settings’. I personally enjoy doing IBA and seeing people contemplate their alcohol use, and I feel as long as I do no harm and never push someone, we can be as opportunistic as we like!