Recognising the ‘right’ group of patients or service users for delivering identification and brief advice is one of the first hurdles to be overcome by non-specialists getting to grips with delivery. Most IBA guidance, based on reasonable evidence, suggests that those who might benefit from brief advice are drinking at increasing or higher risk levels. We spend quite a bit of time on training talking about how you can identify these people using screening questions, and crucially, how you can’t identify them by looking, guessing or assuming!
So why is it then that when we follow-up participants some months after training courses, some still report that they have not delivered IBA because ‘my clients don’t need it’? Some say that all their clients are drinking too much to benefit from IBA; others that their service users do not drink enough to need help, but these conclusions are not necessarily based on screening. Why?
Well, I have a few theories…firstly I think it is worth acknowledging that this could just be an excuse, perhaps training participants just feel bad if they haven’t delivered and so they want to give us a good reason why.
Or perhaps it is true – though it seems unlikely that practitioners working with the general public, have not come across anyone at all who is drinking more than the recommended limits, but not in a dependent way!
I think the former is more likely, but it is not as simple as them making it up to satisfy us. I think they are rationalising to themselves as well as us, why they haven’t delivered. And I think (among other reasons) it comes down to the fact that in order to truly recognise the target groups for IBA, we need to recognise that included in the target group are folk, well, just like us. Or if not us, like folk we know and like. Not a stereotype ‘heavy drinker’, never mind ‘alcoholic’. And that might mean recognising that we, or our family or friends, have a choice to make too…enjoy our drink and accept the risks, or cut the drink and cut the risk…
Delivering IBA is just about giving everybody that information, and that choice.
How ‘opportunisitic’ can IBA be – a step too far?
30 JulOne 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.
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!
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Tags: alcohol, IBA