Archive | April, 2012

Who needs IBA?

16 Apr

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.

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How did IBA fare in the new national alcohol strategy?

12 Apr

IBA was not mentioned at all in the Drug Strategy 2010 and the focus was very much on “severe alcohol dependence” (3) and recovery.  So I have been waiting with bated breath to see what the alcohol strategy would bring.  Well IBA definitely fares better in the new alcohol strategy than treatment.  The new alcohol strategy makes some positive comments about the evidence base for IBA, encouraging local areas to implement IBA locally.  Reference is made specifically to learning lessons from SIPS; IBA delivered by Alcohol Liaison Nurses in hospital settings, particularly for pregnant women; and alcohol intervention pathways for offenders.  The most concrete gain for IBA in the UK is the introduction of alcohol into the NHS Health Checks which will extend primary care provision beyond new registrations.  The planned social marketing activity focused on young people will also improve prevention work nationally.

Two concerns (I’m sure there are more …):

  • Terminology: Cameron’s foreword reads like a modernised Hogarthian vision of a “Broken Britain” and the language throughout is not much better.  Why are we still talking about the “drunks” “drunken” “the drunks” in punitive terms?  Where is the language of Lower, Increasing and Higher Risk?  One of the major barriers to people accessing support for alcohol is terminology and stigma: how productive is Cameron’s language?
  • NHS Health Checks: Will local areas invest in IBA training for NHS Health Check practices AND clear local pathways into support?  As we know screening, Brief Advice and the pathways from alcohol Direct Enhanced Service (DES) screening are poor or patchy, we need to act now to ensure that this major improvement isn’t scuppered by poor delivery.

So that’s my first ever blog post done!   Hope it makes sense!

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Why an IBA blog?

9 Apr

I have thought long and hard about whether to do this blog. My main reservation was that it may be duplicating existing web resources, but overall I think there is room for a blog that highlights new ideas and relevant updates. I hope this blog will attract a range of contributions and prove of value as a simple space largely aimed to support those delivering IBA.

Another decision I wrestled with was whether to use ‘Identification and Brief Advice’ (IBA) or Screening and Brief Interventions (SBI) terminology. Actually, I lean towards SBI for a number of reasons, namely its used by NICE and has a longer history. However in my experience, it seems IBA now has a wider recognition outside the research field. The Department of Health coined IBA, along with the ‘risk’ terminology and so I wanted to keep the language as consistent as possible for the target audience of this blog.

In defence of IBA, I would also back this as applying to the simpler form or simple ‘brief advice’, not lasting much more than 5 minutes at the most. ‘Brief intervention’ however covers a wider range of approaches including longer lifestyle counselling or ‘brief motivational interviewing’ approaches. Following the release of the recent SIPS trial findings, we know that overall shorter approaches are in most cases as effective as longer interventions. For this reason, emphasising IBA as a short but effective brief intervention approach seems pragmatic to me.

See here for a paper on ‘Clarifying brief interventions’ or here for further links.

IBA bloggers wanted!

8 Apr

Do you have ideas or experience that is relevant to readers of the IBA blog? We want this blog to open to expert contributors who can support the blog through sharing their IBA learning, experience and ideas.

Here’s a few simple things you should consider if thinking about contributing to the alcohol IBA blog:

  • Do you have specific experience or knowledge of IBA that can benefit readers? This blog aims to promote understanding and confidence in IBA amongst those who can deliver it.
  • The art of blogging… is arguably to keep things accessible and easily understood. The blog therefore aims to keep things simple, clear and pretty concise because our audience are not alcohol or IBA experts. We want IBA to appeal to the many different roles out there that can help people reduce risky drinking through IBA.
  • It’s not a space for marketing or promotion. Most of us work for services and organisations that we want to highlight the good work of, especially in tough times. Contributions will need to have the primary aim of sharing IBA learning, ideas or experience that will benefit readers.

If you think you have ideas or experience that will benefit our readers and want to contribute, please do get in touch!

Common alcohol questions

3 Apr

Here’s a few common general knowledge alcohol questions that tend to come up:

1. What is the legal limit for drinking and driving?

A classic – and often starts a rush of speculation as to whether one or two ‘drinks’ is legal. But the legal drink drive limit is not measured in drinks, or even units of alcohol. It is also not to be confused with a ‘safe limit’ – a contradiction in terms as any amount of alcohol could have a negative impact on driving abilities.

The legal alcohol limit for drivers in Great Britain is:

  • Breath Alcohol Content (BrAC): 35 microgrammes of alcohol per 100 millilitres of breath
  • Blood Alcohol Content (BAC): 80 milligrammes of alcohol in 100 millilitres of blood
  • Urine alcohol content: 107 microgrammes of alcohol per 100 millilitres of urine

See here for Direct.gov limits and penalties and drink driving advice (don’t do it!).

2. Do pubs and drinking establishments display the units of drinks and if not why can’t they be legislated to do so

Licensed premises are not by law required to display unit information, however there are commitments to improve information on units including the labelling of glasses and bottles themselves as part of Government’s controversial Responsibility Deal.

Under the Responsibility Deal, business that have signed up have agreed to:

“provide simple and consistent information in the on-trade (e.g. pubs and clubs), to raise awareness of the unit content of alcoholic drinks”.

One of the main commitments is for industry to achieve clear unit labelling on over 80% of alcohol by 2013. The Government  has not stated what action it will take if this is not met – groups such as Alcohol Concern have warned that voluntary action has not delivered in the past.

3. Why do men and women exhibit some differences when it comes to Alcohol Health Risks?

Men and women’s bodies are made up of different ratios of water, muscle and blood, so as a general rule women are more affected by alcohol. This is why women have a lower recommended guideline for low risk consumption. In general, women have around 9% less body water than men of similar body weight, so higher concentrations of alcohol would be in a woman’s blood after drinking equivalent amounts of alcohol.

Whilst men and women are at equal risk of certain conditions if going above the guidelines, some conditions have greater risk. For instance, a man or woman who regularly drinks more than double their recommended guideline would equally be increasing their risk of liver disease by around 13 times. However a man would be increasing his risk of stroke by 2 times drinking at this level, whereas the risk for a woman would be increased 4 fold. However men are more at-risk from conditions such as high blood pressure or depression.