Archive | July, 2012

How ‘opportunisitic’ can IBA be – a step too far?

30 Jul

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!

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Brief advice bullets: try lower strength drinks?

12 Jul

As recently explored, highlighting the negative impact of alcohol on sleep is a winner for motivating risky drinkers to cut down. But punchy ‘brief advice’ strategies to actually help the drinker to do so are perhaps a bit harder to find. Many people may be unenthusiastic about to switching to weaker drinks or alternating with soft drinks.

So can lower-strength drinks play a role in reducing consumption? A recent report from John Moore’s University has urged caution from a policy perspective. It found that although lower strength drinks will help reduce harm where people swap them for stronger drinks, they may also create more drinking occasions where alcohol consumption is introduced. For instance, a weaker lager may make a lunchtime tipple more acceptable.

This conveniently reminds us that keeping an eye on the number of drinking occasions we have, as well as how much we drink when we do, is key for keeping as close to lower risk drinking as possible. But actually I did recently try a 2.8% ‘extra pale’ lager that was actually quite satisfactory. Not something I was expecting if I’m honest!

Brief advice bullets: alcohol disrupts sleep

9 Jul

There are some valuable bits of ‘brief advice’ that are more likely to resonate with all risky drinkers who engage. The negative effects of alcohol on sleep is surely one of those because everyone needs sleep and everyone wants to sleep well. I often speak to people who have cut down on their alcohol use, and improved sleep is probably what I hear volunteered most often as a positive outcome.

So whilst many risky drinkers might believe alcohol ‘helps’ them to sleep, they’re unaware the quality of the sleep is affected and so is less regenerating – even if they slept for as long. Alcohol reduces the capacity for deep re-energising sleep because as blood alcohol level declines, the body becomes more alert (known as the “metabolic rebound” effect). There must be something about waking up to go to the toilet too!

A recent study has found that even moderate consumption disrupts sleep. This and the fact that there seemed to be less of an impact on lost sleep time amongst heavier drinkers might negate the value of this particular benefit. Either way, alcohol isn’t good for the deep sleep we need. I know that the best shot I have of feeling fresh and well rested is to have an alcohol-free night – which is why I always aim for that on a school night!

Is IBA ‘girly’?

5 Jul

On a recent training course on IBA for lifestyle change, I was discussing the motivational style inherent in some forms of IBA with two prison officers. As officers working in the physical education department of a prison, they described their upfront approach to supporting prisoners to get fitter in words such as these:

“If they come to us and say I want to get fit, I’m overweight.  We say, yeah you are overweight and here’s what you need to do to sort it.  We’ll write you a programme but we can’t do it for you. You just need to get off your ar*e and do it.”  

Well, its certainly emphasising personal responsibility, but the ‘no nonsense’ nature of the response had the rest of us, who happened to all be women, squirming.  Where’s the rapport and empathy, the listening, the motivation matrix? And it got us talking – does all that ‘touchy-feely’ stuff make IBA a bit wimpy? Is it women’s stuff?  As a new-age feminist, I don’t even like framing the question in that way… and let’s remember motivational interviewing was invented by two men! But it is not the first time that people have questioned whether patients really want to be ‘listened to’, or whether they would prefer to be told what to do.

According to Silverman et al. (2005 p.185), it is a mistake to assume that all patients want to be actively involved in decision-making in medical consultations in general, and they cite a range of studies that explore this issue further. It is worth remembering that this kind of collaborative approach to consultation may be new to some patients; they may need some gentle encouragement to get them to engage fully with IBA or indeed other patient-centred approaches.