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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