IBA – are all settings equal? Presentations and experiences

27 Oct

Two recent events explored evidence, experience and views on delivering IBA across different settings. The first – ‘IBA: are all settings equal?’ – was held in partnership between the Alcohol Academy and DrinkWise NorthWest in July. More recently the Academy teamed up with the Nottingham Recovery Partnership to deliver ‘IBA: Making Every Contact Count?’.

Both events aimed to bring together alcohol leads and practitioners to assess how IBA implementation is going – and how and whether it should be extended across further settings. Of course, ‘all settings are not equal’ because the evidence base and policy focus is on IBA in Primary Care. Yet there is clearly both an enthusiasm and investment in delivering IBA across a wide range of settings.

A few of the key presentations and discussion points are outlined below, but all presentations can be accessed here and here.

In his presentation, 30 years of evidence – a short history of brief intervention, Professor Nick Heather gave a revealing insight into the development of brief intervention and key questions to address. To list some key insights; commont to popular belief, brief intervention did not originate from the US, rather than from Scotland! Alcohol dependence should not be considered only as a serious condition applying only to serious problem drinkers, rather something that reaches across the spectrum of alcohol misusers including risky/hazardous drinkers. And then, what grounds do we have to deliver IBA in largely unresearched settings? The best argument for doing so may be the ‘precautionary principle’. As essentially one of the most important minds in alcohol and brief intervention research, Professor Heather’s presentation is well worth a read.

Of key relevance, Don Lavoie of the Department of Health alcohol team addressed the same issue from the policy perspective. Some key facts were illustrated, for example alcohol is the third biggest risk factor for illness and death in the UK (after smoking and obesity), and that 40% of alcohol consumption is concentrated in 10% of the population. Some headline SIPS findings were also highlighted in simple form, before exploring some key challenges, opportunities and resources for IBA delivery.

An excellent presentation exploring ‘Transferable skills of IBA’ was given by David Henstock, breaking down all the evidence around brief intervention approaches across lifestyle approaches. A previous Academy IBA event found that brief interventions should be often integrated within lifestyle agendas, but that alcohol-specific IBA must not be lost or demoted. Thanks to David, the evidence on that can now be easily assessed for smoking, diet, exercise and more! A recent post on this blog also reviewed some of these issues.

Other key subjects included an exploration of online alcohol interventions. Andrew McAuley, of NHS Health Scotland, presented a Computer-based Alcohol Interventions review based on a recent report. Andrew set the scene of Scotland’s alcohol problems and explored how computer-based interventions may provide part of the answer. However there are many reasons to be cautious – for instance those groups who may be most vulnerable to alcohol and its effects may be those most likely to not have online access.

Dr Laura Pechey, Haringey Advsiory Group for Alcohol (HAGA) also explored online alcohol interventions by reviewing some of the key examples out there and recommendations for establishing or running online resources. HAGA’s expertise in this area has led to the development of the smart Don’t Bottle it Up online IBA resource.

Also explored was the issue of how to ‘Crack the nut’ of Primary Care IBA?’. Mark Holmes presented on this from the perspective of how to win the ‘hearts and minds’ of GPs and other staff through engagement and training. Invaluable advice included securing ways in, such as through ‘Protected Learning Time’, and being flexible but well prepared. From another perspective, Wendy Edmunson of Locala CIC highlighted the value of champions in the form of alcohol specialists. Such roles, though not there to do IBA, can play key leadership roles in establishing and supporting proper IBA delivery amongst GPs and staff, whilst being there to meet the needs of dependent drinkers.

In review, there is clearly an enthusiasm for improving the delivery of IBA and reaching it out to key settings – the challenge is that this enthusiasm is largely confined to those with a direct interest in alcohol problems. The very essence of the IBA challenge is how do we transfer our enthusiasm to the many thousands of non-specialists that are also needed on board…

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