An EBI case study: where are the rest?

18 Sep

‘It’s Your Choice’ Evaluation – Making the case for EBI

Last year, I delivered an Extended Brief Alcohol Intervention (EBI) program called It’s Your Choice. I hope that sharing the results and learning from the program will be helpful for other people who are looking to develop alcohol EBI’s. The aim was to reduce alcohol related harm in Sefton by providing EBI in the form of a one to one coaching service. The program was promoted as a “coaching” service rather than an “alcohol intervention”, in order to test how effective this approach would be in engaging patients.IYC

NHS Sefton Public Health identified a cohort of drinkers, who whilst not requiring or consenting to a referral to specialist treatment support, do require more than IBA (Identification and Brief Advice). NHS Sefton worked in partnership with Sefton Council for Voluntary Service to develop a program to meet the needs of these drinkers. I was the coach that delivered the program.

It’s Your Choice is based on the principles of Motivational Interviewing that have been in proven effective in previous programs such as Project Match in the USA and the United Kingdom Alcohol Treatment Trial.

It’s Your Choice was available to increasing and higher risk drinkers (those who scored between 8 and 19 on the AUDIT – Alcohol Use Disorders Identification Test). Drinkers were referred by Primary care staff and coaching sessions took place in GP surgeries and a community healthy living centre. Drinkers were able to have up to 6 x 1 hour one to one sessions (with an optional further 2 follow up sessions if required). However the program highlighted that more sessions do not necessarily mean better outcomes.

42 patients were referred onto It’s Your Choice of which 76% of those patients engaged fully in the programme. 80% of all sessions were attended. 72% of patients reported a post intervention reduction in their drinking and 65% of patients reported a reduction in their drinking 12 weeks post intervention. On average patients reported a 30% reduction in their drinking, equating to an average AUDIT reduction of 6 points.

The full report is available here, including quotes, key learning and recommendations for future work.

At present there is very little EBI in comparison with IBA, as highlighted in a recent blog EBI: lost in the shadow of IBA?.

NICE guidance recognises that access to EBI’s such as It’s Your Choice is currently limited.  This gap in EBI type approaches is noted in NICE costing report CG115: Alcohol dependence and harmful alcohol use which highlights that the national proportion of people with mild alcohol dependence who are provided with evidence-based specialist treatment is estimated at 1.13%.

NICE also acknowledge that “some people drink alcohol as a result of underlying problems. Clearly these need to be addressed along with any alcohol related issues”. (NICE PH24 Preventing Harmful Drinking). Whilst only a small scale pilot, the results and feedback from the drinkers who took part in It’s Your Choice show that this way of working provides a means of addressing both the alcohol use and the underlying problems.

As the coach, the most powerful learning for me was understanding how coaching can help people develop an awareness of how their problems and their drinking are connected. Once the patients make this connection, then making a change to their drinking becomes possible and in many cases, it happens.

Matt Ball

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