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#UKalcohol – Twitter discussion on IBA/brief interventions

30 Jul

A planned Twitter discussion on addressing alcohol harms will take place on Wednesday the 13th August at 8pm (= 20.00 BST = 19.00 GMT = 3pm/15.00 EDT) on the theme of alcohol brief advice and brief interventions.  This follows on from an initial discussion on alcohol-related hospital admissions which you can read here.

Who can take part?

The aim of the #UKalcohol discussions is to identify and discuss key issues facing those working in the alcohol field – either as commissioners, researchers, service providers or policy roles. It is hoped a different ‘theme’ will be addressed each month, reflecting key areas of interest.

#UKalcohol discussion 13th August: alcohol brief advice, brief interventions

The 2nd planned discussion is intended to cover the broad theme of design, delivery, support and monitoring of alcohol brief advice in addressing alcohol-related risks and harm.

The following issues may be used as needed as prompts/themes for discussion:

  1. What is brief advice, what is a brief intervention, does it matter?
  2. How widely should we implement brief advice/interventions on the basis of current evidence?
  3. What is needed to support brief advice/interventions in practice? How do the needs of different settings differ?
  4. How should brief advice/interventions on alcohol fit with attempts to address other lifestyle issues?
  5. What monitoring and evaluation of these interventions is needed and is it feasible?

Partnership

This 2nd discussion is being brought to you by the UK Centre for Tobacco and Alcohol Studies with the support from a range of partners and stakeholders who will be jointly supporting the alcohol Twitter discussion, and may initiate further themed discussions in future.

Next steps

If you are interested in participating in the proposed Twitter discussion either as an individual or on behalf of your organisation simply sign in via Twitter on Wednesday the 13th August at 8pm and use the #UKalcohol. Discussion may be subsequently captured and shared via Storify.  You can also follow @ukctas to see tweets about this in advance.

If you’d like to ask any questions or help with Twitter please do get in touch via niamh.fitzgerald@stir.ac.uk or james@alcoholacademy.net.

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NDSAG 2014 Conference Focuses on IBA and Alcohol Policy

27 Feb

The New Directions in the Study of Alcohol Group will hold their annual conference in Dundee from Wednesday 23rd until Saturday 26th April 2014.  The conference is available as a residential or day conference, but participants can also opt to attend one of three individual day symposia.  The latest conference programme has just been announced: NDSAG 2014 Full Conference Programme.NDSAG

The event has a reputation for being an excellent forum for debate, supporting individuals new to the alcohol field, and enabling networking between colleagues old and new.

Friday 25th April focuses on Alcohol Brief Intervention Research (or IBA) and will feature inputs from the Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) team, Glasgow University, Stirling University, University of St. Andrews, University of Dundee and the Alcohol Academy.

Thursday 24th April will focus on policy including minimum unit pricing and the implications for alcohol policy if Scotland opts for independence in September.  A half day research symposium on Saturday 26th February completes what promises to be an excellent event.

You can book online for the conference now – residential spaces are limited.   You can also book using this form: NDSAG 2014 Booking Form

Selincro & IBA

21 Nov

Really interesting post by Dylan Kerr Clinical Nurse Manager at HAGA today on Alcohol Policy UK about Selincro…a new drug for treatment of mild to moderate dependence in conjunction with psychosocial interventions.

This post raises some very important issues and concerns – about medicalisation, and how appropriately the drug will be used in practice.

For me these issues relate to whether the drug will lead to medicalisation of a level of alcohol problem that would not normally be medicated.  The issue of medicalisation is well recognised, and relates to the impact of marketing activities on perceptions of health and illness such that issues and problems that people experience, become highlighted in such a way that more people are led to believe they have medical conditions which can, or even ought, to be treated with medication.  This process is at its most stark as described previously by Moynihan.

With Selincro, the problem it is seeking to tackle (mild alcohol dependence) clearly exists. In re-defining responses to it, however, there is a risk that it moves the alcohol treatment field a little further away from behavioural approaches and backwards (I would argue) to a medicalised view of alcohol problems…to a place where people could see themselves as having less control over their own behaviour.  The idea of personal responsibility and control is a central tenet of IBA and brief motivational interventions in general.

Given previous posts about why professionals are reluctant to talk about alcohol anyway, many will be attracted to the idea of Selincro if they (mistakenly) feel that it offers a quick way to deal with this middle group of drinkers.  The history of off-label or inappropriate use of medicines (some would argue as a result of the marketing activities of pharmaceutical companies) (Orlowski,1992), also suggests that Dylan’s concerns about it being used without the psychosocial interventions may not be not entirely unreasonable.  We can already see extensive marketing efforts from Lundbeck in sponsoring alcohol conferences (most recently Alcohol Concern 2013, and INEBRIA 2013), and may wonder at the purpose, influence, and appropriateness of such funding.

What training will be provided to doctors prescribing Selincro to deliver the psychosocial intervention?  Will that training also describe the evidence base for psychosocial interventions alone?  Will it discuss natural recovery from alcohol dependence?  As the IBA/BI field seeks to fill gaps in knowledge about what effective content in BI looks like, will optimal psychosocial interventions represent a better investment?  And if the health service spent the cost of Selincro on improving delivery of BIs over multiple sessions, would that be more effective and cost-effective?  The gaps in research about effective BI content provide a ripe marketplace for Selincro, and make further independent research not only important, but urgent.

As a postscript, I just signed up to the Selincro website for health professionals (I am a registered pharmacist).  2 of the first headlines flashing at me do not fill me with confidence either on the medicalisation or marketing issues.

First headline I see: Selincro (nalmefene) reduces alcohol consumption by 61%.  Studies have shown that patients taking Selincro reduced consumption from 10.5 to 4 bottles of wine per week after 6 months’ treatment.

No mention of the fact that the effective treatment was Selincro (nalmefene) with psychosocial intervention…here.  This information appears as a footnote in the page ‘about Selincro’.

Second headline I see: Alcohol dependence is a medical illness.   Alcohol dependence is a chronic relapsing brain disease that is characterised by compulsive alcohol seeking and use, despite harmful consequences.

Now this may be true when you look at treatment populations but fails to recognise the much larger group of people who recover by themselves.  The problems with the term ‘chronic relapsing disorder’  (never mind ‘brain disease’) are discussed by Jim McCambridge in his recent FEAD video post.

Talking or Testing? Which is easier?

4 Sep

I recently read a brilliant insight from Dr. Richard Saitz on the INEBRIA Google Group – he was commenting on a discussion about doctors objecting to IBA delivery on the grounds that it is ‘additional work’.  His insight was:

“BUT I have never heard a physician object to doing an electrocardiogram or checking a blood pressure or listening to a heart or ordering a mammogram…So…”additional work” must be code for “additional work for a stigmatized problem” or for something about which people have attitudes about….”

As Richard is a doctor himself, this got me thinking about how we need to get into the psyche of doctors if we want them to implement IBA.  That psyche is undoubtedly formed and normed throughout their lives and especially in education and early years of post-graduate training.

It reflects a wider problem I think which is a reluctance to accept a social model of health where a genuine curiosity about someone’s life and health is helpful in diagnosis and treatment (in the broadest sense).  Why the emphasis on the physical?  My experience is that doctors would love to have a (better) biomedical test for over-consumption of alcohol, even though screening tools are very good, non-invasive etc., because they really don’t want to have to talk to people about it…what does that say?

This reluctance, fear, distaste for actually communicating effectively with patients is very pervasive, and GPs who are very caring, lovely and wise still do not seek out people’s own story, their perspective, their ICE (ideas, concerns and expectations) in consultations as well as they could.  Why?  Well there are many reasons.  But our research in the NHS found that they were not taught it, and even if they were, it was not modelled by others so it wasn’t valued/encouraged.  Our system simply does not prioritise it.  My guess is that the reason underpinning that is probably that we don’t have deep enough pockets to prove it helps, or failing that ‘market it’ anyway (as Pharma do).

So a reluctance to communicate effectively in general makes it hard to feel comfortable with an open conversation about alcohol that IBA really entails.

Your thoughts?

INEBRIA Conference 2013 – 15th May Abstract Submission Deadline

8 May

INEBRIA

INEBRIA is the International Network for BRief Interventions on Alcohol and other drugs and exists “to provide global leadership in the development, evaluation and implementation of evidence-based practice in the area of early identification and brief intervention for hazardous and harmful substance use.”

The annual conference of INEBRIA is an excellent opportunity to hear the latest research and practice developments in IBA in a wide variety of settings and groups.  The 10th Annual Conference will be held in Rome on 19th and 20th of September 2013.

The conference is relatively small and informal and abstracts are welcome from both researchers and practitioners.  The deadline for abstract submission has been EXTENDED to 15th May 2013.  You can submit your abstract here.

In general, involvement in INEBRIA is a great way to have access to advice on IBA from leaders in the field both through the conference and through the INEBRIA Google Group.  INEBRIA is FREE to join.

SBI & Health Inequalities

30 Jan

What do we know about how SBI (aka IBA) may impact on health inequalities?  The evidence we have so far is fairly limited on this.  There has been a suggestion that effectiveness may be less well-proven for women for example, but little conclusive in relation to SBI for those from lower socio-economic groups.

As those interested in SBI/IBA, we need to be aware of to whom the SBIs are being delivered.  I would love to see an analysis of the socio-economic characteristics of those for whom it has proven effective and comparing that to different lengths of intervention.  Until we have that, I think we need to be taking a careful look at how mass delivery of SBI might impact on health inequalities.  If those who are most likely to engage with it, are those who are least in need in general, then it is possible that SBI will increase health inequalities.

The Cochrane systematic review of SBI in primary care concluded that:

“There is a clear need for more evaluative research on brief interventions with women, younger people and those from cultural minority groups. In addition there is a need for more research in transitional and developing countries.”

No mention of socioeconomic deprivation or health inequalities though – this would seem a clear gap in what we know and something we should be mindful of.

For more info on health inequalities – check out the Glasgow Centre for Population Health’s Framework described in their:

Briefing Paper 23: The development of a framework for monitoring and reviewing health and social inequalities.

Briefing Paper 30: Focus on Inequalities: A Framework for Action

How intense an intervention is IBA? And competencies needed?

5 Aug

I have recently been reminding myself of the content of the NHS Health Scotland document ‘Health Behaviour Change Competency Framework, which is a forensic analysis of knowledge, skills and techniques for all forms of health behaviour change effort.

The framework outlines three different levels of intervention – low, medium and high intensity which raise interesting questions about where IBA fits.  The intensity levels are described as follows:

Continue reading

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.