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Substance use and sight loss guide

4 Dec

A new practice guide has been produced to help practitioners support people with overlapping sight loss and drug and alcohol issues.

Download Substance Use and Sight Loss: A guide for substance use and sight loss professionals [pdf]

The guide follows research identifying that neither sight loss or substance abuse services feel adequately equipped to deal with these overlapping issues, and as such aims to help support better identification and responses in this area.

The issue highlights how many professionals with the chance to offer alcohol brief interventions will be working with a range of different issues that may be closely interlinked. As such ensuring practitioners feel able to respond appropriately is essential, and often why often IBA itself is overlooked as an important early intervention.

Sight loss is of course one of a large number of issues that may be contributing or linked to drug and alcohol problems. Professor Sarah Galvani, one of the authors of the guide said: “Substance abuse can sometimes be used as a coping mechanism for sight loss but the combination of both issues can create a complex challenge for support professionals.”

IBA is about offering a person an opportunity to make an informed decision about their alcohol use. Sometimes it will be straightforward, and discussions around motivations and strategies for change will be along more common lines. At other times, discussion may need to reflect and support other issues – for some people sight loss will be one of them.

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Should Drinkaware support IBA?

25 Feb
Whats in your glass kit

Drinkaware’s ‘What’s in your glass?’ kit used in the Berkshire Pharmacy project.

Drinkaware, the industry funded education charity recently held their annual conference and showcased some projects focused on behaviour change. However for several of them I was left wondering ‘where does IBA fit in?’ – a question I think applies more generally to the organisation.

Drinkaware’s activities have come under fire from some groups for not being evidence based, or worse counter productive. Understandable from a policy perspective when ‘educational’ approaches are regarded as among the least effective approaches for reducing alcohol misuse. This is in contrast to IBA, which if delivered well, is probably considered the most effective individual level intervention to affect behaviour change. So why do Drinkaware not recognise it?

On the one hand, it could be argued that IBA as a ‘brief intervention’ is not an educational approach – which Drinkaware cannot extend beyond as a term of their funding. On the other hand, IBA is about supporting informed decision making, so is arguably just a targeted and effective ‘educational approach’. In fact recently Drinkaware included the AUDIT-C on its website which the Chief Exec cited this as one of its recent successes at the conference.

One interesting project claiming to have changed drinking behaviour was something called the ‘What’s in your glass?’ project. Teaming up with Berkshire Public Health,  24,000 ‘What’s in your glass’ kits were distributed by 150 pharmacies across Berkshire. The kits were clearly appealing, well marketed, and … free! The evaluation claimed positive outcomes for people who took the kits, although it used its own questions to assess behaviour change rather than something validated like AUDIT.

But what I couldn’t understand was what should other areas take from this when Pharmacies are increasingly being used as a key opportunity for IBA? I approached the speaker after and she suggested that the kits work well as an engagement tool as staff were often not confident about asking about alcohol. Good point, although shouldn’t we be building Pharmacist’s skills and confidence to ask about alcohol so they realise asking in the right way isn’t a problem? Perhaps there is room for both IBA and ‘engagement tools’, and maybe such tools are even a useful nudge for IBA?

If so, should we welcome such Drinkaware projects that produce resources that might help engage people in alcohol discussion? Although NHS alcohol leaflets can be ordered for free, it does seem as though more access to unit and other resources would support IBA delivery. Or should we be careful of diluting effective IBA with less evidenced ‘educational’ approaches paid for by the industry? Are Pharmacists more likely just to give a ‘What’s in your glass?’ kit to someone and overlook IBA opportunities?

Drinkaware want to build the trust of the health community – perhaps they need to establish an independent working group to decide what Drinkaware’s role is in relation to its projects or resources that may support – or hinder – IBA, and be clear on their position.

IBA for children and young people: evidence, guidance and resources?

11 Jun

Although NICE advises that IBA be offered to those aged 16 and over, there is limited evidence as to the effectiveness and best delivery approaches for children and young people. However a new SIPS junior trial is getting underway focussing on younger adolescents presenting to A&E departments (but don’t expect the results anytime too soon – it’s a 5 year project!). The SIPS junior website has a good summary of the issue though, highlighting:

“advice to children under 15 years (2009) is to abstain from alcohol due to risks of harm, and 15-17 year olds are advised not to drink, but if they do drink it should be no more than 3-4 units and 2-3 units per week in males and females, respectively. In contrast, alcohol use is increasing in adolescents in the UK: the average amount consumed by 11-15 year olds doubled in the last 13 years to 2007. Adolescents in the UK are now amongst the heaviest drinkers in Europe.

Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self harm, unprotected and regretted sex, violence and disorder, poisoning and accidental death. Early drinking in adolescence is associated with intellectual impairment and an increased risk of more serious alcohol problems in later life. Methods of alcohol screening and early intervention have been developed for adolescents in the USA, and show evidence of benefit, but have not been studied in the UK. Further these methods have several shortcomings including not providing screening and intervention methods appropriate to the age and developmental stage of the younger adolescent.”

In the meantime, I believe there is still a good case for IBA with younger adolescents as long as safeguarding and other risks are covered (see NICE PH24 recommendation 6). If IBA opportunities present, practitioners should be able to use a combination of common sense and good IBA skills. For instance it’s broadly accepted that children and young people are more likely to be motivated around risks to their personal safety, injuries, appearance or other more immediate harms. So highlighting things like risks to high blood pressure probably aren’t going to be the most effective approaches for framing IBA for younger groups. Nonetheless, we shouldn’t overlook that we have been seeing a trend in younger and younger adults presenting with liver disease.

Here are a few useful IBA resources aimed at practitioners working with children and young people:

One of the key things SIPS Junior will reveal will be which screening (identification) tools may be best suited for younger adolescents. For children aged 10-15 in contact with professionals, NICE suggests consent and use of the Common Assessment Framework (CAF) to obtain a detailed history of their alcohol use, including background factors such as family problems or other issues.

A comprehensive list of further guidance, resources and reports relating to children and young people is available here from the Alcohol Learning Centre.

IBA in Wider Settings: Conference Report

9 May

Social work, criminal justice, pharmacy, housing, homelessness, police: all these settings are becoming increasingly the focus of research and implementation initiatives relating to IBA.  A recent conference (27th March 2012) organised by Edinburgh Cyrenians, in association with Comic Relief, Create Consultancy, Alcohol Research UK and INEBRIA was attended by professionals and researchers from all these fields.  With a key note address on the state of the evidence base for IBA by Dr. Richard Saitz, and a following presentation ‘How to decide what to do, whatever the evidence‘ from Dr. Andrew Tannahill, the day got off to an intriguing start.

Further presentations focused on how to implement IBA into routine practice, an example of how Edinburgh Cyrenians rolled out alcohol interventions across their frontline homelessness services, and a discussion of the place of alcohol in the lives of hard to reach groups.  Workshops discussed selection of screening tools, training, gender issues and web technology relating to IBA.

The full list of speakers and presentations from the conference are available.

Last year the Alcohol Academy held an event and published a briefing paper exploring ways to achieve widespread IBA delivery.