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Is self-completing the AUDIT OK for IBA?

22 May

Potential IBA’ers often ask if they can hand out the AUDIT or other screening tool for people to self-complete. Although better than not doing so, generally its a wasted opportunity if the person is able to go through it with them.

The main issue is what happens after a person has self-completed a screening tool rather than worked through it with a practioner. Where a practitioner has gone through the AUDIT with the drinker, this should flow nicely into ‘feedback’ and ‘brief advice’. The practitioner will probably have gotten a feel for the person’s alcohol use and a sense of whether they might be starting to contemplate their alcohol use.

Going through the AUDIT may be a crucial chance to build rapport with the drinker, and perhaps reassure them that you are adopting a non-judgemental and empathic approach. Other benefits, such as being able to check or clarify units knowledge are also missed by self-completion approaches.

In contrast, handing back a completed AUDIT seems to me a bit like handing in some homework and waiting for the teacher’s verdict. Not exactly in line with motivational principles. Worse still, I know some GP practices have been handing out screening tools for new registrations to self complete, but fail to follow it up with drinkers. This is unacceptable, especially given they are receiving a payment as part of the DES.

One of the key things some of the evidence seems to show is that screening itself appears to be a significant trigger for ‘contemplation’ that leads to change. Feedback and brief advice can capitalise on that process, helping the drinker to weigh up the pros and cons and perhaps identify a plan. Self-completing AUDIT  seems to mean that opportunity may be missed.

Nonetheless, self-completing an AUDIT is still likely to be beneficial when accompanied by feedback and an information leaflet. It’s also the foundation of online brief intervention approaches which are gaining recognition as having a valuable role to play in the overall IBA agenda. So in conclusion, someone self-completing an AUDIT + feedback can be valuable, but talking through it and being ready to guide someone (i.e brief advice) would be an opporutunity that I wouldn’t want to miss.