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IBA – before addiction sets in…

30 Oct

One of the fundamental points about IBA is that it is an early intervention – a chance for a drinker to change their alcohol use before it becomes a problem. By problem in this sense I mean a dependency or addiction issue. Of course many non-dependent drinkers experience serious alcohol problems, even death, as a result of their drinking (think accidents and injuries as well as liver disease etc.)

A big challenge though is that many people tend to perceive dependency only in its extreme or physical form. Yet the majority of drinkers with some level of alcohol dependence will not have a physical reliance on alcohol, but a psychological one. Broadly, this means they experience a strong psychological desire to drink and difficulty controlling their alcohol use. For most dependent drinkers, that is not because their body needs it (yet), but perhaps because their brains have become overly used to drinking, often to deal with other problems or as a coping mechanism.

Perhaps the easiest way to think about the importance of the psychological aspect of dependence is the high re-lapse rate amongst severely dependent drinkers having undergone detox. Their body has dealt with the physical need to drink, but it is the ‘addicted mind’ that compels them back to drink. Whilst there is great debate over what works for ‘recovery’, one thing can be agreed for sure – achieving it is not easy.

But most alcohol misuse is amongst non-dependent drinkers so their drinking is still well within their control. They can therefore very often change their drinking without great difficulty should they choose to. They may be confronted with peer pressure, or need to find some other ways of enjoyment, but these challenges are small compared to overcoming dependency. IBA empowers risky drinkers to recognise the value of cutting down their drinking – while it still well within their control.

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IBA – who should do it and how do we convince them?

4 Dec

we not meOne of the big IBA challenges is that those who we really need to do IBA are not likely to see it as part of their job role. We need doctors, nurses, Criminal Justice roles and other front line professionals to routinely ask (screen) about alcohol – of course these are not exactly people with plently of spare time on their hands.

So the challenge facing IBA delivery is not just to equip front line roles with the knowledge, skills and resources to do IBA, but also motivate them to embrace it as a worthwhile cause – despite all the other pressures they face. Continue reading

Extended Brief Interventions: who, when, where, and other questions?

29 May

Last year, I did a study Evaluating EBI in alcohol settings – May 2011 as part of a Certificate in Drug and Alcohol Studies at University of Stirling which I thought might be useful for other people looking to offer EBI/Brief Treatment in alcohol settings delivered by alcohol specialists.  It is very small scale and, of course, biased by my position in relation to the research participants, and was my first foray into the Social Sciences but hoping it will be of some use.

Abstract

While Increasing Risk drinkers can access Brief Advice (short, structured advice) through generalists, and High Risk/dependent drinkers can access specialist alcohol treatment, the needs of those drinkers who fall between these two groups—known as Higher Risk drinkers—are often overlooked by both generalist services and specialist alcohol settings.  Extended Brief Interventions (EBI)—short motivational sessions with follow-ups—have been recommended in national guidance as a means of filling this gap in provision.  The present study sought to explore and evaluate the effectiveness of alcohol specialists delivering EBI as a form of Brief Treatment (BT).

A literature review was conducted, focusing first on the evidence regarding the comparative efficacy of Brief Advice (BA) and EBI, and then on comparative studies of EBI with more intensive treatment.  In reviewing the literature, it was concluded that, whilst there is a broad consensus that BA is as effective as EBI and that BT can be as effective as intensive treatment, it does not follow that either EBI or more intensive treatment is ineffective or unnecessary.  In spite of some patent flaws in the evidence base, EBI and BT are legitimate modalities for Higher or High Risk individuals who require more than BA and less than treatment proper.

In January 2011, a local alcohol service in North London, HAGA—the author’s employer—introduced EBI as a new treatment option.  Under this new treatment pathway, all clients were to be screened at entry and exit using the Alcohol Use Disorders Identification Test (AUDIT) in addition to the Treatment Outcomes Profile (TOPS).   All appropriate Higher Risk drinkers (AUDIT score 16-19) were to be offered one to four EBI sessions instead of longer-term treatment.

The researcher undertook analysis of data relating to HAGA’s EBI client cohort (January-March 2011), conducted semi-structured interviews with members of this cohort, and sought commissioner perspectives on EBI through an online questionnaire

During the period under analysis, twelve individuals were allocated as EBI clients; of which 75% (n=9) received EBI.  All twelve clients were approached to take part in semi-structured interviews and 41.67% (n=5) took part; of which 80% had received EBI.  The interviews explored client’s experiences of EBI, and the advantages and disadvantages of alcohol services providing EBI.

At follow-up, all EBI clients had improved AUDIT and TOPS scores, which while subject to biasing effects, were not negligible.  There was a 53.6% reduction in the mean TOPS drinking days over the last month from entry to follow-up.  This is a substantial short-term change in cohort drinking levels. 100% of EBI clients reported either sustained abstinence or controlled drinking.

Commissioning leads were not so much interested in debates around terminology but rather driven by a perceived need to fill an identified gap in provision for Higher Risk and motivated High Risk drinkers with EBI (or other BT modalities).

The provision of EBI as a form of BT in a specialist service appears to have met the needs of the majority (80% n=4)) of the follow-up cohort assessed here.  The findings of this study further support the idea that local alcohol services should integrate EBI (and/or other BT modalities) into their service provision.  In order to reach those individuals put off by the stigma of attending an alcohol service and less motivated to seek treatment, commissioners should seriously consider specialist-led EBI satellites in primary care and other settings.

A large-scale longitudinal study of the short- and long-term outcomes for treatment-seeking Higher Risk and suitable High Risk drinkers allocated to three different study groups who would either receive EBI as BT in an alcohol setting, receive EBI from a specialist in a primary care setting, or remain in primary care and receive no support (or only BA) would test these recommendations.