#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?


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.

IBA Primary Care case study: a rare new example

29 Jul

preventionIn 2011 a ground-breaking document (in the IBA world at least) was released by a brilliant local service in Haringey. The document was a step-by-step guide to implementing the DES incentive scheme for IBA for new registrations in Primary Care. However what was arguably most impressive was the work revealing the local ‘DES picture’, which was not pretty reading.

The review found, to give just a few examples, that 75% of practices were using incorrect screening questions, and that only 50% of practices were offering face-to-face Brief Advice to identified risky drinkers. However such issues are likely to be commonplace if anecdotal reports and mystery shopping are anything to go by. The Haringey work though subsequently enabled action to significantly improve local IBA delivery.

So it seems apparent that the DES scheme itself does not result in good quality IBA – much more is needed to make that happen. Not a surprise really, but part of the problem has been a lack of available reports to identify this.  Any new pieces of work evidencing local IBA experiences and action in relation to the DES are therefore to be welcomed.

A new case study – Cruddas Park Practice

I recently came across a valuable piece of work in the North East – a report from a pilot [pdf] which aimed to assess the practicality of implementing IBA into a busy GP practice. Again, this seemed to be the result of prior some work looking at the local picture. A survey of GPs carried out by Balance found that GPs were typically only addressing alcohol in response to clinical indicators, rather than routinely as IBA is intended. Time pressures and competing priorities were the recurring reasons offered for this.

The report provides a valuable insight into a local effort to properly implement IBA and supporting pathways into a busy GP practice. It looks at the compelling local need, and evidence base, but most of all, it gives a real insight into how perceptions and practice in relation to IBA can be changed by a relatively simple project.

Some of the best insights from the report related to the feedback from the staff who delivered IBA. It is always heartening to hear a busy practitioner relay a real life positive attitude to IBA, like this example:

“One guy had a health check and his cholesterol was up, he was drinking most days, now he has cut out drinking through the week. I told him his attitude was great. He had never thought about it until he came to the GP, he is sleeping better, he feels better. He thanked me and it made me feel good.”

Of course the reality is its not straightforward. This quote really captures probably the biggest overall challenge to IBA:

“Sometimes the timing is an issue, for people who screen mid way it’s not too bad, but if people score high you need to spend more time with them. It takes a double appointment – about 20 minutes. Or I add it into an annual check it takes an extra five minutes. It’s hard to judge how long it will take until you ask the questions. You definitely need longer – especially if they need to discuss the issues more, you don’t want to hurry people if they are listening.”

There is one issue I feel I should point out with the report itself. It suggested higher risk drinkers (16-19 AUDIT scores) were offered referral for advice or extended brief interventions as the main output, rather than offering ‘brief advice’ as a starting point and only then offering referral if needed or sought. The evidence doesn’t suggest EBI is superior to IBA for higher risk drinkers in most cases – see Clarifying Brief Interventions for more.

However the report is still a highly valuable and rare example of the type of attention that’s needed to convert patchy or inadequate IBA to a standard that really makes a difference. Good, simple IBA isn’t that hard after all.. is it?

Alcohol IBA ‘training app’ released

1 Jul

IBA An IBA training app was recently released on the apple store, Google play and also on the amazon app store. The free app is available to download to support front line health or social care professional roles to offer simple alcohol brief intervention.

The app contains a simple format to introducing the key fundamental knowledge and skills required to offer alcohol ‘Identification and Brief Advice’, with a focus on possible scenarios and responses. Firstly, the app offers a background to IBA and how early intervention for alcohol misuse is suitable for around a quarter of the adult population. It also offers interactive sections exploring key areas such as alcohol units and the AUDIT screening tool.

risk groupsThe main focus of the app focuses on a number of scenarios demonstrating suggested ‘brief advice’ responses as well as examples of how not to respond to ambivalent or resistant responses. The scenarios include actors playing increasing, higher risk and possibly dependent drinkers, each showing a range of possible attitudes and practitioner responses.

The app offers a shorter alternative to the 2 hour online IBA e-learning which has proven a popular resource. Nonetheless, good face to face training should still be considered the gold standard training approach. Of course many busy front line roles may not have access to face to face training so the app offers a quick and effective introduction to IBA delivery.

The alcohol calorie catastrophe

19 Jun

A single drinking occasion can lead to a multiple calorie catastrophe that can really undermine attempts at weight loss or healthy lifestyles. So even if health or other risks aren’t a concern for someone, its hard not respect the extra calorie count that alcohol can ramp up. But its not simply the calories in drinks themselves to be aware of…calories

First off, the calories in alcohol itself – an average UK drinker may consume 10% of their total calorie intake through alcohol alone. Per gram, alcohol has nearly the same calorie content as fat (7 calories per gram for alcohol and 9 per gram for fat).

And its not just beer that’s calorie loaded – a large glass of wine can have as many calories as a pint of lager. That’s around 180 calories, significantly more than a  packet of crisps (130 kcal in a 28g bag). So whilst someone on a diet would presumably never consider three bags of crisps in one go, three glasses of wine on a weekend occasion might not get a second thought.

There’s then there’s the possibility of a drink induced food binge. Alcohol is thought to interfere with the brain in way that can lead to hunger cravings, despite the body not needing more food. It is also thought that alcohol reduces the amount of fat the body burns for energy.

The final nail in the great calorie catastrophe is what might follow the next day – a recent study said drinking more than three large glasses of wine can push people to consume up to 6,300 extra calories in the following 24 hours. The survey found that around half of people consuming over 9 units consumed an extra 2,051 calories the next day on top of their usual diet. In addition, many stayed in bed, watching TV and using social media while hungover – instead of doing anything active.

Of course the additional downside is that alcohol calories are empty calories – there is not real nutritional value. So no, cider does not count towards your five a day!

Adding it all up…

So the alcohol calorie catastrophe can be a quadruple whammy of:

  • The calories in the drink itself
  • The extra calories consumed due to alcohol induced hunger (or perhaps loss of self-control!)
  • Alcohol reducing the amount of fat the body burns for energy
  • The extra calories consumed or not burned the following day

So it’s not surprising that many people might be more motivated to cut back on the drinks for reducing calories above reducing longer term health risks. This might be especially true for younger people, where more immediate issues like appearance or saving money might have stronger appeal.

One concern sometimes raised is young people aware of alcohol’s high calorie content opting to skip meals to compensate. Certainly a worrying issue and unfortunately sometimes there is little parents or professionals can do to prevent young people taking such risks. But adopting motivational brief intervention approaches, supporting and encouraging a person to reflect on the pros and cons of any risky behaviour can help.

But generally, cutting back on alcohol consumption for reducing calories can still bring many other benefits. When it comes to changes in drinking, it’s often a world of vicious -or virtuous – cycles.

Aim for an extra ‘alcohol free day’?

5 May
Mocktail anyone?

Mocktail anyone?

‘Brief advice bullets’ are motivators or tips to offer to people contemplating cutting down their drinking, like improved sleep, switching to lower strength drinks or reduced hangovers. However one of the most achievable goals for many drinkers seems to be to aim for an extra alcohol free day or two within the week.

Adding an extra alcohol free day often works best for those who have got into a ‘regular’ drinking pattern, perhaps without realising it.  The biggest trend in alcohol consumption has been the rise in home drinking, often synonymous with ‘a glass of wine to relax at the end of the day’.

Many such drinkers may have assumed that because they are not ‘binge drinking’, there are not significant health risks. Yet someone drinking an average of 2 medium glasses of 13% wine each night is clocking up around 32 units a week. Adding just two alcohol free nights will bring that down to around 23 units, much closer to the weekly guideline of 21 for men.

However since the recommended guidelines were changed from a weekly to a daily guideline, one of the concerns is that the message of at least two alcohol free days has been lost. Do most people realise that ‘not regularly exceeding 2 to 3 units (women) or 3 to 4 units (men)’ means having at least two nights of a week off the sauce? Even drinking five nights of the week within the daily guidelines seems a little too close to a ‘habit’ for my comfort. Perhaps the forthcoming change to the alcohol consumption guideline will better account for alcohol free days.

Of course like all ‘ brief advice bullets’, aiming to add an extra alcohol free night or two won’t appeal to everyone. But over the course of a week, a month, a year.. those health, financial or functioning improvements could really add up.

Making Every Contact Count for alcohol… not always IBA

17 Mar

MECCIn this guest post, Deryn Bishop, Health Behaviour Specialist, explores why the Making Every Contact Count is important, and doesn’t always mean doing IBA.

Much has been written regarding the effectiveness of alcohol interventions, brief or otherwise. Recently some of the concerns about the delivery of what has come to be known as “IBA-Lite” have been highlighted, particularly following the publication of PH49 Behaviour Change: Individual Approaches, which states:

Recommendation 9:  Encourage health, wellbeing and social care staff in direct contact with the general public to use a very brief intervention to motivate people to change behaviours that may damage their health. The interventions should also be used to inform people about services or interventions that can help them improve their general health and wellbeing. Encourage staff who regularly come into contact with people whose health and wellbeing could be at risk to provide them with a brief intervention. (The risk could be due to current behaviours, sociodemographic characteristics or family history.)

The use of the term “very brief intervention” may at first glance seem to be a deviation away from the recommendation of “Clarifying alcohol brief interventions 2013 update” which discussed concerns about diluting alcohol brief advice (IBA).

As a member of the Development Group for the  above NICE Guidance, I can assure readers that much discussion was had regarding the evidence supporting behaviour change techniques, and we upheld the view that workforce staff should be properly trained and supported to deliver interventions appropriate to their role or to the environment within which they work. The existence of very brief interventions in no way assumes that it is only the minimal intervention that should be offered, where there is the opportunity to offer a more in-depth intervention.

One concern I have about the Clarifying Brief Interventions briefing is it’s continuance to use the word “patient”, even within the case study chart at the end of the document. My viewpoint would be that in any situation where staff are having a conversation with a “patient”, there surely must be the opportunity to deliver IBA as the minimum.

Making Every Contact Count (MECC) is about developing the larger public health workforce to look for opportunities to empower the people whom they meet, whatever health behaviour it is concerning.

MECC brief advice describes a short intervention, which may last from one to 3 minutes, delivered opportunistically.

It may differ from “IBA Lite” however. “IBA lite” is comprised of a screening process but is “lite” because of the absence of Brief Advice or a full AUDIT.

A “MECC” conversation, as delivered by a Community Police Officer, or a Trading Standards Officer, or as part of a conversation from one colleague to another, where an opportunity to raise awareness about alcohol has proffered itself, may not include a screen, even one as short as SASQ. One can easily see that in these circumstances it is inappropriate to whip out a screening tool. That is not to say, however, that the understanding of how to assess risk has not been part of the MECC training, and that an assessment of risk is not implicit.

In MECC training, frontline staff gain the capability and confidence to assess risk, to deliver feedback that it pertinent and salient to the person with whom they are conversing, and to encourage the person to consider the benefits of making a change. Staff working in situations where a conversation may open a door to a more in-depth intervention, should also feel confident and capable to move into a brief intervention (as say a worker engaged in a home assessment, for fire risk, for health and safety concerns or whatever, who has the time and skills to go a little further with the conversation).

There is an excellent MECC Competency Framework that sets out in detail the knowledge and skills base required to deliver MECC effectively (Y and H MECC competency framework), whatever the level of intervention.

As a MECC trainer I strongly believe that the quality of the intervention is paramount, whatever the length.

MECC is one way in which we can  “shape the way citizens are involved in their own health and well-being” (What Local Authorities Need to Know about Public Health: South et al Feb 2014);  we should encourage all staff to consider how and when they can best be advocates of healthier lifestyles.

Deryn Bishop is a trainer for The Training Tree, specialising in health behaviour change. You can contact Deryn at deryn.bishop@live.co.uk.

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

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.