Tag Archives: health

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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The Evidence of Effectiveness & Minimum Standards for IBA in Community Health Settings

31 Mar

A new document outlining the evidence for IBA and standards for delivery in a range of settings has been released. Commissioned by the Safe Sociable London Partnership, the document provides an overview of the evidence base for IBA as a short ‘brief intervention’, and suggests how it should be delivered in key community health settings.IBA evidence and standards_community health

The Evidence of Effectiveness & Minimum Standards for the Provision of Alcohol Identification and Brief Advice in Community Health Settings [pdf]

‘Identification and Brief Advice’ has been central to England’s alcohol policy, particularly given its effectiveness in comparison to other individual level interventions. Brief intervention is most likely to ‘work’ because a combination of ‘identifying’ a level of risk – and ‘feedback’ to the drinker to inform them of this – may trigger a process of change.

In contrast, just handing someone a booklet means even if it is read, a risky drinker may not realise the information is relevant to them and assume they are fine. Brief advice may also give added benefits, such as helping build a person’s motivation or belief in their ability to change.

As such, the guides summarises the evidence base behind IBA, for example it states:

“On average, following intervention, individuals reduced their drinking by 15%. While this may not be enough to bring the individual’s drinking down to lower risk levels, it will reduce their alcohol-related hospital admissions by 20% and “absolute risk of lifetime alcohol-related death by some 20%” as well as have a significant impact on alcohol–related morbidity.”

As well as setting out an interpretation of how IBA should be delivered, it provides specific suggestions and statements for key community health roles including:nurse IBA

  • Primary Care Staff
  • Community Pharmacists
  • Midwives and Health Visitors
  • Mental Health Service Staff
  • Drug Service Staff
  • Delivery by Sexual Health Workers

The report also addresses the crucial issue of ‘making it happen’ through what it describes as ensuring ‘organisational ownership’, as well as the need for training, materials and inter-linking IBA with related issues and policy.

Some of the statements within the report will still be subject to debate. In particular, exactly what ‘brief advice’ consists of, and whether IBA should be implemented in all community health settings without more setting specific evidence.

Exactly what ‘IBA’ is as a form of brief intervention has been explored in the ‘Clarifying brief interventions’ briefing [pdf], and IBA in non-health settings has been explored in recent research report.

Why ask staff about drinking in the workplace?

22 Feb

First, a bit about me: I’ve worked in alcohol addictions, counselling, policy and research for   over 20 years. I’m now interested in how to support employers and employees to reduce alcohol harm through the workplace.

I’d like to start with an overview: 36 million people are in work in the UK and we know that the majority of problem drinkers are also in employment and do not seek help or treatment. This is probably due to two reasons – firstly, while drinking above recommended levels carries health risks the symptoms of alcohol misuse can remain undetected for some time. This means increased-risk or high-risk drinkers can still work as normal, appear to be their usual selves and even do well at work.

In organisations where drinking is part of the culture, it may appear wholly normal that colleagues drink both moderately or heavily together and turn up to work the next day, possibly complaining of a sore head. This is par for the course in what I would call a ‘pro-drinking’ culture such as ours and across Europe where drinking levels are the highest in the world. Drinking among colleagues – or a circle of colleagues – is therefore seen as culturally acceptable and valued. However, if the drinking is at increased risk levels, then organisations need to reflect on how to tackle this, as alcohol misuse among staff is bad for business. The other trend is for employees to simply drink at home after work, enjoying a relaxing drink after the pressures of the day. In this situation it is often difficult to keep track the number of units consumed and home servings can be more generous than pub measures.

The second reason why problem drinkers can continue undetected at work is that for many the stigma of acknowledging a problem with alcohol prevents people from discussing it. The last thing an employee would want to acknowledge to their employer is that they have a drink problem. It may also be hard to discuss this openly with colleagues or even friends or family. The evidence shows however that the longer heavy drinking occurs, the more likely that drinking will become habitual or even dependent.  People who are already drinking at moderate to higher levels can often turn to heavier drinking when faced with stressful life events such as marriage difficulties, stress or problems at work or financial worries.

HR and Occupational Health professionals charged with improving health and wellbeing at work, will be all too familiar with cases of alcohol abuse in the workplace. The problem is they usually only get to know about this when the drinking has already reached a critical point and employees’ work is now being affected by alcohol. Disciplinary action may now be needed and the chance of retaining that employee at work is now reduced.

There is a simple solution to this. There is now excellent evidence that simply asking people about their drinking – using standardised alcohol screening tools – in a non-confrontational way supports greater understanding and awareness of the risks of heavy drinking, prompting at-risk drinkers to cut down through greater self-awareness alone. The AUDIT tool (covered in this blog earlier in the year) has been recommended by NICE for practitioners to use. There is no reason why the workplace cannot also be a place where staff are able to discover if their drinking is within government guidelines. Employers have long supported staff to stop smoking, check blood pressure and get fit. Alcohol seems to have been left off the list.

HR and Occupational Health professionals have a unique opportunity to think through how these conversations can be promoted at work and I’ll be blogging about this issue in the weeks and months to come.

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

IBA ‘mystery shopping’ experiences: the good, the bad and the…

12 Sep

Recently I posted about opportunities to ‘mystery shop’ IBA when signing up to new GP practice. Whilst there are some issues to consider, generally I think this can be a really valuable way to make a difference. As we seem to know IBA is often poorly delivered in Primary Care, so we need to take every opportunity we can to help improve it.

So here is summary of some of my three actual ‘mystery shopping’ experiences, which interestingly ranged from good to bad. And something in-between…

Continue reading

‘Mystery shopping’ for IBA in Primary Care?

14 Aug

Chances are that if you sign up to a new GP practice any time soon you’ll be given the chance to answer some questions about your alcohol use. If you’re reading this, chances are you’ll also probably know more about IBA than the person asking you the questions, or following them up. This presents a unique opportunity to unofficially ‘mystery shop’ and see what’s really happening out there in practice. If it’s bad, coming clean and providing some feedback could make all the difference, as I’ve found out. Continue reading

Brief advice bullets: try lower strength drinks?

12 Jul

As recently explored, highlighting the negative impact of alcohol on sleep is a winner for motivating risky drinkers to cut down. But punchy ‘brief advice’ strategies to actually help the drinker to do so are perhaps a bit harder to find. Many people may be unenthusiastic about to switching to weaker drinks or alternating with soft drinks.

So can lower-strength drinks play a role in reducing consumption? A recent report from John Moore’s University has urged caution from a policy perspective. It found that although lower strength drinks will help reduce harm where people swap them for stronger drinks, they may also create more drinking occasions where alcohol consumption is introduced. For instance, a weaker lager may make a lunchtime tipple more acceptable.

This conveniently reminds us that keeping an eye on the number of drinking occasions we have, as well as how much we drink when we do, is key for keeping as close to lower risk drinking as possible. But actually I did recently try a 2.8% ‘extra pale’ lager that was actually quite satisfactory. Not something I was expecting if I’m honest!

How to decide what to do, whatever the evidence.

7 Jun

At the recent Cyrenian’s conference on the potential for delivery of alcohol brief interventions in untested or unproven community settings, Dr. Andrew Tannahill’s presentation with the above title, may be of interest. Rather than an ‘evidence rules’ approach decision-making, his thesis (part of his work for NHS Health Scotland) advocates 10 principles to underpin an ethics-based approach to deciding how to improve population health and reduce health inequalities. The alternative motto of this approach, he claims is ‘ethics rule: evidence serves’.

Importantly, evidence remains an important part of the decision-making framework, but so does logic and theory about the probable and possible impact of any decision or intervention made. The 10 principles can be organised into 3 categories:

1. Four principles fundamental to main health outcomes and how the organisation goes about its
business: Do good, Do not harm, Fairness, Sustainability
2. Five principles to do with other outcomes and/or how the organisation goes about its business:
Respect, Empowerment, Social responsibility, Participation, Openness
3. Principle of Accountability – for consequences of decisions and actions, use of resources, value for
money, etc

Dr. Tannahill’s presentation goes through each of the principles and considers how it might be applied to the rollout of IBA in new or untested settings and is well worth a look.  You can also read his journal paper on the framework.

Personally, I find it offers an answer to concerns I have had about how to balance the need for evidence with the great need to do something effective about alcohol consumption.  A solely evidence based approach is not always possible – many, many aspects of what we do are not evidence-based, and it seems to me unlikely that we will ever have really robust, hard evidence for many ‘interventions’ by many practitioners.  Dr. Tannahil’s approach offers part of the answer.  A shorter answer may be that – if we choose to do new things – we have a responsibility to contribute to knowledge about them – by clearly describing why and how and what happened – and to be honest with ourselves and others about exactly what the level of evidence is.