Alcohol Policy UK

Recent Findings bulletins: combine medications for depressed drinkers, brief intervention - a population approach?, mental health, 12 step & more

Recent bulletins and hot topics from the drug and alcohol bank:

Combine medications for depressed dependent drinkers

First evidence that combining sertraline for depression with naltrexone for drinking is more effective than either medication alone when dependent drinking is complicated by clinical depression.

Hot topics:

Can brief alcohol interventions improve health population-wide?

In Britain the ambition to implement universal screening of adult primary care patients has been scaled back to targeted screening of new patients or those thought possibly at risk. Unchanged was the insistence that risky drinkers should then be offered brief but well structured and scientifically developed advice. Then came the government-funded SIPS project, which called both targeted screening and the need for advice in to question.

Mental illness and substance use: which is chicken, and which egg?

With as many as three quarters of their clients suffering from mental health problems, deciding how to respond is a major and long-standing concern for British drug and alcohol services. Should they or psychiatric services take the lead, and should dependence be treated first, or treatment run in parallel?

Can 12-step mutual aid bridge recovery resources deficit?

Paralleling the rise in abstinence-based recovery in UK national strategies has been a rise in the profile of the best-known programme for achieving this – the 12 steps of mutual aid fellowships and allied treatments. For the UK, these offer a way to reconcile diminished resources with the desire to get more patients safely out of treatment, but is the resurgence of interest matched by evidence of effectiveness?

Job opportunity – Findings editorial assistant

Drug and Alcohol Findings is seeking a full-time Editorial assistant to work with the Editor collecting and analysing research evaluating treatment and prevention interventions. Read more about job requirements and application process here [pdf] - closing date 13th July.

Alcohol Research UK reports: 2014 review, Online Health Check for Employees, AUDIT accuracy tested

Recent Alcohol Research UK funded reports, and a review of their 2014 activity have been released:

Alcohol Research UK: Spotlight 2014

This review describes Alcohol Research UK's recent research, achievements, events and initiatives and also looks to the year ahead. It includes an overview of the key flagship grant projects as well as PhD and small grants support. Download here [pdf].

Online health check for reducing alcohol intake among employees

New research funded by Alcohol Research UK and Balance North East suggests workplace health screening and feedback is feasible. The conclusion states challenges include low participation rates, potentially attracting ‘worried well’ employees rather than those at greatest health risk, and less acceptance of the approach among older employees and those from ethnic minority backgrounds and routine or manual occupations.'

Accuracy of Alcohol Use Disorders Identification Test (AUDIT) for detecting problem drinking in 18 to 35 year olds

'The use of AUDIT in primary care screening is widespread. This report analyses how AUDIT scores can be used most effectively to identify a range of alcohol problems, taking into consideration gender differences. It identifies a number of optimal scores at which patients might be considered for further interventions, while recommending that doctors consider approaching such scores less as absolute ‘cut-points’ than as a starting point for patient dialogue.'

Assessing the role that entertainers play in alcohol marketing and the maintenance of good order within on-trade licensed premises

'This study suggests that the relationship between alcohol and live entertainment is culturally embedded in the UK. When combined, alcohol and entertainment (e.g. music) can alter moods, of crowds and individuals, often in a pleasurable direction, for example the idea that drinking and dancing go in tandem... Thus, on-trade entertainment provision could provide an alternative attraction for nightlife patrons instead of mere intoxication, and alternative income for venues (e.g. entry fees or more attendance, a selling-point over the off-trade) as opposed reliance on alcohol provision alone.'

Lead author of the report Dr Alasdair Forsyth, Glasgow Caledonian University, will be discussing the findings at various forthcoming events - contact for more information.

A Measure of Change: The impact of the public health transfer on local alcohol provision

Alcohol appears increasingly to be a public health priority and in many local areas the new structures are facilitating joined-up working. However, treatment providers are concerned about future funding. Alcohol Concern previously released the report.

See here for all Alcohol Research UK publications.

Latest from the IBA blog: evidence & standards, setting achievable goals, 'binge drinking' considerations, GPs & more

The alcohol IBA blog was set up to promote understanding and the delivery of IBA through news, links and ideas on IBA. 

Recent posts from the IBA blog include:

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

A new document outlining the evidence for IBA and standards for delivery in a range of settings has been released... read more here.

 

Setting achievable goals & the ‘dose effect’ 

Mentioning either ‘units’ or the ‘guidelines’ alone can trigger a sceptical response from a drinker. I’m sure you’ve heard someone protest that “units are confusing”... read more here.

 

Can we quit “binge drinking”?

‘Binge drinking’ is probably the defining alcohol term of the last few decades... As such, people often frame their ideas of problem drinking around ‘binge drinking’ (and of course ‘alcoholics’). Both potentially problematic terms.. read more here. 

 

IBA for young people: a promising picture?

A common question about IBA is ‘does it work for young people?’... two new publications have reviewed the evidence.. read more here.

 

Other recent posts also include:

• Delivering alcohol IBA in non-health settings?

• Mind the credibility gap: 5 insights to give ‘binge drinking’ public health interventions more punch
  

• Should we ease off GPs not doing alcohol IBA (properly)?

 

See here for the previous round-up from the IBA blog which also has specific 'About IBA' and 'IBA tools' pages, and also aims to highlight other resources such as INEBRIA and the Alcohol Learning Centre IBA pages. Please get in touch if you have any IBA projects or ideas to share. 

GP 'brief intervention' incentive for new patients to end - a blow for IBA?

General Practice will no longer be incentivised to deliver 'Identification and Brief Advice' (IBA) for new patients from April next year following changes announced to the General Medical Services (GMS) contract.

Instead of the alcohol Direct Enhanced Service (DES) funding, NHS Employers states 'the associated funding will be reinvested in global sum' - the total amount paid to Primary Care. It will then be a 'contractual requirement for all practices to identify newly registered patients drinking alcohol at increased or higher risk levels'.

On the one hand, this means all practices will be obliged to identify at-risk drinkers when new patients join a practice. On the other, removing the requirement to record 'identification' to generate the payment will presumably not help focus attention on IBA. Nor will the changes help address questions over whether 'identification' of at-risk drinkers actually results in patients receiving 'brief advice', although the current DES guidance states it is for local commissioners to quality check.

NHS England have committed to monitoring recorded activity via the General Practice Extraction Service (GPES), so will be able to assess the impact of the change.

The alcohol DES: 2008-2015

Since 2008, practices have been able to take part in the alcohol 'Direct Enhanced Service' (DES) and claim a payment (currently £2.38) for each new patient screened using a validated initial 'identification' tool such as the FAST or AUDIT-C. Originally only planned for two years, the alcohol DES was then extended each year. However its value has been much debated with questions over whether the scheme has actually resulted in sufficient quality IBA, or led to a 'box ticking' exercise to generate a payment.

One often raised issue is that the DES payment is collected when a patient completes FAST or AUDIT-C and recorded by the practice, regardless of the score or 'brief advice' being delivered. The original guidance only stated that practices 'should' subsequently complete a full AUDIT and offer brief advice to at-risk drinkers, or referral for those indicating dependency. Not surprising then that recording of 'brief advice' or 'referral' activity on the same systems usually appear significantly lower.

In 2011 Haringey's local alcohol service HAGA produced a comprehensive DES report after finding 75% of local practices were using incorrect screening questions, and that only 50% of practices were offering face-to-face Brief Advice. Informal mystery shopping accounts also indicate a very mixed picture - some practices may simply hand out screening tools without any follow up, whereas some might ensure staff are suitably trained and appropriate pathways are in place.

In fairness to the limitations of the DES, wider pressures on Primary Care roles, as well as broader attitudinal barriers around alcohol are also likely to be significant. Meanwhile IBA has been integrated as part of the NHS Health Checks programme and is increasingly being delivered by Community Pharmacies.

Where next? 

Clearly there is some way to go before we are likely to see a picture of quality IBA being routinely delivered in Primary Care. Research points to the importance of incentives, but it is also clear that more than incentives alone are required - training, pathways and organisational and other factors also crucial. Little has been done to really explore what would further motivate belief in the value of IBA by busy frontline roles.

Meanwhile the role of IBA in local alcohol strategies seems increasingly popular as it continues to be sought in a range of further settings where the evidence is less clear. Also under question is whether more minimal or 'lite' versions, online approaches or other channels of engaging at-risk drinkers can be considered as 'evidence based' approaches to 'brief intervention'...

For more see the IBA blog, Alcohol Learning Centre, INEBRIA, or the 2013 'Clarifying Brief Interventions' briefing.

Latest from the IBA blog: Are GPs doing enough?; IBA in non-health settings; 5 insights for alcohol interventions; IBA for young people? Primary Care case study

The alcohol IBA blog was set up to promote understanding and the delivery of IBA through news, links and ideas on IBA. 

Recent posts are highlighted below:

• Should we ease off GPs not doing alcohol IBA (properly)? Primary Care is the key setting for IBA...but.. is there any point in organising good IBA training, resources and pathways if there’s no interest in taking them up? .. read more here.

• Delivering alcohol IBA in non-health settings? In this guest post Dr Fizz Annand takes a quick look at recent research exploring alcohol brief intervention as ‘IBA’ in non-health settings...read more here.

• Mind the credibility gap: 5 insights to give ‘binge drinking’ public health interventions more punch  In this guest post John Isitt reports on some of the key lessons learned from local work to reach at-risk drinkers beyond IBA... read more here.

• IBA for young people: a promising picture?  A common question about IBA is ‘does it work for young people?’ – a straightforward answer isn’t easy, though we are getting closer...read more here. 

• IBA Primary Care case study: a rare new example A new case study provides a rare but valuable insight into a local effort to properly implement IBA and supporting pathways into a busy GP practice.. read more here.

The blog also has specific 'About IBA' and 'IBA tools' pages and also aims to highlight other resources such as INEBRIA and the Alcohol Learning Centre IBA pages.

Please get in touch if you have any IBA projects or ideas to share.

Alcohol Interventions in Primary Care & Beyond: Leeds PHE conference presentations

Earlier this year a conference exploring 'alcohol intervention in Primary Care & beyond' took place in Leeds. The event aimed to look at interventions from Identification & Brief Advice (IBA) to treatment models within Primary Care. Topics also included ambulance pathways and the broader evidence and policy base.

Presentations from the day included:

• 'Alcohol messages for Primary Care' - Don Lavoie, PHE [ppt]

• 'Alcohol within Primary Care in the North East' - Neil Martin, Balance [ppt]

• 'Developing an Alcohol pathway pilot in primary care' – Dawn Scott & Guy Pilkington, Newcastle CCG [pdf]

• 'Strengthening the IBA evidence base' - Amy ODonnell, Newcastle University [pdf]

• 'IBA in Pharmacies for Women Accessing Emergency Contraception (EHOC)' - Dawn Cruickshank, Durham [ppt]

• 'Implementing an alcohol referral pathway: Ambulance service experience' - Cathryn James & Tom Heywood, Yorkshire Ambulance Service [ppt]

• 'The Stockton-On-Tees Solution: A model for the delivery of alcohol services in Primary Care' - Jo Heaney [ppt]

• 'Intelligent Commissioning in Alcohol Services: Beyond the Units…' - Dr Graham Sanderson

The event was organised by Public Health England who also co-delivered events earlier this year on alcohol treatment and NICE standards.

The event demonstrated although some good practice was taking place, nationally there appears some way to go before quality alcohol interventions are being routinely offered in Primary Care. A continued point of discussion appeared to be the long running issue of the differences between brief intervention approaches and treatment interventions - something addressed in the revised Alcohol Academy 'Clarifying Brief Interventions' briefing.

Next month, the SMMGP 9th National Primary Care Development Conference looks at "Treating Alcohol and Drug Problems in Primary Care" - Thursday 23 October 2014, Birmingham - details and booking here.

See here for further forthcoming alcohol events including the Alcohol Concern annual conference.

Alcohol Research UK reports: IBA in non-health settings, Hospital 'Alcohol Health Workers' & Licensing and Public Health

Alcohol Research UK has published three new reports on key issues relevant to the alcohol field:

• Delivering Alcohol IBA: Broadening the base from health to non-health contexts

• A national study of acute care Alcohol Health Workers

• Using licensing to protect public health: From evidence to practice

The reports are findings from projects funded under Alcohol Research UK's research and development grants.

IBA in non-health settings?

The IBA in non health contexts report looks at the key issue of whether IBA as alcohol brief intervention can or should be delivered outside of more recognised health contexts like Primary Care. The evidence may be limited, but given the central role of IBA delivery across much of the UK, attempts are being made to integrate IBA in a wide range of settings.

The report suggests there is potential to for alcohol IBA to be delivered in a range of health and non-health settings, although 'organisational, professional and context- specific challenges impede implementation'. Certainly those in the field know well the difficulties of ensuring IBA takes place in practice, and even training, monitoring or incentives do not guarantee good routine delivery. One key finding: 'evaluation and monitoring should be built in to new initiatives to ensure appropriate use of resources and to promote a culture of learning from practice'.

Read the alcohol insight here or the full report.

Alcohol Health Workers - the national picture?

Another key strategy area is the employment of 'Alcohol Health Workers' (AHWs) in hospitals, as this report reviews. 45 out of the 48 hospitals responding to the survey had at least one dedicated AHW, but the services were 'frequently precarious, with limited management support, short-term funding and a lack of ownership from key agencies'.

As such the services are highly varied in terms of function, capacity and even target group. 'AHWs tended to migrate up the alcohol problem gradient, working with dependent drinkers rather than undertaking or encouraging identification and brief advice'. Although some correlation between services and high admissions were found, AHWs are more likely to be found in areas where alcohol is a broader strategic priority. Assessing the impact is a particular challenge, as such there is 'a need for an urgent need for more sophisticated outcome evaluations in this field.'

Read the alcohol insight here or the full report.

Using Licensing to Protect Public Health?

Another highly relevant area in UK alcohol policy, this report looked at work mainly in Scotland around improving knowledge and dialogue relating to public health and licensing. The study identifies the importance of the availability of alcohol as a key influence on consumption, hence Scotland's unique licensing objective “to protect and improve public health”. As part of this, using health based data to act on areas at risk of 'overprovision' is part of the statute.

However, in practice the use of Scotland's legislative levers face a number of challenges. One finding suggested 'confidence in the ability to gather, analyse and interpret the necessary information, including health data to inform effective regulation, was relatively low, suggesting the need for support'. A finding consistent with Scotland's own MESAS evaluation, but continuing to build 'capacity to promote and support using licensing to protect public health' should be undertaken.

Read the alcohol insight here or the full report.

Latest from the IBA blog: IBA training app; calories & alcohol; alcohol free days; making every contact count & more

The alcohol IBA blog was set up to promote understanding and the delivery of IBA through news, links and ideas on IBA. 

Recent posts from the IBA blog are highlighted below:

• IBA training app released
  An IBA training app was recently released on the apple store, Google play and also on the amazon app store.... Read more here..

• The alcohol calorie catastrophe
  A single drinking occasion can lead to a multiple calorie catastrophe that can really undermine attempts at weight loss or healthy lifestyles.... Read more here..

• Aim for an extra ‘alcohol free day’?
  Adding an extra alcohol free day often works best for those who have got into a ‘regular’ drinking pattern..  .Read more here...

• Making Every Contact Count for alcohol… not always IBA
  In this guest post, Deryn Bishop explores why the Making Every Contact Count is important, and doesn’t always mean doing IBA... Read more here...

• Should Drinkaware support IBA?
  Drinkaware, the industry funded education charity have recently showcased some projects focused on behaviour change. However ‘where does IBA fit in?’... Read more here...

The blog also has specific 'About IBA' and 'IBA tools' pages and also aims to highlight other resources such as INEBRIA and the Alcohol Learning Centre IBA pages.

Please get in touch if you have any IBA projects or ideas to share. 

Online interventions and IBA apps: web based alcohol resources for public and professionals

The availability of online alcohol resources for both individuals and professionals  continues to rise, but raises some questions over the exact role these should play in helping prevent and support those with alcohol problems.

Generally evidence seems to suggest an important role to play for web based interventions, but not as a substitute for face to face services or brief intervention. There is also less research on more recently popular phone apps and online brief intervention approaches than for more established approaches intended for addressing dependent drinking. 

Resources for individuals

The appeal of reaching straight to the public via apps and online resources is clear. Most people who recover from alcohol problems do so mainly 'on their own', and there are big questions over the implementation of face to face brief intervention by health and social care roles. Identification and Brief Advice (IBA), as a simpler form of brief intervention, also appears to lend itslef well to simple online tools or apps.

Don't Bottle It Up! www.dontbottleitup.org.uk

Don'tBottleItUp! offers users a simple online 'IBA' approach based on the gold-standard AUDIT screening tool and providing personalised brief advice.

Drinks Meter  www.drinksmeter.com

The drinks meter app provides feedback based on AUDIT and other questions, also comparing the users answers against the Drinks Meter community to give unbiased, anonymous feedback.

Down Your Drink www.downyourdrink.org.uk

Down Your Drink (DYD) is a longer established online programme based on AUDIT and also including an extended programme. User registration required.

Change4Life 'drinks swap' & checker

As part of the Change4Life campaign, a Drinks Checker page and app are available, allowing the user the check their calories, units and risk level.

MyDrinkaware via www.drinkaware.co.uk

Drinkaware is the alcohol industry funded education charity that allows users to track their drinking, calories and progress cutting down via MyDrinkaware.

NHS Choices www.nhs.uk/LiveWell/Alcohol

NHS Choices offers a comprehensive range of resources including a drinks tracker for iphone users, and an online self-assessment based on the AUDIT, as well as a local service directory.

Resources for professionals - IBA training app

An IBA training app was recently released on the apple store, Google play and also on the amazon app store. The app offers a shorter alternative to the 2 hour online IBA e-learning with more focus on visual IBA scenarios.

See here for a comprehensive list of alcohol support options or call Drinkline, the free national alcohol helpline if you're worried about your own or someone else's drinking on 0300 123 1110 (weekdays 9am – 8pm, weekends 11am – 4pm). 

Latest from the IBA blog: beware 'IBA lite'?, can 'nudge' help IBA?, Selincro & IBA, & more

The alcohol IBA blog was set up to promote learning, understanding and the delivery of IBA through news, links and ideas on IBA from a range of contributors. 

Recent posts from the IBA blog are highlighted below:

• Clarifying Brief Interventions: 2013 update – beware ‘IBA lite’?  The recent briefing looked at 'IBA lite' as increasingly popular, reflecting its simplistic appeal. But what opportunities are being lost if we are offering just a leaflet and not 'brief advice'?.. Read more here...

• Can ‘nudge’ help IBA delivery?  There may be some simple ‘nudges’ for supporting IBA delivery that are being overlooked. This blog explores what 'nudge' is and how some 'nudges' might help increase IBA activity...Read more here...

• Selincro & IBA  Selincro or 'Nalmafene' is a new drug for treatment of mild to moderate dependence in conjunction with psychosocial interventions. This post raises some very important issues and concerns – about medicalisation, and how appropriately the drug will be used in practice.... Read more here...

• Are we using social media enough to enhance alcohol working?  What missed social media opportunities are there for using Twitter, Facebook and the likes to promote substance misuse work?... Read more here...

• IBA – before addiction sets in…   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. Read more here...

Other key IBA blog posts include:

• Full AUDIT screening Vs shorter tools (FAST, AUDIT-C etc) for IBA
• IBA – making it happen?
• SIPS Primary Care Research: not just a leaflet
• Step-by-step IBA (in a nutshell)

The blog also has specific 'About IBA' and 'IBA tools' pages and also aims to highlight other resources such as INEBRIA and the Alcohol Learning Centre IBA pages.

Please get in touch if you have any IBA projects or ideas to share.