Alcohol Policy UK

NICE publish guidance on 'Behaviour change: individual approaches (PH49)'

NICE have released new guidance to promote and support individual level behaviour change. The guidance makes seventeen recommendations covering policy, commissioning and practice aspects of implementing individual 'behaviour change' interventions relating to alcohol, diet, physical activity, sex and smoking. 

Although 'Behaviour change: individual approaches (PH49)' clearly advocates the importance of brief intervention for all health behaviours, it does not refer explicitly to 'Identification and Brief Advice' (IBA), the most common term for alcohol specific brief intervention in England.

The guidance advocates as recommendation 9 the delivery of very brief, brief, extended brief and high intensity behaviour change interventions and programmes. However questions over the evidence for 'very brief interventions' for alcohol were highlighted by the recent Clarifying Brief Interventions: 2013 update. Although recognising that such 'IBA lite' approaches may be easier to implement, it suggested that full IBA should still be sought as a minimum standard. The NICE guidance is likely to recommend very brief or 'lite' intervention approaches largely on the basis on evidence supporting very brief smoking interventions.

Discussions around improving the delivery of alcohol IBA often include questions over how other behaviours should be addressed. Harmful or risky health behaviours are often closely inter-linked, so front line roles should be able to carry out brief intervention for any of the key health behaviours. This is largely the goal of the 'Making Every Contact Count' (MECC) agenda.

However those championing IBA may point out concerns that alcohol too often gets 'left out', despite alcohol brief intervention probably being the most cost-effective. Practitioners have sometimes reported being less willing to raise the issue of alcohol compared to smoking, diet or exercise. There is some way to go before good quality, individual level behaviour change interventions are routinely carried out, and still lessons to be learned as to what exactly works best.

See here for the Alcohol IBA blog, Alcohol Learning Centre IBA pages, NICE alcohol guidance and NICE Behaviour change: the principles for effective interventions (PH6).

'Clarifying alcohol brief interventions: 2013 update' - caution over 'IBA lite' approaches?

A new briefing Clarifying alcohol brief interventions: 2013 update [pdf] has been released by the Alcohol Academy. It updates the 2010 briefing to account for new developments in the field and key issues relating to the national implementation effort.

In particular, the briefing paper explores 'IBA lite' or 'minimal brief intervention' - an approach whereby at-risk drinkers are offered only feedback and a leaflet, as opposed to structured brief advice offered as part of IBA. Such 'minimal' or 'lite' approaches appear to have been increasingly popular, in part following the SIPS Primary Care findings which did not show better outcomes for longer intervention approaches.

The appeal of shorter approaches is understandable given the real world challenges for routine IBA delivery, particularly time pressures on busy front line roles. However the briefing cautions that although 'lite' approaches may be easier to achieve, there is a risk that brief intervention will be prematurely reduced to less than it should be. Therefore full IBA approaches, including the offer of verbal brief advice, should be sought wherever possible - but minimal approaches may be acceptable where not.

Another issue is whether shorter screening tools such as AUDIT-C or FAST can be used to lead straight to brief advice without first completing the full AUDIT. Shorter tools do not tend to differentiate risky drinking (suitable for brief advice) from probable dependent drinking (suitable for referral). Again the answer is not clear cut - ideally full AUDIT should always be used, but if time or other issues prevent this there is still likely to be value in using shorter tools alone to lead to brief advice.

The paper includes a table identifying the key brief intervention approaches and differences, now including exploration of 'minimal' or 'lite' approaches. The briefing was co-authored by Professor Nick Heather, Don Lavoie and James Morris.

For more on IBA see the IBA blog or Alcohol Learning Centre.

Findings bank alcohol 'matrix bites' cover brief interventions

Following the release of the Alcohol Matrix, the first in a series of 'matrix bites' have been released the Drug and Alcohol Effectiveness Bank  on the theme of alcohol screening and brief interventions, often known as 'IBA' in England.

• Matrix Bite 1: Alcohol: Screening and brief interventions  explains that screening and brief interventions usually aim to reduce alcohol-related harm across a population of drinkers rather than focusing on dependent individuals
• Alcohol Matrix Bite 2: Practitioners; Screening and brief intervention looks at whether impact depends on the interpersonal style and other features of the person doing the counselling  
• Alcohol Matrix Bite 3: Management/supervision; Screening and brief intervention looks how implementation and impact are affected by the management functions of selecting, training and managing staff and managing the intervention programme
• Alcohol Matrix Bite 4: Organisational functioning; screening and brief intervention looks at how implementation and impact are affected by how the organisation responsible for the programme supports managers, supervisors and staff, and creates an environment conducive to screening and brief intervention.
• Alcohol Matrix Bite 5: Treatment systems; screening and brief intervention  looks at how implementation and impact are affected by commissioning, contracting and purchasing decisions across an administrative area.

The drug and alcohol matrixes were recently released by the Drug and Alcohol Findings Effectiveness Bank for the Substance Misuse Skills Consortium to support practitioners, managers and commissioners to access the key research and evidence. The weekly Matrix bites can be used as cumulating to a year-long foundation course on the evidence base for treatment and allied interventions.

An Alcohol IBA blog explores brief interventions news and ideas and the Alcohol Learning Centre has pages covering IBA links and resources. INEBRIA is the International Network on Brief Interventions for Alcohol and Other Drugs.

Latest from the IBA blog: Extended Brief Interventions (EBI) - losing out?; Sefton EBI case study; Talking or Testing?; IBA bullets - reducing hangovers?

The alcohol IBA blog aims to promote the delivery of IBA through news, links and ideas on IBA from a range of contributors.

Recent posts are highlighted below:

• EBI: lost in the shadow of IBA?   Over recent years there has been a strong policy focus on IBA as a simple brief intervention. A big issue though is whether Extended Brief Interventions (EBI) have been left in the shadow of simple IBA? Read more here

• An EBI case study: where are the rest?   An evaluation of an Extended Brief Alcohol Intervention (EBI) program called 'It’s Your Choice'. The aim was to reduce alcohol related harm in Sefton by providing EBI in the form of a one to one coaching service. Read more here

• Talking or Testing? Which is easier?  Following discussion about doctors objecting to IBA delivery on the grounds that it is ‘additional work', how can we get into the psyche of doctors if we want them to implement IBA? Read more here

• Brief Advice bullets: reducing hangovers?   Not everyone gets hangovers, but for those of us that are susceptible, one must assume they act as a powerful preventative agent. Is the appeal of reducing those painful after effects a useful ‘brief advice’ bullet for a risky drinker to contemplate? Read more here

See here for the June IBA blog round up or the January round up.

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. See here for the Alcohol IBA Twitter Updates (@Alcohol_IBA).

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

London Pharmacy IBA Scratch Card project

A pan-London pharmacy initiative that distributed over 24,000 'IBA scratch cards' has published a UCL evaluation report detailing the project. The report indicates the potential for community pharmacies to deliver lifestyle interventions.

Scratch-cards included the 3 AUDIT-C alcohol screening questions often used as part of 'Identification and Brief Advice' (IBA). Patients scoring 5 or more, indicating some level of alcohol misuse, were offered either a leaflet, brief advice or referral. The project however aimed only to establish the acceptability of a 'scratch-card' approach, rather than evaluate IBA effectiveness in pharmacy settings.

With nearly 44% of patients scoring positive (5 or more), over ten thousands patients were offered at least an information leaflet. 92% of patients offered a scratch-card completed it within the pharmacy and anonymous data was recorded. 3% of patients refused to complete the scratch-card and the remaining 5% took the card away.

The report found wide variation in activity across the 240 participating pharmacies. Pharmacies received a payment to cover implementation costs and a further payment was offered to those recording 200 interventions. Results showed the project captured a range of age, ethnicity and occupations and an even gender split, giving good representation of London's diverse profile.

Whilst the project undoubtedly generated significant activity identifying many at-risk drinkers, it does raise key questions relevant to the broader issues of implementing 'IBA' approaches. One issue is whether shorter screening tools such as AUDIT-C only are sufficient, or whether positive scores should always be followed up with full AUDIT - see discussion here.

In the case of this project, there appeared no method to determine whether leaflet, advice, or referral was offered to those scoring positively other than the pharmacist's discretion. The report acknowledges the nature of interventions were not recorded, but as other primary care findings would suggest, this was most likely to have been highly variable.

Such initiatives may therefore be valuable in continuing to develop opportunities for IBA delivery, but debate will continue as to what level of screening, intervention and quality needs to take place. Community pharmacies seem like an obvious IBA opportunity, but experts might point out there will be no quick wins in establishing regular, high quality IBA in any setting. The appeal of scratch cards and leaflets may be strong, but should not come at the expense of good practitioner skills and clear referral options.

Latest from the IBA blog: discussion forum launched; AUDIT Vs shorter tools; INEBRIA 2013; alcohol and the workplace; IBA - making it happen? & 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. 

The blog now has a discussion forum for anyone to share their views, comments or questions on any IBA issues. 

Recent posts from the IBA blog are highlighted below:

• Full AUDIT screening Vs shorter tools (FAST, AUDIT-C etc) for IBA The 10 question full AUDIT is the ‘gold standard’ screening tool for the identification of alcohol use disorders. But does IBA always require the full AUDIT to be completed Read more here...

• INEBRIA Conference 2013  The annual conference of INEBRIA is an excellent opportunity to hear the latest IBA research and practice developments - the 10th Annual Conference will be held in Rome on 19th and 20th of September 2013. Read more here...

• Supporting colleagues with drink problems  How do you respond when a colleague you respect is drinking at levels which affect their work? How do you address this if you are their manager? Read more here...

• IBA – making it happen?  It’s no secret that the big challenge is to get IBA happening large scale. That means in such a way that it will reach many of the 10 million or so adults regularly drinking above the guidelines... Read more here...

• Why ask staff about drinking in the workplace?  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. Read more here...

• SBI & Health Inequalities? What do we know about how SBI (aka IBA) may impact on health inequalities?  The evidence we have so far is fairly limited on this. 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. See here for the Alcohol IBA Twitter Updates (@Alcohol_IBA).

Latest from the IBA blog: SIPS - not just a leaflet; IBA in a nutshell; IBA should do it? INEBRIA 2012 presentations and more

A selection of recent posts from the IBA blog, which aims to promote news, links and ideas relating to alcohol brief interventions are included below: 

• SIPS Primary Care research: not just a leaflet
• Step-by-step IBA (in a nutshell)
• New look to the blog…
• IBA – who should do it and how do we convince them?
• INEBRIA 2012 presentations
• IBA – are all settings equal? Presentations and experiences
• INEBRIA 2012: research into practice?
• IBA ‘mystery shopping’ experiences: the good, the bad and the…

The blog also has dedicated 'About IBA' and 'IBA tools' pages. See here for the Alcohol IBA Twitter Updates (@Alcohol_IBA).

The 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. It also aims to highlight other resources and links such as INEBRIA and the Alcohol Learning Centre IBA pages.

Latest Findings alcohol bulletings: brief interventions findings including SIPS review

Recent bulletins from the drug and alcohol bank:

First major report from crucial English alcohol screening and brief intervention trials

Confirming preliminary releases, the first major formal account of findings from the SIPS trials reports no benefits from adding 20 minutes of theory-based counselling to a straightforward few sentences warning primary care patients they are drinking too much. 'Do just the minimum' is the message austerity-hit commissioners might take from the studies, but that would be to over-read their implications.

See here for the BMJ SIPS Primary Care results.

Single question identifies most problem drinkers

Can you get away with asking just a single question to identify risky and even dependent drinkers? When the thresholds are suitably adjusted, asking either about frequency of heavy drinking or maximum single-occasion consumption worked remarkably well in the US general population. Results could help extend screening to more venues and more patients.

Half-hour of advice may cut drinking in repeat drink-driving offenders

Can repeat drink-driving offenders be swayed by just 30 minutes with a therapist, and would those minutes best be spent in motivational interviewing or providing information on alcohol? This Canadian study hints that 'Yes' is the answer to both questions – but only hints.

See the Alcohol IBA blog or Alcohol Learning Centre for brief interventions news and resources.

Latest Findings alcohol bulletins: Canadian experience supports minimum pricing evidence; Scotland exceeds brief intervention target

Recent bulletins from the drug and alcohol bank:

Real-world Canadian evidence supports minimum alcohol pricing
Mathematical models for Britain predict that high minimum per unit alcohol pricing would substantially reduce consumption, but are consumers and markets that predictable? From British Columbia in Canada, real-world support for this first step in the chain expected to lead to improved public health and productivity and reduced crime.

Minimum price for alcohol has reduced consumption
Further and arguably stronger Canadian evidence from Saskatchewan of the real-world impact of something close to minimum per unit alcohol pricing applied more consistently to more beverage types and at a higher level than in British Columbia.

Scotland exceeds national brief alcohol interventions target
In three years from 2008 Scottish national policy drove delivery of nearly 175,000 brief alcohol interventions, testament to what can be done when policy is backed by funding and infrastructure and incentive payments contingent on implementation. Leverage and acceptance were greatest in primary care, where the vast majority of the work took place.

LHIB action on early intervention: London IBA reviews; IBA Practitioners' Network & 2013 Leadership Summit

The shadow London Health Improvement Board (LHIB) alcohol programme has announced a number of projects and events as part of its aim to promote alcohol early intervention across the capital.

The LHIB alcohol priority is committed to ensuring that Identification and Brief Advice (IBA) is delivered effectively across a wide range of key settings in London including criminal justice, acute and primary care. It will also be engaging with senior leaders to develop a shared vision and partnership framework, and supporting local licensing and enforcement teams.

As part of the early intervention programme, the LHIB commissioned two key reports to assess the extent of IBA delivery across the capital and challenges and opportunities for moving forward - see summary reports here:

• IBA Interventions across London - Executive Summary.pdf
• Systematic Review of Alcohol Early Intervention in Criminal Justice Sector - Executive Summary.pdf

An IBA Practitioner Network has also been established, aiming to bring together a practitioners from health, social care and criminal justice sectors to promote and lead on IBA delivery. The Network is currently recruiting practitioners from a range of key settings, though is not intended for drug and alcohol roles - see here for more information.

An IBA leadership Summit will also take place in January 2013 with the intention of securing senior level buy-in to embedding IBA delivery across London.