Alcohol Policy UK

London Health Improvement Board's alcohol priority takes shape

Since 2011, the shadow London Health Improvement Board (LHIB) has been working with a variety of partners to improve the health of all Londoners and reduce inequalities in health outcomes. The LHIB aims to deliver city-wide action to generate better outcomes for Londoners, with a particular focus on key areas of alcohol, obesity and cancer.

For the alcohol priority, work has been developing to deliver action on:

• Vision and Partnership - developing a London-wide vision for how London should view and relate to alcohol and a partnership framework t support action across sectors
• Licensing and Enforcement - supporting local authorities and their partners in creating a well-managed night time economy by developing a set of licensing and enforcement standards
• Early Intervention - 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.

As part of the 'Early Intervention' work programme, an IBA Practitioners Network is currently being established to develop leadership and peer support around IBA delivery. The Network is currently seeking London practitioners from a range of health, social care and criminal justice settings who are committed to supporting IBA delivery. If you are a London based health or social care practitioner and committed to IBA delivery please get in touch.

In 2013, an Early Intervention and Prevention Leadership Summit event will take place to support the programme and ensure strategic buy-in and leadership.

Latest from the IBA blog: first INEBRIA 2012 report; 'mystery shopping' for IBA?; Brief Advice 'bullets' & 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:

• INEBRIA 2012: research into practice?
• IBA ‘mystery shopping’ experiences: the good, the bad and the…
• ‘Mystery shopping’ for IBA in Primary Care?
• How intense an intervention is IBA? And competencies needed?
• How ‘opportunisitic’ can IBA be – a step too far?
• Brief advice bullets: try lower strength drinks?
• Brief advice bullets: alcohol disrupts sleep
• Is IBA ‘girly’?

The blog also inlcudes an about IBA page and quick reference IBA tools & resources page. Previous popular posts include:

• IBA for children and young people: evidence, guidance and resources?
• Extended Brief Interventions: who, when, where, and other questions?
• Is self-completing the AUDIT OK for 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.

SIPS Junior trial underway; sessional researchers sought for London

The SIPS Junior research trial is underway, and the team are seeking to recruit sessional workers for part of the study.

The SIPS Junior research programme will provide estimates of the level of alcohol consumption and alcohol-related problems in adolescents attending Emergency Departments (EDs). It will also develop, implement and evaluate screening and alcohol interventions for adolescents in the ED setting. Funding was awarded by the Department of Health National Institute for Health Research (NIHR) to a consortium of research centres led by the Institute of Psychiatry (IoP), King's College London.

As part of the programme, 10 sessional Research Workers are needed to work in London Emergency Departments (King’s College Hospital, St George’s Hospital, Lewisham Hospital, St Thomas’ Hospital) between 8am until 4pm or 4pm until midnight recruiting 10 to 17 year olds into the study for the period of three months (September-November 2012).

Download the SIPS jr researchers advert here. To obtain further particulars, an application form and further information about the Institute, please email [email protected].

Results of the adult SIPS trial are soon to be published following peer review. A post on IBA for children and young people: evidence, guidance and resources is available on the IBA blog.

Latest Findings bulletins: Single alcohol question effective but routine screening low across offender settings

Recent bulletins from the drug and alcohol Bank:

Single question enough to identify most heavy drinking offenders         At English prisons, police stations and probation offices, offenders and arrestees in this study usually scored as at least hazardous drinkers and over half as problematic on the AUDIT drink problem questionnaire; nearly all would have been identified by a much briefer screening method usually requiring just a single question.

Despite senior support most detainees not screened for risky drinking  Risky drinking was widespread among the disorder and assault suspects screened for alcohol problems and (as indicated) offered brief advice by civilian staff at a police station in north east England, but despite senior officer support, they constituted just a quarter of the arrestees intended to have been screened.

Screening offenders for risky drinking not a priority in Scotland      Though drinking problems were widespread, Scottish probation and community service staff were unconvinced of the appropriateness of screening their offender clients for risky drinking and (if indicated) offering brief advice. Not a priority, was the common feeling.

Previous Findings bulletins suggested alcohol-related offending measures do work, but also that Probation resources too stretched to adequately tackle huge drink problem.

Last year the Centre for Mental Health called for more support for offenders with alcohol problems.See here for further Offender Health publications and links on the Alcohol Learning Centre.

Latest from the IBA blog: When to do extended brief interventions; young people's IBA resources; is self-completing AUDIT OK?..

A selection of recent posts from the IBA blog, a resource promoting news, links and ideas relating to alcohol brief interventions are included below:

• Extended Brief Interventions: who, when, where, and other questions?
• IBA for children and young people: evidence, guidance and resources?
• Is self-completing the AUDIT OK for IBA?
• IBA for alcohol… and diet…and physical activity…and smoking….and…
• A breath of fresh air: when GPs do IBA
• How to decide what to do, whatever the evidence.
• Is the unit message getting through?
• INEBRIA Conference 2012
• Audiovisual resources can be invaluable in IBA training

The IBA blog was set up to promote learning, understanding and the delivery of IBA through regular items and updates 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.

Alcohol IBA blog aims to share news, info and links for alcohol brief interventions

A new Alcohol IBA blog has been set up to help promote the delivery of 'Identification and Brief Advice' (IBA), also known as alcohol brief interventions.

The blog, available at www.alcoholiba.com, aims to promote learning, understanding and the delivery of IBA amongst all roles that have the opportunity to deliver it.

IBA is a cost-effective simple intervention that proven to reduce risky drinking. It is a key part of the national effort to reduce alcohol-related harm, but it needs widespread delivery to achieve this.

The blog aims to support the IBA agenda by sharing information and learning relating to IBA, and sign-posting to key resources. It should also offer a space for new ideas about improving the delivery or implementation of IBA, particularly in settings or organisations facing challenges to delivery.

The blog has been set up by James Morris of the Alcohol Academy, but will be supported by a number of expert contributors in the field. Dr Laura Pechey, an IBA specialist for HAGA, recently explored how has IBA done in the new strategy, whilst Dr Niamh Fiztgerald of Create Consultancy has started with an exploration of who needs IBA?

You can also follow the blog on Twitter @Alcohol_IBA or subscibe to its feed here. To get in touch about the blog or propose a contribution see here.

Dentists urged to ask about alcohol

Dentists are being urged to ask patients about their alcohol consumption, in an article in the Royal College of Surgeons' Dental Journal. Professor Jonathan Shepherd, the main author of the paper, states that asking about alcohol consumption should be routine, and that there is a "need to introduce a screening tool" to support this process.

Alcohol is linked to problems with oral health, including oral cancers, which have doubled in males aged 40-49 years over the past 20 years. Alcohol can also cause dental erosion in young people, increased tooth decay due to the sugars and acids in alcoholic drinks, poor oral hygiene and slower recovery from dental surgery.

Professor Shepherd is an Oral Maxillofacial surgeon who has often been at the spearhead of attempts to tackle alcohol harms. He insists that dental surgeries can offer a "major contribution to Government health priorities" and that currently dentists are missing an "untapped opportunity" to ask and advise about alcohol and oral health. See BBC report.

Earlier this year Ministers backed calls for health proffessionals to 'make every contact count' by delivering lifestyle interventions. See here for a report 'Brief interventions: achieving widespread delivery? which explores opportunities and threats for mainstreaming alcohol interventions.

Don't Bottle It Up - HAGA launches online self assessment and referral resource

HAGA has launched DontBottleItUp, a website that allows visitors to work out the level of risk they are at as a result of their drinking and access personalised advice online. For areas such as Haringey where it is commissioned locally, users can find out where to get face-to-face support.   

DontBottleItUp was developed with support from the Department of Health and aims to improve local best practice in prevention and early intervention, whilst also building clear pathways into treatment. The site aims to add value to existing Identification and Brief Advice (IBA) activity, such as the alcohol Direct Enhanced Service and NHS Health Checks and uses the validated AUDIT alcohol screening questions.

HAGA suggest the site can be used to target individuals who may not engage with mainstream health services - i.e. young people - through targeted marketing. DontBottleItUp additionally aims to offer professionals a best practice resource which they can use directly with individuals or as a training aid.

DontBottleItUp is open to all and so can be used in all local areas but the site’s Postcode Finder function is only set up to provide information for Haringey. However there is potential for local areas to purchase tailored versions of the site in order to provide local service information, along with a campaigns package, including banner stands, posters and business cards - for more information contact [email protected] or call 07917423664.

Alcohol Research UK recently highlighted a Findings review of the potential effectiveness of web-based self-help resources. The review indicates that web-based self-help resources can play a role in supporting risky drinkers to cut down.

SIPS alcohol screening and brief interventions findings released

Findings from the SIPS trial, the largest UK alcohol screening and brief intervention study, have been released.

The study took place across key settings of Primary Care, Emergency Departments and Probation and tested the effectiveness of a range of brief intervention approaches and screening tools. A conference event took place on the 5th of March 2012 to launch the findings, with presentations available to download.

Download the 3 key SIPS factsheets:

• Alcohol Screening and Brief Intervention in Emergency Departments
• Alcohol Screening and Brief Intervention in Primary Health Care
• Alcohol Screening and Brief Intervention in Probation

SIPS covered 9 Emergency Departments, 29 GP surgeries and 20 Probation Offices across London, the South East and the North East of England. During the 13-month data collection period 10,530 patients were screened with 2,481 recruited into the study. The trial tested three key 'brief intervention' approaches of:

1. Feedback [of screening result] + Patient Information Leaflet (PIL)
2. Feedback + five minutes of structured advice using the SIPS brief advice tool + PIL
3. Feedback + 20 minutes of 'Brief Lifestyle Counselling' (BLC) + PIL

For Emergency Departments, the Modified Single Alcohol Screening Question (M-SASQ) was found to be the most efficient and effective screening tool. However successful implementation in EDs required champions and dedicated staff. In terms of results, all three approaches showed positive outcomes on drinking behaviours, with greater effects at 12 than 6 months. However when compared to simple feedback and leaflet, brief structured advice or longer 20 minute lifestyle counselling did not offer any significant advantage in terms of drinking behaviour or alcohol use disorder outcomes. However lifestyle counselling was considered to have a greater cost impact due to greater QALY gains and a greater reduction in societal costs.

In Primary Care settings, the FAST alcohol screening tool was the most efficient and effective screening tool. Successful implementation though required financial incentives, training and ongoing specialist support, though longer lifestyle/extended interventions were harder to implement. All brief intervention approaches resulted in reductions in alcohol use, but when compared to simple feedback and leaflet, brief structured advice or longer 20 minute lifestyle counselling did not offer any significant advantage in terms of drinking behaviour or alcohol use disorder outcomes. Feedback and leaflet was found to be the most cost-effective approach.

In Probation (Criminal Justice) settings, the FAST was also found to be the most effective screening tool. Successful implementation was challenging, requiring managerial support and ongoing specialist input to maintain activity. For 'increasing risk' [hazardous drinkers] who scored between 8-15 on the AUDIT, simple feedback and leaflet was as effective as longer interventions or lifestyle counselling. However for 'higher risk' [harmful] drinkers scoring 16 or more on the AUDIT, more intensive interventions were beneficial.

For tools and resources to support the delivery of alcohol brief interventions see here on the Alcohol Learning Centre. See the SIPS website for forthcoming further analysis and details of the SIPS 'junior' trial which will explore the impact of brief intervention approaches on young people.

'Tackling alcohol misuse: Should abstinence be our preferred approach?' British Liver Trust call for public health action on alcohol

The British Liver Trust have released a new report outlining the need for a comprehensive approach to tackling alcohol misuse. It warns against a "one size fits all approach for treatment" for a range of problem drinkers "each of whom will need tailored approach with the interventions and appropriate treatment goals."

Download 'Reducing alcohol harm: recovery and informed choice for those with alcohol related health problems'

A supporting commentary piece by Andrew Langford, Chief Executive of the British Liver Trust also appeared in the Guardian.

The report highlights that alcohol accounts for 80% of all deaths from liver disease, the prevention of which should be the core focus of alcohol policy debates. GPs, nurses and other health professionals should screen for alcohol misuse more widely, to ensure that those drinking at harmful levels are identified and offered appropriate support, advice and treatment.

The report chimes with a recent call from 2020 health to focus on 'risky drinking' and the prevention of alcohol problems, as well as a more traditional focus on treatment for a smaller number of dependent drinkers. Both reports call for public health approaches in response to the growing impact of alcohol related harm, as also set out in NICE public health alcohol guidance, Alcohol Concern reports, Department of Health commissioning guidance and calls to mainstream brief interventions.

Further information on alcohol and 'risky drinking' can be found from NHS Choices alcohol pages, Drinkaware, and resources and guidance are available from the Alcohol Learning Centre.