Dear Neil,
In response to your request to address some questions not (properly) answered in the Forum, I would like to provide information on the following point:
How can all healthcare workers be empowered to provide brief advice?
What is an alcohol brief intervention?
“Brief interventions are those practices that aim to identify a real or potential alcohol problem and motivate an individual to do something about it.”
Face-to-face alcohol brief interventions (ABIs) are heterogeneous interventions that include “short conversations aiming in a non-confrontational way to motivate individuals to think about and/or plan a change in their drinking behaviour in order to reduce their consumption and/or their risk of harm” .
ABIs have historically included the use of a screening questionnaire to assess an individual’s consumption level and risk of alcohol problems, and the provision of personalized feedback to those identified as being in need of support .
Evidence supports the use of widespread screening for alcohol problems in primary care so as to identify people who may benefit from an intervention at the earliest opportunity.
Some large-scale programmes (such as in Scotland, United Kingdom) have chosen to take a very broad targeted approach in primary care, in which practitioners were provided with a long list of potential presenting conditions and issues for which screening was recommended.
Although this approach potentially missed some patients, it was felt to make it easier for practitioners to feel comfortable raising the issue of alcohol and to take a patient-centered approach.
ABIs also include interventions delivered electronically, such as through mobile phone applications and websites. These interventions may be accessed independently by patients, accessed following a recommendation from a professional, used with guidance or together with advice from, for example, a primary care professional.
There is evidence from several systematic reviews that electronically delivered interventions are also effective in reducing alcohol consumption by a small but significant amount.
Digitally delivered screening and brief interventions may cost less to establish and implement per patient and have the potential to reach a wider population, but they might not be accessed by those less motivated to change.
Brief interventions are known in research literature and practice by many different names and acronyms.
The most common terms in the international research literature are screening and brief intervention (SBI) and, in the United States of America, screening, brief intervention and referral to treatment (SBIRT). In the United Kingdom, identification and brief advice (IBA) is the most common term. There is little consensus about specific differences between the different terms, and the content or delivery of an intervention cannot necessarily be identified by the acronym by which it is described.
The term brief intervention is, therefore, best seen as an umbrella term encompassing a wide range of interventions that fit within the broad definitions given above. Most types of brief intervention draw (or have drawn) to a greater or lesser extent on two key concepts: stages of change and motivational interviewing.
We are using the term ABI, meaning an alcohol brief intervention which includes screening, and SBI, meaning screening and brief intervention.
Types of brief intervention
Brief interventions vary in several ways:
• length: from five minutes to several sessions of an hour or more
• tone: advice-giving versus guiding
• based (or not)on MI
• based (or not)on stages of change
• focused on different severities of alcohol problem (hazardous/harmful/dependent drinking).
Brief Advice --------- Brief Intervention --------- Extended BI or brief MI
Screening. Screening Screening
Feedback Listen and motivate. MI- Based counselling
Advice 1+ sessions 1+ sessions
1 session (5-15 min) (20-30 min)
(< 5 min)
Although they may be known under different names and acronyms, they are all brief interventions.
While the length of brief interventions does not dictate the content or style, they are best viewed as a continuum.
Regarding where HCW can reach further information:
1. WHO alcohol brief intervention training manual for primary care
https://www.drugsandalcohol.ie/28029/1/WHO_Alcohol-training-manual-final...
This manual provides information to plan training and support for primary care practitioners to confidently deliver SBI for alcohol problems to their patients. The manual outlines the background and evidence base for SBI, and gives practical advice on establishing an implementation programme as well as detailed educational materials to develop the knowledge and skills of participants in organized training sessions.
2. New NIAAA Resource Helps Healthcare Professionals Provide Better Alcohol-Related Care
https://niaaa.scienceblog.com/415/new-niaaa-resource-helps-healthcare-pr...
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has released The Healthcare Professional’s Core Resource on Alcohol (HPCR) to help healthcare professionals provide evidence-based care for people who drink alcohol.
Created with busy clinicians in mind, the HPCR provides concise, thorough information designed to help them integrate alcohol care into their practice. Healthcare professionals can earn free continuing education (CME/CE) credits for completing HPCR articles.
Here you are some videos showing how to perform an Alcohol Brief Intervention:
https://www.ccsa.ca/brief-intervention-establishing-rapport-discuss-alco...
https://www.youtube.com/watch?v=b-ilxvHZJDc
https://www.youtube.com/watch?v=PaSKcfTmFEk
I hope this information can be useful to you.
Kind regards,
Eduardo
Dr. Eduardo Bianco
Director, Addiction Training Program (ATP)
Email: ebianco@nextgenu.org
Web: NextGenU.org
HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Masters in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Biancos research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. ebianco AT nextgenu.org
