Brief tips on Using the Drink-less package for brief intervention for alcohol use disorders. The University of Sydney 2004

Transcription

1 Brief tips on Using the Drink-less package for brief intervention for alcohol use disorders The University of Sydney 2004

2 What is the Drink-less package? Based on World Health Organization validated techniques [WHO, Am J Pub Hlth, 1996] Identification using the WHO AUDIT questionnaire [Saunders, Addiction, 1993] Scoring template to guide treatment approach 5-10 minute intervention using a visual aid this intervention produces significant benefits at 6 months Self help booklet based on the above

3 The patient / client can fill in the AUDIT questionnaire before seeing you, if comfortable to do so Score the questionnaire responses using the template Moving from left to right across the responses : Q1-8 responses are scored 0, 1, 2, 3 or 4 Q 9 & 10 are scored 0, 2 or 4

4 Practise screening: Complete AUDIT now, using information from a remembered patient, friend or yourself! Score AUDIT using the template

5 Some cases to consider Think how you can personalise your feedback and advice on drinking, and make it relevant to the individual The discussion of drinking is always non judgemental, and respects the individual s right to choose The handycard is a visual aid to support you in a conversation on drinking

6 Practice using the handycard Brian is a 34 year old man who presents for renewal of his antihypertensive script You are screening patients in the waiting room using AUDIT Brian reports 4 schooners of beer most days of the week Not aware of any adverse effects His AUDIT score is 9

7 Case Study: Mark 29 year old male BAC of 0.15 after a collision Reports never drink driving before Usual consumption 9 schooners once a week when he goes out Footballer who considers himself fit and well

8 Issues: Mark What points of feedback & what benefits of change are likely to be of interest to a young, fit 29 year old man?

9 Discussion points: Mark Mark s drink driving was picked up after a collision. There may have been acute impairment, and so tolerance (and dependence) may not have been present Episodic heavy drinking is a common pattern in young people Discussion of acute risks of intoxication may be useful, & of gains to fitness and finances in cutting down

10 Case 2: Jane 39 year old; not in paid employment while her children are young BAC of 0.20 % on random testing Drinks a small cask (500mls) of wine daily Tried to cut down without success: Is driven back by the agitation, insomnia When admitted for hysterectomy, had tremor post operatively, and needed valium for sleep

11 Jane: Issues Does she need to stop drinking? Children in her care Where is the best place for her withdrawal to be managed? What would be your likely monitoring and management regime?

12 Jane: management Outpatient withdrawal may be feasible Daily monitoring with alcohol withdrawal scale Diazepam titrated against withdrawal signs E.g. 10mg qid plus 10mg nocte day 1 Thiamine 100mg oral mane Acamprosate or naltrexone for relapse prevention Consider other needs/issues

13 Case 3: Mr T. 60 y.o. man, interviewed via interpreter Type 2 diabetes, oral hypoglcyemics Hypertension, and recurrent falls Reports max 3 glasses spirits/day at BBQ Drink driving BAC 0.2 g% on random breath test Agitation but no tremor if stops drinking

14 Issues: Mr T What are the issues with this history? How might you clarify what is going on?

15 Mr T: later input from son Drinks up to a bottle of whisky per day On further questioning Mr T admits each of his three drinks of whisky is 250mls

16 Mr T: progress Accepted acamprosate ii tds Reduced drinking to 2 occasions per week (?2-6 standard drinks)

17 Summary Brief intervention has been shown to be effective in reducing consumption Non judgemental, personalised feedback and advice on drinking If the drinker appears to be dependent on alcohol, may need additional treatment (as per template) You can also provide the self-help booklet

18 Further information Management of alcohol and drug problems: NSW drug and alcohol withdrawal clinical practice guidelines www0.health.nsw.gov.au/policies/gl/2008/pdf/gl2008_011.pdf Drug and Alcohol Specialist Advisory Service (for clinicians only) or (02) Alcohol and Drug information Service (for general public) or (02)