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Brief Interventions for Alcoholism and Behavioural Change

Introduction

Alcoholism refers to the most severe type of alcohol abuse which creates the inability to manage one’s habit of drinking (DiClemente 2018). It is also known as an alcohol use disorder. People addicted to alcohol mostly feel that they cannot normally function without taking alcohol and this creates several issues and influences personal matters, personal relationships, professional goals, as well as the individual health. After sometimes, severe side effects of alcoholism become worse creating damaging complications. Today, alcoholic behaviours affect many people from many walks of life, therefore, making it appropriate to address. For instance, as per the office for national statistics (2018), alcoholism/alcohol use resulted in 7,697 deaths in 2017 in the United Kingdom which is an average of 12.2 cases per hundred thousand people. Additionally, as cited by Franco (2015), the world health organisation statistics show an increasing number of young people taking alcohol yearly in the UK. Unfortunately, alcohol users are school students who admit taking alcohol during the previous week. Peacock et al (2018), suggest that There were approximately 1.1 million admissions which were related to alcoholism in 2015/16 which is a four per cent increase compared to 2014/15 statistics in England. Of those populations, two-thirds of the patients were male. The study also suggests that teenagers from British are currently among the heaviest alcoholics in Europe; having more chances of getting drunk, drinking, or even suffering from alcoholic issues compared to young people from other states in Europe. This is an indication that the UK may well be on its way to an Alcohol-related epidemic. First to combat the possible outcome of this rapidly increasing alcoholic use, there is need to train staff how to deliver a brief intervention and the use the appropriate equipment and evoke the efficient pathways so we can control or limit the damage done to patients. This paper aims to explore and discuss literature which supports interventions and behavioural change as well as tools which can be used in treatment plans for patients as well as in paramedic practice.

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Brief Interventions for Alcoholism and Behavioural Change

Stonerock & Blumenthal (2017) describe brief interventions as a technique used to initiate change for risky behaviour such as alcohol misuse. Additionally, Timko et al (2016), argues that brief interventions mostly range from five minutes of counselling to 30 minutes of short advice session. Importantly, these sessions are not meant for treatment of patients with severe alcoholism; rather, the brief interventions are used as an element for the management of dangerous substance abuse. Moreover, the short Interventions are also utilised while encouraging people who are addicted to substance abuse to accept to undergo treatment which is intensive within the hospital setting (Berger et al 2017). The study also concludes that; brief intervention is an attempt to change an individual's behaviour within a short period through utilising an unplanned opportunity. In Prehospital care, there is very minimal opportunity to follow a plan with a patient since it is difficult for health care providers to check the same patient more than once. Therefore, there is need to try to use the tools and interviewing techniques given to them.

While looking at the work of Hettema et al (2005); Wittleder et al (2019) suggest that Motivational interviewing is a kind of brief interventions which suit alcoholism. The study defines motivational interviewing as a directive as well as patient-centred counselling technique for prompting change of behaviour which involves assisting a patient to explore and as well resolve ambivalence. The research also goes ahead to explain that the ultimate objective of motivational interviewing is to assist an alcoholic individual to identify and change behaviours which can result to severe health problems or which may hider maximum chronic disorder management. To simplify the meaning, Petticrew et al (2018) suggest that brief interventions usually take a supportive and non-confrontational approach to empower a patient to recognise the risks associated with their drinking patterns. This results in reduced intake of substances as well as motivation to adjust their initial lifestyles.

This suggests that after identification of alcoholism motivational interviewing techniques is a powerful tool that can be used to ascertain further information and as well find out the effect of the problem to social life such as an effect to individual's children/family routines and health issues. To diagnose alcoholism, the alcohol use disorders identification test also known as The AUDIT tool, developed by the World Health Organisation in 1982 is very crucial (Connor et al 2016). Lundin et al (2015) argues that this tool is accurate and quite specific it is also long-winded and is better suited to General Practitioner based care or hospitals. Moreover, as per Tuunanen et al (2019), Hodgson, et al study of 2001 came up with a better tool for pre-hospital-based care. The scholars invented The FAST tool which could be incorporated into a motivational interviewing technique with ease and in most cases without offending patients. Nevertheless, Smith et al (2010), suggest that alcoholism identification test is more cost-efficient and effective compared to what General Practitioners were previously using. Furthermore, the study while looking at the literature of Rapley & Kaner (2006), suggested that the alcohol use disorders identification test (AUDIT) questionnaire, is an efficient and cheap tool for diagnosis of hazardous as well as harmful alcoholics in the setting of a primary care, therefore, benefiting from brief interventions. Unfortunately, this opposes the modern low identification of alcoholism level by health care professionals (Rossi et al 2018).

In 1993, The University of New Mexico, department of psychology released a review on a study which involved numerous trials of 6000 problem drinkers from 14 states (Witkiewitz &Vowles 2018). The review indicated that brief interventions are effective in reducing alcohol consumption and achieving treatment referral of alcoholics. The study further stated that brief interventions are more effective compared to counselling. The scholars also argue that it has similar effectiveness as extensive treatment. From the literature review, it is evident that of harmful alcohol use effects can be alleviated effectively by well-designed intervention plans which include brief-contact contexts like employee assistance programs as well as primary health care settings (Witkiewitz &Vowles 2018). From this study, it is also evident that brief interventions work well with primary health care settings and with the correct training which could be adapted and used in the pre-hospital care setting. Besides, Miller et al (2017), urges that apart from verbal techniques, physical aids such as the Public Health England scratch cards which can be left with patients may also be used. These aids are based on the AUDIT system of 1982.

In their view, Petticrew et al (2018), argues that the health care creates a chance to reach young people who require intervention. The study has also showed the efficiency of brief interventions for adult alcoholics in medical care facilities. Powers et al (2016) state that there are many strategies which can assist physicians to use the screening as well as the brief interventions in their practices. These strategies include making use of group education to hone clinicians’ expertise and other counselling techniques, providing performance feedback, offering training to all clinic staff, providing monetary support to staff and lastly, offering the education using qualified professionals. The study also suggests that younger people mostly seek treatment in an Emergency Department. Moreover, teenagers treated for alcoholism may be receptive to an intervention due to the regency of the event and the patients' state of emotion (Kenna & Leggio, 2017). This represents brief interventions in an emergency department but I believe the same should be provided in pre-hospital setting due to the regency of the event since patients are picked up directly from the scene and with consideration of the patient’s emotional state which makes them more easily influenced.

In 2004 the government released a framework called the alcohol harm reduction strategy for England or AHRSE for short (Hawkins et al 2012). It consisted of four sections which included; Treatment, Alcohol-related Crime and Disorder, Education and Communication, and finally Supply and Industry Responsibility. In the second section -Identification and Treatment, the Government evaluates the best way of diagnosing and treating people who have established alcohol dependency which might affect their health or even the social functioning and recognises. In one study conducted by Petticrew et al (2018) showed that 20 per cent of primary care patients showed high levels of alcohol consumption which is above the National Institute on Alcohol Abuse and Alcoholism’s standard limits. The study showed that brief interventions offer medical care professional an ideal strategy for offering patients the assistance they require. After screening, people may benefit from a brief intervention. Simple interventions are often ‘opportunistic' which means they are administered to clients who have not been into a consultation to discuss their risky drinking behaviour. Such brief intervention is usually effective for clients whose conditions are yet to be severe. Several action points in the chapter are relevant to research and screening implementation and simple intervention and the need to train healthcare staff to deliver it. This shows that brief interventions can be successful if primary care staff are given the correct training to be able to deliver the correct information in the right manner and as a whole the medical industry seems to be moving in the right direction and looking at the problem with prevention is better than cure attitude, by trying to train primary healthcare staff.

Jepson et al (2010), also indicate that simple interventions are effective. In research conducted on three hundred and four women who were pregnant and who were to receive alcoholic intervention. Some participants showed positive results for prenatal use of alcohol. The outcome showed that participants with the highest drinking levels also had greatly reduced their drinking behaviour when they were put under brief intervention. Additionally, the impact of this strategy was greater in cases where couples participated. Wittleder et al (2019), also suggest that brief interventions can reduce alcohol consumption among people that are at risk of drinking hazardous or harmful levels of alcohol although are not alcohol dependent. Also, that evidence suggests brief interventions increase a person's willingness to change and that 1 person in 8 changes their drinking pattern following a brief intervention. For those unfortunate enough to be alcohol dependant the only intervention which is proven to help is a referral to a specialist.

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Conclusion

As demonstrated by the evidence given above it is clear that Brief interventions have a positive effect on the treatment problem drinkers receive and the care plans put in place for them. However, for effective brief interventions to take place staff should be given correct and quality training. Although currently, staff can give basic brief interventions they may feel unsure and unqualified to offer advice on a subject that they have been given little to no training on. Staff may feel that they do not want to be seen digging and prying into people's personal lives when in fact patients feel more open and honest about their habits when in the comfort of their own home. Staff may employ a host of motivational interviewing techniques to assess whether the patient is mentally in the right place to consider accepting help or at least to see that they may be at risk of doing long-lasting damage to themselves. Once the patient has identified that there may be a problem the clinician can then use a variety of assessment tools to discover how far the alcohol problem has progressed and can treat or refer the patient accordingly. However, if the patient is in denial about the problem or sees no need to change then the brief intervention is not worth starting, although the patient could still be left with one of the AUDIT information/self-assessment cards, leaflets or websites to possibly peruse in their own time. By and Large, Brief interventions are very successful in a patient with alcohol problems but the patient must be willing to consider a change in behaviour for it to be fruitful and effective.

References

Berger, L., Hernandez-Meier, J., Hyatt, J. and Brondino, M., 2017. Referral to treatment for hospitalized medical patients with an alcohol use disorder: a proof-of-concept brief intervention study. Social work in health care, 56(5), pp.321-334.

Connor, J.P., Haber, P.S. and Hall, W.D., 2016. Alcohol use disorders. The Lancet, 387(10022), pp.988-998.

DiClemente, C.C., 2018. Addiction and change: How addictions develop and addicted people recover. Guilford Publications.

Franco, S. ed., 2015. Tackling harmful alcohol use economics and public health policy: Economics and public health policy. OECD publishing.

Hawkins, B., Holden, C. and McCambridge, J., 2012. Alcohol industry influence on UK alcohol policy: a new research agenda for public health. Critical public health, 22(3), pp.297-305.

Hettema, J., Steele, J. and Miller, W.R., 2005. Motivational interviewing. Annu. Rev. Clin. Psychol., 1, pp.91-111.

Jepson, R.G., Harris, F.M., Platt, S. and Tannahill, C., 2010. The effectiveness of interventions to change six health behaviours: a review of reviews. BMC public health, 10(1), p.538.

Kenna, G.A. and Leggio, L., 2017. Alcohol use disorder. In Integrating psychological and pharmacological treatments for addictive disorders (pp. 76-98). Routledge.

Lundin, A., Hallgren, M., Balliu, N. and Forsell, Y., 2015. The use of alcohol use disorders identification test (AUDIT) in detecting alcohol use disorder and risk drinking in the general population: validation of AUDIT using schedules for clinical assessment in neuropsychiatry. Alcoholism: Clinical and Experimental Research, 39(1), pp.158-165.

Miller, J.D., Lynam, D.R., Hyatt, C.S. and Campbell, W.K., 2017. Controversies in narcissism. Annual Review of Clinical Psychology, 13, pp.291-315.

Peacock, A., Leung, J., Larney, S., Colledge, S., Hickman, M., Rehm, J., Giovino, G.A., West, R., Hall, W., Griffiths, P. and Ali, R., 2018. Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction, 113(10), pp.1905-1926.

Petticrew, M., McKee, M. and Marteau, T.M., 2018. Partnerships with the alcohol industry at the expense of public health.

Rapley, and Kaner, E.F., 2006. Still a difficult business? Negotiating alcohol-related problems in general practice consultations. Social science & medicine, 63(9), pp.2418-2428.

Powers, M.D., James, S., Benningfield, M.D., Margaret, M. and Clinton, M.S.W., 2016. SBIRT (Screening Brief Intervention and Referral to Treatment)-A Primary Care Tool to Assess for Substance Use Disorder. Tennessee Medicine E-Journal, 2(1), p.5.

Rossi, P.H., Lipsey, M.W. and Henry, G.T., 2018. Evaluation: A systematic approach. Sage publications.

Smith, P.C., Schmidt, S.M., Allensworth-Davies, D. and Saitz, R., 2010. A single-question screening test for drug use in primary care. Archives of internal medicine, 170(13), pp.1155-1160.

Stonerock, G.L. and Blumenthal, J.A., 2017. Role of counseling to promote adherence in healthy lifestyle medicine: strategies to improve exercise adherence and enhance physical activity. Progress in cardiovascular diseases, 59(5), pp.455-462.

the Office for National Statistics (ONS). 1 May 2018. Adult drinking habits in Great Britain: 2017; Annual data on alcohol consumption by adults, including changes in drinking patterns in recent years and data for those who do not drink. Pp.3

Timko, C., Kong, C., Vittorio, L. and Cucciare, M.A., 2016. Screening and brief intervention for unhealthy substance use in patients with chronic medical conditions: a systematic review. Journal of clinical nursing, 25(21-22), pp.3131-3143.

Tuunanen, M., Aalto, M., Levola, J. and Seppä, K., 2019. The FAST in screening for at-risk drinking among middle-aged women. Journal of Substance Use, pp.1-4.

Wittleder, S., Ajenikoko, A., Bouwman, D., Fang, Y., McKee, M.D., Meissner, P., Orstad, S.L., Rehm, C.D., Sherman, S.E., Smith, S. and Sweat, V., 2019. Protocol for a cluster-randomized controlled trial of a technology-assisted health coaching intervention for weight management in primary care: The GEM (goals for eating and moving) intervention. Contemporary clinical trials.

Witkiewitz, K. and Vowles, K.E., 2018. Alcohol and opioid use, co‐use, and chronic pain in the context of the opioid epidemic: a critical review. Alcoholism: clinical and experimental research, 42(3), pp.478-488.

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