screening and brief advice tools an introduction deryn bishop
DESCRIPTION
Introducing AUDIT Alcohol Use Disorders Identification Test Helps identify excessive drinking, dependence and some consequences of harmful drinking Used in the non-treatment seeking population Can be self administered or used by non- health professionals The Gold standard toolTRANSCRIPT
Screening and brief advice tools
An introductionDeryn Bishop
NICE alcohol use disorders PH24
• Quality statement• Health and social care staff opportunistically
carry out screening and brief interventions for hazardous and harmful drinking as an integral part of practice
• Using a validated screening tool followed by structured brief advice
Introducing AUDIT
• Alcohol Use Disorders Identification Test• Helps identify excessive drinking, dependence
and some consequences of harmful drinking• Used in the non-treatment seeking population• Can be self administered or used by non-
health professionals• The Gold standard tool
AUDI T
Questions Scoring system Your
score 0 1 2 3 4
How often do you have a drink containing alcohol? Never Monthly
or less
2 - 4 times per
month
2 - 3 times per
week
4+ times per
week
How many units of alcohol do you drink on a typical day when you are drinking? 1 -2 3 - 4 5 - 6 7 - 9 10+
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you found that you were not able to stop drinking once you had started?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you failed to do what was normally expected from you because of your drinking?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you had a feeling of guilt or remorse after drinking? Never
Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
Have you or somebody else been injured as a result of your drinking? No
Yes, but not in the last year
Yes, during
the last year
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?
No
Yes, but not in the last year
Yes, during
the last year
Scoring: 0 – 7 Lower risk, 8 – 15 Increasing risk, 16 – 19 Higher risk, 20+ Possible dependence
SCORE
Questions Scoring system Your
score 0 1 2 3 4
How often do you have a drink containing alcohol? Never Monthly
or less
2 - 4 times per
month
2 - 3 times per
week
4+ times per
week
How many units of alcohol do you drink on a typical day when you are drinking? 1 -2 3 - 4 5 - 6 7 - 9 10+
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you found that you were not able to stop drinking once you had started?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you failed to do what was normally expected from you because of your drinking?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you had a feeling of guilt or remorse after drinking? Never
Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
Have you or somebody else been injured as a result of your drinking? No
Yes, but not in the last year
Yes, during
the last year
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?
No
Yes, but not in the last year
Yes, during
the last year
Questions 1, 2 and 3 =Hazardous alcohol use Questions 4, 5 and 6 = Dependent symptoms Questions 7, 8, 9 and 10 = Harmful drinking
AUDIT Score 8 – 15
Increasing Risk
AUDIT Score 16-19
Higher Risk
No Action
AUDIT Score 0 – 7
Lower Risk
AUDIT Score 20+ Possible Dependence
Full Assessment for physical
dependence .
Not Dependent
Extended brief
interventions Severe Dependence
requiring In Pt Detoxification
Dependent not requiring
In Pt Detoxification
Brief AdviceHigher Risk drinkers
Full AUDIT Assessment Positive Pre-ScreenEg MSASQ, FAST or
Audit C
Questions Scoring system Your
score 0 1 2 3 4
How often do you have a drink containing alcohol? Never Monthly
or less
2 - 4 times per
month
2 - 3 times per
week
4+ times per
week
How many units of alcohol do you drink on a typical day when you are drinking? 1 -2 3 - 4 5 - 6 7 - 9 10+
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you found that you were not able to stop drinking once you had started?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you failed to do what was normally expected from you because of your drinking?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you had a feeling of guilt or remorse after drinking? Never
Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
Have you or somebody else been injured as a result of your drinking? No
Yes, but not in the last year
Yes, during
the last year
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?
No
Yes, but not in the last year
Yes, during
the last year
Scoring: 0 – 7 Lower risk, 8 – 15 Increasing risk, 16 – 19 Higher risk, 20+ Possible dependence
SCORE
M-SASQ
Questions Scoring system Your
score 0 1 2 3 4
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
Scoring: A total of 0 – 1 indicates lower risk drinkers. A total of 2 – 4 indicates increasing or higher risk drinkers. An overall total score of 2 or above is SASQ positive.
SCORE
Questions Scoring system Your
score 0 1 2 3 4
How often do you have a drink containing alcohol? Never Monthly
or less
2 - 4 times per
month
2 - 3 times per
week
4+ times per
week
How many units of alcohol do you drink on a typical day when you are drinking? 1 -2 3 - 4 5 - 6 7 - 9 10+
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you found that you were not able to stop drinking once you had started?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you failed to do what was normally expected from you because of your drinking?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you had a feeling of guilt or remorse after drinking? Never
Less than
monthly Monthly Weekly
Daily or
almost daily
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
Never Less than
monthly Monthly Weekly
Daily or
almost daily
Have you or somebody else been injured as a result of your drinking? No
Yes, but not in the last year
Yes, during
the last year
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?
No
Yes, but not in the last year
Yes, during
the last year
Scoring: 0 – 7 Lower risk, 8 – 15 Increasing risk, 16 – 19 Higher risk, 20+ Possible dependence
FAST…a shortened AUDIT• A 2 stage procedure: ask the more detailed questions only if
required• FAST will indicate if the individual is possibly drinking at
increasing or higher risk levels• FAST will NOT determine dependency
• Brief• Rapid • Flexible• Effective
• A positive score means a Full AUDIT should be conducted
QuestionsScoring system Your
score0 1 2 3 4
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
NeverLess than
monthlyMonthly Weekly
Daily or
almost daily
Only answer the following questions if the answer above is Never (0), Monthly (1) or Less than monthly (2). Stop here if the answer is Weekly (3) or Daily (4).
How often during the last year have you failed to do what was normally expected from you because of your drinking?
NeverLess than
monthlyMonthly Weekly
Daily or
almost daily
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
NeverLess than
monthlyMonthly Weekly
Daily or
almost daily
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?
NoYes, but not in
the last year
Yes, during
the last year
FAST
• Score 3 or 4 on Q1 = Fast Positive. Stop here• Overall score 3 or more on all 4 Qs = Fast Positive
Audit C
Audit C Questions Scoring system Your score 0 1 2 3 4
How often do you have a drink containing alcohol? Never Monthly
or less
2 - 4 times per
month
2 - 3 times per week
4+ times per week
How many units of alcohol do you drink on a typical day when you are drinking? 1 -2 3 - 4 5 - 6 7 - 8 10+
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
Never Less than
monthly
Monthly Weekly Daily or
almost daily
Score >5 = audit C positive
Brief advice
• Too short for major change but long enough to get people thinking
• Structured brief advice uses evidence based behaviour change techniques to accelerate change thinking
• Must be used alongside empathic communication skills
Brief Advice tool
Brief Advice Delivery Structure1. Start with general information regarding drinking that increases risk of
harm.
2. Give the person an opportunity to consider what this means to them.
3. Show the person how their drinking compares with the general population.
4. Go through the benefits of reducing drinking.5. Look at strategies for reducing drinking.6. Discuss the sensible drinking targets they should aim for.
“Your drinking at the moment places you at an increased level of risk … some of the effects of drinking at this level could be…”
“ How do you feel about this?”
Take the leaflet with you and have Take the leaflet with you and have a think about what we have a think about what we have
discussed.discussed. If you want some further support If you want some further support then we can signpost you to our then we can signpost you to our
local services .local services .