Screening And Brief Intervention In Alcohol Consumption

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Alcohol is responsible for health problems and injuries and contributes significantly to 40 specific diseases with increased risk and attribution of a significant part of preventable mortality and morbidity 1,2.

associated with alcohol consumption

alcohol consumption

The morbidity associated with alcohol consumption includes digestive, psychiatric, neurological, infectious (tuberculosis), cancer of various types, cardiovascular diseases (hemorrhagic stroke, heart failure, arrhythmias, cardiomyopathy), intentional injuries (aggressions, suicides), unintentional damages (traffic accidents), social pathology (addiction) and family problems 3. 

level of consumption

 In 2016, alcohol consumption was the seventh risk factor for deaths and loss of disability-adjusted life years globally. The same report indicates that the risk of mortality from all causes, and specifically from cancers, increases with increasing consumption, and the level of consumption that minimizes loss of health is zero.

The Idea Of Avoiding Risky Consumption

​​Avoiding risky consumption should be emphasized and conveying to patients and the population that the most beneficial thing for health would be not to consume alcohol or to do so below low-risk limits and to avoid occasional intensive consumption.

  • Reducing alcohol consumption is a priority and is one of the sustainable development goals of the United Nations, having sufficient evidence and consensus on which are the most effective policies to reduce it that are included in international strategies10 and national 11.

 One of the most profitable policies, which includes the SAFER, is the intervention of health professionals in their consultations, facilitating access to screening, brief interventions, and treatment of problems caused by alcohol consumption.

 In addition, it is important to consider that alcohol consumption is associated with social and health inequalities, so consuming alcohol is not only an individual decision but is also influenced by the conditions and circumstances in which people live (social determinants of health).

 For this reason, in the consultation, risk factors and protective factors can be identified, considering the people’s environments and the specific needs of certain population groups. A community approach is essential to reach groups who do not frequent consultations

What Is The Brief Intervention In Risky And Harmful Consumption Of Alcohol?

The brief intervention (BI) in risky and harmful consumption of alcohol has as its objectives the reduction in alcohol consumption, the reduction of risky drinkers of alcohol, the reduction of harmful drinkers of alcohol, and the reduction of alcohol-related problems. The BI is based on cognitive-behavioral methodological elements but also the contributions of the motivational interview. The BI is a form of opportunistic intervention by the health professional (demand for attention other than alcohol consumption), carried out by a non-specialist professional, aimed at less serious problems caused by alcohol, with a less motivated patient, and in a short and unstructured manner. The effectiveness of BI depends to a large extent on the relationship established between the primary care professional and the patient, regardless of the professional who administers it (family doctors, nurses, psychologists).

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Motivational Interviewing

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Motivational interviewing is a direct assistance style centered on the patient, which aims to provoke a behavior change, helping to explore and resolve ambivalence. It is based on respecting the patient’s autonomy and compassion, collaborating with the patient, and evoking the reasons for the change in himself. To do this, try to express empathy, facilitate the appearance of discrepancies, move forward with resistance, and encourage self-efficacy. It is proposed to use specific interview tools to encourage patients to talk, explore their ambivalence about substance use, and clarify their reasons for reducing or stopping alcohol use. Specifically, ask open questions, use affirmation techniques of what the patient says, reflective listening, and summary techniques. In patients with risky consumption but without criteria for alcohol dependence syndrome, behavioral treatment should be considered. The intervention consists of medical advice aimed at changing the consumption pattern. This advice should be personalized and include five points for the brief intervention. The target population is the risk drinker (the threshold for intervention). We are talking about a risk drinker when alcohol consumption is 28 SDUs per week (4/day) for men and 17 SSUs (2.5/day) per week for women. Any degree of consumption is also considered a risk in the case of a family history of alcohol dependence. This risk threshold determines the intervention in PC since the estimate is that one in 10 patients has daily intakes greater than these amounts. Intensive consumption ( binge drinking) can be defined as consumption equal to or greater than 6 SDUs (men) or 4 SSUs (women) in a consumption session (usually 4-6 h). Although the clinical criterion of one or more times a month is usually used, it is well known that the risks of intensive consumption are significant even when this pattern is adopted sporadically, even once a year

In non-alcohol-dependent patients who do not want complete abstinence or do not meet the criteria, the reduction can be negotiated, reaching a consumption agreement in the low-risk range between 10g/ day in women and 20g/day in men 19. In any case, the idea that “alcohol, the less, the better” should always be transmitted. It must be clear that the person who consumes risk or even the one who makes a harmful consumption is not “yet” an “alcohol-dependent” to prevent this feeling of stigma. On the other hand, the allusion to the concealment of consumption is not valid for most cases of risky or harmful consumption, being a characteristic of dependent drinkers.

Risk Estimation To Modulate The Intervention

Various risk assessment strategies have been used, such as the simple quantification of consumption in units (UBE) or grams, the CAGE test, the MALT test, Etc. However, for two decades, numerous authors and institutions (the WHO, among others) have established that the AUDIT test is the most appropriate method to estimate the level of risk and adapt the intervention. Various authors have evaluated the reliability of the AUDIT. The AUDIT-C includes all three questions on alcohol use from the full 10-item AUDIT test). The study by García-Carretero et al. shows the validity and utility indices presented. Unpublished data indicate that the prevalence of risky consumption in PC using the AUDIT-C criteria ≥5 in men (≥4 in women) is around 11%. The percentage of individuals in the early phases of dependence has not been estimated in our country (AUDIT 15-19). Still, it could be hundreds of thousands, and these would be the target population for interventions from primary care. On the other hand, 8.8% of the adult population admits to consuming alcohol daily, and within this group, a part of the population is at risk. In contrast, others are at risk due to chronic intensive consumption (binge drinking). Although one usually speaks of a brief intervention in practice, it would be more correct to speak of “brief interventions.”There is great heterogeneity in everything related to the IB. For example, in the Swedish National Program, the BI took on average less than minutes; however, in England, the National Program, based on the SIPS study, recommends using between 5 and 10 minutes, while the Cochrane Collaboration defines the BI in primary care as an average time of 25 minutes. Three levels of BI intensity can be considered arbitrarily based on the duration and frequency of the interventions.…

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Effectiveness Of The Brief Intervention

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The Cochrane Collaboration review selected 69 studies, including 33,642 individuals. 55% of the studies were conducted in PC, while others were in hospital emergencies and other settings. 88% compare IB with minimal or no intervention. The average result was a 20g/week decrease after one year. A great heterogeneity of the studies was observed due to the difficulties of obtaining a reliable quantification over time of alcohol consumption. For this reason, it is difficult to propose meta-analyses, which are rather systematic reviews with a wide range of results. Among other results, he observed a generally non-significant decrease in episodes of habitual intensive consumption, a lower number of days of consumption per week, and a decrease in the intensity of consumption.

The study on the efficacy of medical advice to reduce consumption in Spain revealed a decrease in about 100 g of alcohol per week (6.5–13.8g/ day) after one year of follow-up 22. On the other hand, the Spanish studies revealed a reduction in the percentage of risk drinkers submitted to the intervention group, indicating a modest but real qualitative change in the transition from the risk group to the low-risk group. The USPSTF recommends BI in the adult population over 18 years of age, although it does not consider the effectiveness of BI in adolescents between 12 and 18 years to be proven 23. The semFYC Preventive Activities Program (PAPPS) also makes these recommendations

Implementation Of Screening And Brief Intervention

Implementation of screening and brief intervention remains quite low, despite the high prevalence of risky drinking, its association with mortality and disability, and the evidence of the effectiveness of screening and BI. For example, in the United States, only 1 in 6 patients report discussing alcohol with their doctor; rates in Europe are equally low 25. Even when screening is performed, validated questionnaires are used infrequently. Reasons for their low acceptance may include challenges related to implementation and clinicians’ perceptions of their roles. Brief interventions are unlikely to cause harm (unless poorly delivered or confidentiality is breached), and the consequences of risky alcohol use can be severe. Even small changes by decreasing alcohol consumption could improve health outcomes at the population level. Another reason for low BI implementation is that the components of brief behavioral counseling interventions are not standardized in content, delivery, dose, or duration. Besides, patients assessed and counseled about alcohol use report receiving high-quality primary care.

Brief Intervention In A Risk Drinker From Primary Health Care

To analyze the clinical case of a risk drinker from the perspective of primary health care and the use of the brief intervention in said patient. Material and methods: The clinical case of a 52-year-old male patient who attends the primary care clinic for stomach ailments is studied. Medical history is collected, including eating habits and substance use; analytical tests are requested. The clinical history, the physical examination, and the analytical evaluation indicate a gastric pathology and high-risk alcohol consumption. For this reason, a brief intervention is carried out to promote a change in the consumption of identified risks. In the primary care consultation, it would be advisable to carry out a systematic screening of alcohol consumption and administer a brief intervention (assessment, advice or advice, and some follow-up) to patients identified as drinkers with risk or harmful consumption of alcohol.…

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Brief Motivational Intervention

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A Brief Motivational Intervention (BMI) consists of a short interview based on the principles of Motivational Interviewing ​( R. et al., 2012)​ that aims to achieve change in a certain behavior to promote changes toward healthier lifestyles (Field et al., 2005) through a collaborative, person-centered orientation, aimed at strengthening motivation for change (Miller & Rollnick, 2009) ​.

The IbM can be carried out by any professional profile that dedicates part of their time to getting their users or patients to adopt behaviors that favor their health, provided they receive specific training on motivational interviewing (Kaner et al., 2007 ). The amount and duration of this type of intervention can vary from a single session of a few minutes to four sessions of 45 minutes, depending on the type of encounter (opportunistic, programmed), the type of behavior to be addressed, the stage of change, Etc.

This style of health promotion approach, although initially created to treat disorders related to alcohol abuse (Kaner et al., 2007), is being used in different clinical contexts that require changes in lifestyle, acquisition of healthy habits, or abandonment of unhealthy habits such as drug use ( )​ among others.

In certain situations, having experienced an adverse effect related to unhealthy behavior, such as a cardiovascular event related to a poor diet and a sedentary lifestyle or a hospital admission due to trauma related to the consumption of alcohol and other drugs (Cordovilla-Guardia et al., 2017b), or being in a positive condition such as pregnancy (Franco-Antonio et al., 2020 ).​, can place the person who experiences it in a situation of special receptivity to receive interventions to adopt healthy habits. These situations have been called in health sciences “teachable moment” —which could be translated as “propitious moment of teaching”— and generate “windows of opportunity” that increase the success of initiatives that aim to change healthy behaviors ( ​.

Our research group has found IBM an ideal tool to investigate modifiable risk factors in health, which are the basis of the research that supports the MOTIVA lines, such as the one that began with the research on the prevention of recidivism of injuries related to the consumption of alcohol and other drugs ( that intends to develop a program for the prevention of the initiation of cigarette consumption in adolescents.

To Promote Behavioral Change In Primary Care

Brief health intervention is a therapeutic strategy suggested to address behavioral changes associated with risk factors for chronic non-communicable diseases. There is ample evidence of its effectiveness. However, this evidence is based on different definitions of brief intervention, which makes its clinical application difficult. This literature review article proposed a search for systematic reviews in the database to identify common factors in its definition and summarize some frequently used brief intervention strategies in primary health care. Likewise, it seeks to describe its effectiveness in this clinical context for three risk factors: tobacco, alcohol, and physical activity.

The prevention of chronic diseases and the control of associated risk factors are part of the preventive and promotional approach proposed by the World Health Organization to reduce the increasing morbidity and mortality related to chronic non-communicable diseases.…

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How To Help An Alcoholic?

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It has been shown that the role of the family is fundamental in helping an alcoholic. Family support and active participation in treatment are essential to achieve good results.

The family must understand that the patient’s self-control abilities are affected by addiction. Thus, family support focuses on achieving the start of treatment or accompanying the recovery of said capacities, allowing them to overcome addiction. Various scientific studies have demonstrated its superiority over other intervention strategies.

When we talk about family, we specifically refer to the patient’s significant relatives, such as parents, siblings, partners, or any other person who has a relevant link with the addict. This program has two possible applications:

  • to support relatives of patients starting treatment, and
  • to facilitate strategies that allow family members to cause a person reluctant to accept their difficulties with alcohol to end up accepting treatment.

The CRAFT program is based on the importance of the social environment surrounding the drinker (partner, parents, children, friends, colleagues…) in maintaining, increasing, or decreasing alcohol consumption. The program teaches to identify and modify behaviors that can inadvertently stimulate alcohol consumption, replacing them with positive behaviors that promote the reduction of consumption and, ultimately, can cause the drinker to enter treatment.

The Program Uses Various Techniques And Strategies, Such As:

  • Measures against domestic violence.
  • Functional analysis of patient behavior.
  • Positive communication.
  • Make it easier for family members not to forget to care for themselves.
  • Strategies to convince the patient to start or continue treatment.

Helping An Alcoholic: Some Basic Guidelines

Families and close environments do not usually know how to deal with the problem, often blaming the subject, pretending not to know, or justifying their behavior. However, such behaviors do not help the patient but can complicate her condition. That is why we will now review some guidelines to help an alcoholic, both to make him see his problem and to facilitate its solution.

  1. The Environment Must Recognize The Problem

In the first place, although it may seem logical, the first step to take into account is not to justify or ignore the behavior and excessive consumption of the subject with alcoholism. The subject who suffers from this disorder or disease (not a vice, something important to take into account) consumes alcohol that is dangerous and has a large number of short and long-term consequences. This fact, as well as that it is a disease or disorder and not something that the subject does to and over which has total control, must be understood and understood by a close environment.

It is important to remember this point, whether the subject can identify and recognize their problem or is unaware of it.

  1. Carry Out The Approach To The Subject In A Moment Of Sobriety

Another logical aspect, but one that can be difficult to consider when the subject arrives drunk and with irrational behavior, is to deal with the issue when the subject is sober. Dealing with the subject in a state of intoxication will not have the same effect since the subject cannot reflect; easily forgetting what was said or even an aggressive response on his part is possible.

  1. Take A Helping Position And Not Blame

It can be easy that the frustration and pain caused by the state of our friend, partner, family member, or loved one, or their behavior or perceptible lack of intention to change, push us to blame them for the situation. This fact does not help the subject but can generate reactance and the existence of conflicts that, in some cases, can even push the affected person to drink more to avoid discomfort.

It is not about pretending nothing is happening but about addressing the issue directly and adopting an empathetic attitude that allows approaching it proactively and collaboratively. It is also important to remember that you should not be condescending or start from a position of superiority, which will also generate reactance.

  1. Watch How You Communicate

Linked to the previous point, we must remember that we face a very complex situation. We can express our feelings regarding the situation that our loved one is experiencing, being useful that we include ourselves in the sentences.

Concern, if it exists, should be expressed, and it is often helpful to mention some of the behaviors you find concerning. Express yourself with empathy and try to seek dialogue, asking why some behaviors are not excessively demanding.

  1. Maintain Some Degree Of Control

The subject with alcoholism is someone with profound difficulties in controlling alcohol intake, this loss of control being the most defining aspect of this disorder. Although it is not about exercising continuous control of each gesture you make, it is advisable to maintain some control over your situation. One of the ways to do it is through money management, in such a way that you can control the amount that the subject carries and what is spent, and even on what depending on how. A person can obtain money from other sources or even be invited, but this procedure is very useful and limits the possible purchase of alcohol.

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