Nursing in Practice Autumn 2021 (issue 121) - Page 17
The alcohol use disorders identification test ( AUDIT ) tool 3
The World Health Organization ’ s alcohol use disorders identification test ( AUDIT ) tool is the gold standard for screening for alcohol harm . A patient ’ s answers to the 10 questions , each scoring 0 to 4 , indicate the extent of their drinking , its impact on their day-to-day life , and the associated risk level . The following are examples of the questions .
Questions Scoring sysyem Your score 0 1 2 3 4
How often do you have a drink containing alcohol ?
Monthly or less
2 to 4 times per month
2 to 3 times per week
4 times or more per week
How many units of alcohol do you drink on a typical day when you are drinking ?
0 to 2 3 to 4 5 to 6 7 to 9 10 or more
How often have you had six or more units if female , or eight or more if male , on a single occasion in the last year ?
Less than monthly
How often during the last year have you found that you were not able to stop drinking once you had started ?
Less than monthly
Scoring ( the scores are based on the full 10 questions and the 40 points available ): 0 to 7 indicates low risk 8 to 15 indicates increasing risk 16 to 19 indicates higher risk 20 or more indicates possible dependence If the score is 8 or above , give brief advice to reduce risk for alcohol harm . If the score is 20 or above , consider referral to specialist alcohol harm assessment .
GETTY consumption and advice on how to swap drinks to reduce unit intake is sufficient to bring about behaviour and lifestyle changes , explains Dr Margaret Orange , associate director for addictions governance at Cumbria , Northumberland , Tyne and Wear NHS Foundation Trust .
‘ Often , people don ’ t realise that alcohol is a problem until they are asked about their drinking ,’ she says . ‘ Explaining to someone that you ’ re asking how much and how often they drink as part of standard questioning about their health status is less stigmatising , too .’
Research shows screening and brief intervention like this can be effective in supporting people with addiction in primary care settings . 4
Where patients present with physical comorbidities or complex psychosocial problems , these should be considered as part of the initial screening and assessment . It ’ s important to make patients aware of the manifold physical damage that can be caused by alcohol misuse , but that advice sometimes lacks impact .
‘ Unless the patient has come in with a physical health problem , messages about physical harm can be meaningless because they think it ’ s a bit ethereal – that those harms won ’ t happen to them for years ,’ Dr Orange adds .
Nurses must therefore tailor their advice by tapping into what ’ s important to each individual . For example , if a patient relies on driving for a living , reminding them they risk losing their license if they are caught under the influence could be the prompt they need to cut down .
Similarly , a young person who ’ s worried about their sexual health is more likely to respond to advice around relationships and sex , and the impact high-risk drinking can have on those aspects of their life , than to being told they risk developing a fatty liver in the future . ‘ It ’ s about finding that one thing to latch on to that would be most meaningful for that patient to make changes at that time ,’ Dr Orange says .
Funding has waned meaning specialist addiction services are no longer available from GP practices and the expertise has been lost
Referral to specialist services However , when it comes to more complex addictions , and addictions to substances other than alcohol , it ’ s less straightforward to manage patients in primary care .
Pamela Walters , clinical director at addiction charity The Forward Trust , explains that changes in the way addictions are managed , together with budget cuts , have hamstrung primary care addiction and substance-misuse services .
‘ Historically , primary care services used to offer sharedcare models for patients with substance-misuse needs . This meant patients could be shared between specialist services and primary care ,’ she says . ‘ As funding for addictions services waned , specialist services are unfortunately no longer available from GP practices , and the expertise of addictions management was lost from swathes of primary care settings . There are still some practices with an interest in addiction , but far fewer now funding has been taken away .’
Processes that would help primary care are also lacking . For example , no standardised tool exists to screen for opiate harm . While it is possible to offer some brief advice and signpost a patient to local support services , an immediate referral to specialist care is usually recommended , according to Dr Orange .
‘ There is good evidence that you can bring someone off opiates very quickly with substitute prescribing , but most primary care settings do not have the expertise to manage opiate addiction .’
NICE guidelines recommend methadone and buprenorphine as substitutes in the management of opioid dependence 5 , but say these should be given under supervision and as part of a programme of supportive care . ‘ A separate medical service covering prescribing , psychosocial support , bloodborne virus services and psychological support across most areas is provided by specialist drug and alcohol services ,’ Walters adds .