Nursing in Practice Autumn 2021 (issue 121) - Page 17

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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 ?
Never
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 ?
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
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 .
Autumn 2021 nursinginpractice . com