Behavioural Science

EARLY DETECTION OF RISKY DRINKING AND DEPENDENCE

Exam – Focus on early identification of substance use issues

1. Perspective on AOD Use
a. Not a dichotomy
b. Drinking/drug use should be viewed as a continuum of different levels of intensity which is constantly changing throughout a person’s life
2. NZ Statistics
a. Male heavy binge drinking 18-24 age category → high rates of alcohol related injury
b. ↑ binge drinking in women
3. Strategy for managing alcohol problems
a. Routine screening process in the health setting – eg systematic questionnaire screening (AUDIT)
b. Positive screens receive brief assessment (see below) during consultation, primary aim to distinguish those w dependency from those with risky/problematic drinking
c. For those with clear dependency, abstinence or at least a major service intervention should be considered
4. Brief assessment
a. Identify hazardous use – estimate pt’s current weakly consumption (further questioning not reqd if below risky levels)
i. Responsible low risk
1. >21 standard drinks per week (male), >14 standard drinks per week (female)
2. Max of 6 standard drinks on any one occasion
3. No known safe level for pregnant women
b. Assess warning bells – for those drinking risky levels, are they experiencing problems associated with this risky drinking
i. Home – marital conflict, abuse etc
ii. Work – absenteeism, job changes etc
iii. Injuries – road, work,home, having fun etc
iv. Legal – drink driving, possession etc
v. Social – isolation, others concerns etc
vi. Psychological – suicide, anxiety, depression etc
vii. Predictable areas of harm → 4 Ls
1. Liver – health problems (liver, brain, ulcers, injuries/accidents)
2. Lover – r/ship problems (family, friends)
3. Livelihood – employment related issues, poor performance
4. Law – drink driving, assault, possession
c. Identify dependence – for those experiencing problems, are they exhibiting signs of dependence
i. DSM 1VR Criteria for alcohol dependence
1. Hazardous and problem use - >12 SDs / day, multiple areas of problem (work, home etc)
2. Signs of physical dependence – tolerance, withdrawal
3. Impaired control – in greater amounts than desired, persistent desire or unsuccessful effort to control
4. Prioritisation of use – time involved, replacement of impt social/occupational activities
5. Motivational Interviewing
a. Wheel of change (Prochaska and Diclemente) – a series of stages which people pass through in the course of change
b. Normal to go around the wheel several times before achieving stable change
c. Stages
i. Pre-contemplation → give information + raise awareness of the problem and possibility of change
ii. Contemplation → tip the balance in favour of change
iii. Preparation / Determination → window of opportunity, help client determine best course of action
iv. Action → activities to bring about change (eg counselling)
v. Maintenance → help client identify and use strategies to prevent relapse
vi. Relapse → help client avoid discouragement and demoralisation, renew determination, resume maintenance efforts
d. Effective motivational approaches
i. Giving ADVICE
ii. Removing BARRIERS
iii. Providing CHOICE
iv. Decreasing DESIRABILITY
v. Practicing EMPATHY
vi. Providing FEEDBACK
vii. Clarifying GOALS
viii. Active HELPING

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