In the West Midlands the Department of Health is taking steps to reduce alcohol-related harm and to train frontline workers, such as doctors and nurses, to pick up on signs of alcohol abuse when a patient comes in for treatment.

The process of identifying people who may have alcohol issues and then taking action has been called identification and brief advice or IBA.

What is IBA? 

• It is identification using a World Health Organisation validated screening tool the Alcohol Use Disorders Identification Test (or AUDIT). This identification tool can help identify whether people's current drinking pattern put them in a low, increasing or highrisk category for health harms.
• It is brief advice. The practitioner can use a Department of Health brief advice tool to structure a 5-10 minute conversation about alcohol.

What can IBA do?

It can help us to recognise those people who are at risk early on, and hopefully prevent so many people going on to develop serious problems through alcohol use.

What is the evidence for the effectiveness of IBA?

There is a large body of evidence. The Cochrane Review in 2007 showed that there was substantial evidence of its effectiveness.

According to research one in eight people receiving brief advice will reduce their drinking to within lower risk levels. 250,000 men and 67,500 women could reduce from higher risk to lower risk levels as a result. Also, increasing and high risk drinkers receiving IBA are twice as likely to have moderated their drinking 6-12 months after the intervention.

Brief advice can reduce weekly drinking by between 13-34%, with a significant effect on recommended or safer use levels. Reduced alcohol consumption is associated with dose dependent lowering of mean systolic and diastolic blood pressure (Miller et al 2005) Brief advice combined with feedback on CDT levels (a biochemical marker) can reduce alcohol and percentage CDT levels in primary care patients treated for type 2 diabetes.

Who is IBA designed to help?

IBA works effectively with people who are drinking at low, increasing and high risk levels.

It helps people to look at their drinking and to consider the pros and cons, as well as suggesting tips to begin to reduce consumption.

For people whose drinking is becoming more problematic, it may be a first step to them getting further support, say up to six sessions of structured support in reducing their consumption

with help from a tier two alcohol service.

It is not aimed at supporting the dependent drinker, who will need specialist advice and treatment, including possibly medication, in order to safely reduce.

What is the key message about IBA?

IBA is about "having conversations about alcohol".  It's about making it commonplace to talk about alcohol, to "ask, assist and advise".

The more we make it normal to talk about alcohol, the more people will be honest about how much they drink and the support they may need to change. Often people just aren't aware of how many units of alcohol are in their drink, or whether they should be drinking on top of medication; nor are they aware that alcohol can affect you blood

pressure, or be making weight loss harder to achieve because there are a lot of calories in alcoholic drinks.

What are the key messages about alcohol?

Alcohol can be enjoyable, but drink in moderation (ie within low risk levels). The more you drink the higher the risk of problems, be they medical, relationship, health and well being or whatever. Sometimes drinking even at low risk levels can be problematic.

For example, if you are on medication, if you drive or operate machinery, or if you are pregnant or planning to be pregnant.

If you are young or in the older age group, even small amounts of alcohol might adversely affect you.

Think before you drink.

Plan how to get home safely if going out with friends, be aware of the effects of alcohol on yourself and try to stay in control.

There are complications associated with losing control of what you say or do through drinking too much.

These are things like unwanted sex, violent behaviour, depression and alcohol poisoning.

Alcohol causes long term health problems as well as short term adverse effects. Some people, because of certain health conditions, may be especially at risk.

If you want to get healthier, have increased health and wellbeing, be fitter and more in control of your life, learning about the effects of your alcohol consumption on yourself may be a useful first step.

Who should deliver IBA?

Frontline staff from a whole range of services are well placed to deliver IBA.

These includes workers from primary care, acute care, mental health services, maternity services, community pharmacy services, teenage pregnancy services, sexual health clinics, the fire service, the police service, the probation service, youth services, community services, faith organisations and housing organisations.