In 2011, HAGA developed a novel treatment pathway to reach, and provide guidance for, those whose drinking could be putting them at risk
As a result, Haringey residents can now access alcohol related lifestyle counselling through a GP surgery, even if they are not registered. The approach has been a success, with a significant number of those identified as higher risk drinkers able to cut back and control their drinking in response to Extended Brief Interventions (EBI).
Servicing the middle ground: Higher Risk Drinkers
Higher Risk Drinkers are those whose drinking is not at a level to reach moderate dependence, but is potentially damaging to their health long term. A typical score on the Alcohol Use Disorders Identification Test (AUDIT) would be 16 – 19. Historically, interventions for this group have been lacking; alcohol specialist services typically see drinkers in this bracket as not appropriate for their service, and non-alcohol specialists, such as GPs, simply do not have the time to offer the level of support required.
However, evidence indicates that early intervention makes good financial sense. For every £1 spent on alcohol services it is estimated that £5 will be saved across health and the wider public services (UKATT 2005). Furthermore, for every eight people who receive simple alcohol advice, one will reduce their drinking to within lower-risk levels (Moyer etal., 2002).
How HAGA brought treatment to the patient
HAGA have been using the Extended Brief Interventions (EBI) framework to treat higher risk and moderately dependent drinkers for many years, with good results. EBI involves one to six 20-40 minute motivational interview sessions focused on increasing an individual’s motivation and confidence, weighing the pros and cons of change, planning change strategies, and reviewing progress.
The challenge was to determine whether HAGA could bring EBI into local GP surgeries, extending their reach to help more higher risk drinkers cut down their drinking. HAGA developed and provided EBI training and an EBI tool based on best practice examples. They also developed and circulated a simple visual pathway for professionals as a guide to referring patients. Trials were undertaken at two GP practices with EBI delivered by HAGA staff.
The results provided a model for treatment
In April 2011, HAGA analysed the outcomes of all patients who had received EBI as part of the trial between January and March. In addition, about half were interviewed about their experiences. All EBI clients interviewed had improved their AUDIT scores. All clients reported sustained abstinence or controlled drinking and all were positive about the benefits of EBI style support as “non-judgemental,” “optimistic,” and focused on “motivation and listening not jumping through hoops”.
The results supported the case for EBI within HAGA’s service and the extension of this work into primary care settings delivered by alcohol specialists. Today, HAGA runs GP hub practices in Haringey and Barnet, ensuring that GPs and residents alike have access to help and support.