Alcohol misuse: support and advice from the pharmacy team. A CPPE distance learning programme

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1 Alcohol misuse: support and advice from the pharmacy team A CPPE distance learning programme December 2015

2 Contents About CPPE distance learning programmes About this learning programme Introduction to Public Health England alcohol learning resources The Alcohol Learning Centre website vi ix xii xiii Contents Section 1 Facts about alcohol Statistics on alcohol misuse National strategies, policies and drivers 2 Tackling the global problem 3 Local information Safe drinking: recommended limits of alcohol 4 Recommended limits 5 Alcohol use in pregnancy 5 Definitions of levels of alcohol intake Identifying a patient s level of drinking 8 Case study 1 Part 1: Alcohol units 4 Exercise 3 e-activities 4, 5, 8 Summary and intended outcomes 8 Section 2 Alcohol as a drug Pharmacokinetics of alcohol 9 Absorption 9 Metabolism 10 Elimination The impact of alcohol misuse on physical health 10 Alcohol and the brain 11 The impact of alcohol on the central nervous system 11 The impact of alcohol on the liver 12 The impact of alcohol on the cardiovascular system 12 The impact of alcohol on the endocrine system 13 The impact of alcohol on the gastrointestinal system 13 The impact of alcohol on the development of cancer 13 iii

3 Alcohol misuse: support and advice from the pharmacy team 2.3 The impact of alcohol misuse on mental health 14 Delirium tremens 15 Co-occurring disorders Alcohol and older people The impact of alcohol misuse on society 16 Families and relationships 16 Wider society Alcohol and the law 17 Exercise 16 e-activities 11, 14, 17 Summary and intended outcomes 18 Section 3 Alcohol identification and brief advice Alcohol misuse presenting in the community pharmacy The evidence for brief advice Understanding brief advice The alcohol identification and brief advice pathway Screening tools The full AUDIT questionnaire 24 Case study 1 Part 2: Raising awareness 19, 20 Case study 1 Part 3: Attitudes 22 Case study 1 Part 4: Using screening tools 24 Exercise 23 e-activities 21, 22, 23, 24 Summary and intended outcomes 25 Suggested answers 25 Section 4 Clinical approach to brief advice Assessing readiness to change Structuring brief advice Advice for people with a lower risk score at screening Offering brief advice Referral for specialist advice 32 Exercise 29 e-activities 28, 30, 31, 32 Reflective question 31 Summary and intended outcomes 32 iv

4 Section 5 Setting up the service Alcohol identification and brief advice in community 33 pharmacy 5.2 The NHS community pharmacy contractual framework Types of alcohol IBA service Community pharmacy projects 34 Wirral alcohol IBA services 34 The Leeds project 35 Pan-London alcohol awareness campaign 36 Hampshire Pharmacy Alcohol Brief Intervention 37 pilot project NHS Blackpool 37 Other projects Factors to consider in order to deliver an alcohol 38 IBA service The physical environment 38 Declaration of competence 38 Service specification 38 Standard operating procedures 38 Training for the pharmacy team Developing a proposal for an alcohol IBA service Are you service ready? 40 Summary and intended outcomes 41 Contents Section 6 Case studies 42 Case study 2 Peter 42 Case study 3 Melanie 43 Case study 4 Becky 44 Summary and intended outcomes 45 Next steps 45 Suggested answers 46 References and further reading 48 Appendix 1 AUDIT-C tool 51 Appendix 2 The full AUDIT questionnaire 52 Figures and tables FIGURE 1 Alcohol unit calculator 5 TABLE 1 Common physical and mental health 11 complications of alcohol misuse v

5 Alcohol misuse: support and advice from the pharmacy team 1.3 Safe drinking: recommended limits of alcohol In order to understand whether an individual is drinking within recommended limits it is necessary to understand what we mean by this and how it can be assessed. Case study 1 Part 1 Alcohol units Ben is the pharmacist in a busy community pharmacy and he and his team are interested in initiating an alcohol IBA in the pharmacy. Throughout this distance learning programme we will be following the progress of Ben and his team as they explore the issues surrounding alcohol IBA, and how they develop their service. As part of their regular CPD sessions Ben suggests his team work through a quiz to assess their current knowledge of units of alcohol in common beverages. From your existing knowledge try to complete the table below. You will be able to check your answers in the e-activity that follows. Units of alcohol A large glass (175 ml) of wine 14% abv* A small glass (50 ml) of sherry 20% abv* Half a pint of standard lager 3.5% abv* A bottle of wine (typically 14% abv)* A 25 ml measure of vodka 40% abv* A pint of strong lager 5% abv* *alcohol by volume e-activity Alcohol units From the Contents page of the Alcohol IBA e-learning course: Click on Session 01 Facts about alcohol Click on Alcohol facts Click on What do you know about units? and work through the activity presented. Then check your answers to both activities by looking at the Typical unit values pages. 4 The definition of one unit of alcohol is 8 g (or 10 ml) of pure alcohol. The number of units in an alcoholic drink depends on the strength of that drink known as the alcohol by volume measure or abv, and the size of the measure (see Figure 1 below). A half pint of normal strength beer, lager or cider, for example, is equal to one unit of alcohol. In 2006, the unit measurement methodology was updated to take into account the increased strengths of alcoholic drinks and larger glass sizes that have developed over recent years. 16

6 FIGURE 1 Alcohol unit calculator Alcohol by volume (abv%) x volume (ml) = Number of units 1000 Examples Pint of beer/lager/cider 5% 5 x 568 ml 1000 = 2.84 units Bottle (750 ml) wine 12% Section 1 Facts about alcohol 12 x 750 ml 1000 = 9 units There are a number of tools available to help pharmacy staff and patients to identify units, such as the Change4Life drinks checker and drinks tracker app (see the Change4Life resources listed in Section 5.5). Recommended limits The Department of Health recommends the following: 12 Adult men should not regularly consume more than three to four units of alcohol per day (eg, approximately two pints of 3% lager). Adult women should not regularly consume more than two to three units per day (eg, approximately one large glass of 14% wine). Regularly means drinking this amount every day or most days of the week. The Royal College of Physicians (RCP) advises: In addition to quantity, safe alcohol limits must also take into account frequency. There is an increased risk of liver disease for those who drink daily or near daily compared with those who drink periodically or intermittently. 17 The House of Commons Science and Technology Committee advise that people should have at least two alcohol-free days a week. 18 Alcohol use in pregnancy The Department of Health recommends that pregnant women, or women trying for a baby, should avoid alcohol altogether. If they do choose to drink when pregnant, to minimise risk to the baby, the government s advice is to have no more than one to two units of alcohol once or twice a week, and to avoid getting drunk. 18 The Department of Health recommends that pregnant women, or women trying for a baby, should avoid alcohol altogether. e-activity Modern drinking habits From the Contents page of the Alcohol IBA e-learning course: Click on Session 01 Facts about alcohol Click on Alcohol facts Click on Modern drinking habits. By clicking on the glass of wine icons at the bottom of the page, you will see possible reasons for the increase in alcohol intake. 5

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