Don Shenker, Alcohol Health Network

1. Supporting individuals to monitor and
reduce their alcohol intake
Don Shenker
Alcohol Health Network
Recovery Festival
2nd July, 2015

2. Overview
‘What works’ to reduce alcohol harm at
work
Prevention vs. Treatment -
Recognising signs of problem drinking
‘Identification and Brief Advice’ – what
the research tells us
Findings from AHN and UCL /
Middlesex study
Copyright: Alcohol Health Network

3. Alcohol Health Network
Our objective: Early intervention and
prevention of alcohol misuse
• Encourage alcohol self-awareness
and identification
• Provide alcohol awareness
campaigns and advice
• Signpost heavy drinkers to local
services
Collaboration with UCL’s E-Health Unit
and Camden and Islington NHS Trust
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4. Awareness of alcohol units – Health Survey
England
Good news - heard of daily drinking -
75%
Not so good: 35% of men / 47% of
women don’t know recommended
guidelines
“Those who attempted to define the
recommendations were more likely to
be wrong than right”
People can underestimate their alcohol
intake by around 40 to 60% (UCL,
2014)
Copyright: Alcohol Health Network

5. Proportion of drinking patterns – England
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62% Low Risk
12% Abstain
17% Increasing Risk
5% High Risk
4% Dependent
7.1m people
1.6m people

6. Copyright: Alcohol Health Network 6
• Alcohol is the most widely used substance
among working adults
• Almost 80% of risky drinkers are employed
• One UK study found that:
⁻ 1/3 employees admitted having been to work
with a hangover
⁻ 15% reported having been drunk at work
⁻ 1 in 10 reported hangovers at work once a month; 1 in
20 once per week
Normalised workplace culture?

7. ‘Social’ drinking - a problem at work?
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• Time off work due to hangovers
or feeling unwell in the morning
• Poor sleep affects performance
at work
• Long term poor health or
mental health problems
• Concealed from colleagues or
tolerated and this causes stress
and tension for the whole team

8. Copyright: Alcohol Health Network
Impact of heavy drinking on
the workplace
• Heavy drinking is associated with
multiple negative workplace outcomes:
⁻ Increased presenteeism;
⁻ Higher rates of absenteeism;
⁻ Accidents;
⁻ Reduced academic performance;
⁻ Increased risk of unemployment;
⁻ Premature mortality.
• Heavy drinking Reduced productivity  tangible
costs to both employee AND employer

9. Why ask employees questions about their
drinking?
• Majority of heavy drinkers are of
working age and in work
• Majority of individuals poorly
informed of health risks
• NICE: Questions lead to behaviour
change
• Duty of care
Copyright: Alcohol Health Network

10. Alcohol Use Disorders Identification Test (AUDIT)
NICE : Identification and Brief Advice (IBA) one of most cost effective
measures to identify, prevent and reduce risky drinking
Use of AUDIT alcohol screening to identify problem drinking in GP / A&E /
Hospital settings now well established
Review of 32 controlled trials: 1 in 8 problem drinkers reduced drinking to
lower-risk levels (Moyer 2002)
Project Treat in US – use of IBA in GP settings – found cost savings at 12 /
48 month in terms of alcohol related hospital / A&E costs (Fleming 2002)
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11. Copyright: Alcohol Health Network

12. International evidence for impact of IBA
at work
Hermansson 2010 – Scandinavian transport company - 20% of employees drank
excessively
• Following IBA at 12m follow up 28% reduced excessive drinking
• Baseline 51% scored >8 on AUDIT - 23% at 12m follow up
Saitz et al 2006 - US web-based study of 4,000 students – 33% of women and 15%
of men drinking at increased risk reduced their drinking to low risk one month later.
Doumas 2007 found e-based IBA and personalised feedback reduced heavy drinking
by 30% among young workers compared to assessment-only
Quanbeck et al 2010 developed a US cost benefit model - Benefit to cost ratio of 4.4
– 1 for spend on IBA delivery in workplace
Copyright: Alcohol Health Network

13. Identification and Brief Advice approaches – in
the workplace
 Reactive approach – Occupational Health / EAP
 Proactive approach - Encourage employees to use AUDIT tool
privately - to measure own drinking rates
 Online
 Induction
 Market stall / Health Days
 Training managers
 Signposting – services and self-help resources
Copyright: Alcohol Health Network

14. AHN Online IBA Studies
Middlesex University 2013 - Evaluation of the Better Drinking Habits
Online Tool
University College London /
Newcastle University 2013 - Feasibility study
of electronic screening and brief intervention
for alcohol misuse in workplace settings
• Online alcohol / health assessment tool - Promoted via intranet / posters
• Confidential risk-based feedback on drinking and health measures
• Baseline measure and follow up 3-m later
Copyright: Alcohol Health Network

15. Copyright: Alcohol Health Network

16. AHN Online Awareness Study findings
Copyright: Alcohol Health Network
Middlesex University 2014
• 17% completion rate
• Statistically significant reduction in
drinking
• 38% respondents reduced
consumption
• 68% found feedback useful
University College London 2014
• < 35% completion rate
• 7% reduction in proportion of staff
drinking at Increasing or High Risk
levels

17. Learning from workplace alcohol
awareness prevention approaches
Majority of employees using tool value this approach
Anonymity very important
Approach appeals to increased/high risk drinkers
Staff want to understand more about health risks for different levels
Alcohol focus attracts larger proportions of heavy drinkers
compared to health focus
Copyright: Alcohol Health Network

18. Recommendations for companies and
organisations
Review Policy – encourage staff to come
forward and seek support
Alcohol awareness programmes should
encourage self-identification
Pro-actively make workplaces “alcohol
aware” – change the culture
Ensure prominent signposting to support
services
Act as “champions” to engage other
companies and organisations
Copyright: Alcohol Health Network

19. Copyright: Alcohol Health Network
References / Further Reading
Doumas DM, Hannah E. Preventing high-risk drinking in youth in the workplace: a web-based normative feedback program. Journal of
substance abuse treatment. 2008;34(3):263-71. Epub 2007/06/30.
Fleming M.F, Mundt M.P, French M.T, Manwell L.B, Stauffacher E.A, Barry K.L. (2002) Brief physician advice for problem drinkers: long-
term efficacy and benefit-cost analysis. Alcohol Clin Exp Res. 26(1), 36-43.36
Hermansson U, Helander A, Brandt L, Huss A, Ronnberg S. (2010) Screening and brief intervention for risky alcohol consumption in the
workplace: results of a 1 year randomised controlled study. Alcohol and alcoholism. 45 (3) 252-257
Khadjesari Z, Murray E, Hewitt C, Hartley S, Godfrey C. Can stand-alone computer-based interventions reduce alcohol consumption? A
systematic review. Addiction (Abingdon, England). 2011;106(2):267-82. Epub 2010/11/19
Middlesex University / NHS North Central London / Alcohol Academy / IHWUK (2011) Alcohol and the workplace? The importance of
early intervention and workplace policies in reducing the health and business impact of alcohol misuse
Moyer, A., Finney, J., Swearingen, C. and Vergun, P. (2002) Brief Interventions for alcohol problems: a meta-analytic review of controlled
investigations in treatment -seeking and non-treatment seeking populations, Addiction, 97, 279-292.
NICE Public Health Guidelines 24 (2010) Alcohol Use Disorders – Preventing the development of hazardous and harmful drinking, NICE
Quanbeck A, Lang K, Enami K and Brown R. (2010). A Cost-Benefit Analysis of Wisconsin’s Screening, Brief Intervention, and Referral
to Treatment Program: Adding the Employer’s Perspective. Wisconsin Medical Journal ; 109(1): 9–14
Roche AM, Pidd K, Berry JG et al. (2008). Workers’ drinking patterns: the impact on absenteeism in the Australian work-place. Addiction,
103:738–748.
Seymour L. (2010) Common mental health problems at work. What we now know about successful interventions. A progress review.
BOHRF/Sainsburys centre for mental health
Wallace P, Murray E, McCambridge J, Khadjesari Z, White IR, et al. (2011) On-line Randomized Controlled Trial of an Internet Based
Psychologically Enhanced Intervention for People with Hazardous Alcohol Consumption. PLoS ONE 6(3): e14740.
doi:10.1371/journal.pone.0014740
Watson H, Godfrey C, et al (2009) Reducing Alcohol-related Harm In The Workplace - A Feasibility Study Of Screening And Brief
Interventions For Hazardous Drinkers Alcohol Research UK

20. Thank you – please contact us!
Alcohol Health Network
donshenker@alcoholhealthnetwork.org.uk
www.alcoholhealthnetwork.org.uk
4th Floor, 17-23 Willow House, London
SW1P 1JH
Tel. 020 3151 2420
Copyright: Alcohol Health Network 20