Providing Alcohol Brief Interventions (ABIs) to older adults in community settings
Alcohol Brief Interventions (ABI) are short, structured conversations about someone’s alcohol use.
They are proven to help reduce alcohol consumption among people who drink at hazardous or harmful levels but are not physically dependent on alcohol.
ABIs involve giving simple, brief advice about someone’s level of risk and the changes they could make to reduce it.
ABIs normally take place in clinical settings, but they don’t have to.
Drink Wise, Age Well research suggests that 80% of higher-risk drinkers aged over 50 have never been asked about their drinking by a family member, friend or health professional.
For that reason, doing ABIs in public settings has the potential to help many older people reduce the harm from their drinking.
This guide shares best practices for doing ABIs with older adults in public, including:
- Preparing your team
- Finding the right place
- Engaging the public
- Screening for risk
- Feedback and intervention
- Signposting to more support
Preparing your team
Your team’s attitudes and experiences will affect how they approach ABIs:
- They may feel alcohol is a specialist topic, and that they don’t know enough about it. But they don’t need to be able to answer every question. Simply having the conversation is helpful.
- They may feel uncomfortable talking about a sensitive topic like alcohol with strangers. But most older people are happy to talk about alcohol and the effects of their drinking.
- They may fear being asked about their own alcohol use, whether they drink or not. But answering questions honestly will open a useful discussion, and could show that moderation or abstinence are possible.
Whatever their personal experiences, it’s important that your team are well informed about:
- the alcohol content of different drinks
- guidelines for drinking at lower risk
- the general risks of drinking too much
- the specific risks of drinking as an older person
This will make it easier to have honest, helpful conversations about alcohol.
Finding the right place
ABIs are usually done in clinical settings, but Drink Wise, Age Well staff have delivered them in a wider range of community venues.
For the most part, we have found that older adults in these locations are happy to have a conversation about alcohol.
Examples of community settings with a decent footfall of older people include:
- Hospitals and health centres
- Shopping centres
- Bowling clubs
- Train stations
Our research suggests that ABIs in workplaces can get a poor response, as people may not want to talk about drinking in front of their employers.
As well as footfall, you should also think about:
- Privacy: can you have a quiet conversation?
- Visibility: can people easily see you?
- Time: is it somewhere people won’t be rushed or in a hurry?
When you’ve chosen a place, always ask permission from the venue first. The management may also be able to help with facilities and other support.
Engaging the public
Because alcohol can be a sensitive topic, it’s best to let people come to you, rather than approaching them directly.
You can encourage this by setting up a table with an obvious theme of alcohol in a highly visible place. This way, anyone who approaches you is engaged and open to discussing alcohol.
Some teams have designed their stall as a “bar”, with dummy drinks and glasses. Freebies like stress balls and unit measuring cups can also attract attention from passers-by. A banner promoting “Alcohol Health Checks” is also a good way of attracting attention.
When people approach you, be open, warm and engaging. If people feel at ease, they’ll be more open to hearing about risk.
Finally, it’s best not to ask participants about their age directly, even if you’re focusing on older people, as this can be a sensitive issue.
If the focus is on older people, gauge things by appearance - but your team should be prepared to give ABIs to anyone, regardless of age.
Screening for risk
After the introduction, the next thing is to deliver the first component of the ABI: screening the participant for risk.
To do so, we use three simple “AUDIT-C” questions developed by the World Health Organisation.
When going through the questions, it’s a good idea to talk about standard units and how they understand them, as this can help people answer the questions accurately.
Measuring cups and unit wheels can be a big help here. Having a unit wheel to hand when answering the AUDIT-C questions helps people give accurate answers. People can also take the unit wheels home to promote safer drinking in their daily lives.
This kind of discussion isn’t a standard part of ABIs but can be a useful intervention in itself.
Feedback and intervention
As with ABIs in other settings, the kind of feedback you give will depend on the person’s level of risk:
- People scoring between zero and 4 are at low risk. We would say something like “Well done. You’re a lower-risk drinker, and less likely to experience problems caused by alcohol”.
- People scoring between 5 and 12 should be told that this puts them at greater risk of alcohol-related harm.
We start by letting people know their general risk level, then asking if they’re surprised by their score.
At this stage, it’s important to be sensitive to the person’s state of mind. This can be a difficult moment for people: they might be worried or distressed to hear that their drinking is risky.
But at the same time, you should be direct when discussing the potential issues. This will help people make connections between alcohol and problems they’re experiencing in their daily lives.
After the discussion, ask the person whether they would consider making any changes to their drinking. Then ask them what kind of changes they’d consider: a verbal commitment may make change more likely.
These topics can be particularly relevant to older people:
The alcohol content of home measures
People often exceed standard measures when drinking at home, which can give them an inaccurate idea of how much they’re really drinking.
How their drinking adds up
Many older people drink as part of a daily routine, and may not realise that this can add up to risky levels.
You could encourage them to:
- use a unit measuring cup
- use smaller glasses
- avoid topping up glasses that are partly full
Sleep problems and fatigue
Sleep problems can affect anybody, but they’re more common for older adults.
Even a couple of drinks can interfere with the normal sleep process. It can reduce the amount of REM sleep, which is important for restoring and repairing our bodies during sleep.
Alcohol can also make you more likely to get up in the night to use the loo.
It’s best to avoid alcohol for at least four to six hours before going to bed.
Alcohol and depression are closely linked. Alcohol can lead to low mood and anxiety, and can worsen the symptoms of pre-existing mental health problems.
Using alcohol to treat depression symptoms can often mask underlying problems, meaning they are not properly addressed.
Alcohol and calories
Older people often find it difficult to manage their weight, and may not know that the calories in alcohol make this harder. This can be a strong motivator for changing drinking habits.
Alcohol and driving
Many older people rely on driving to stay independent, and the risk of losing their driving licence can be a strong motivator to change.
Older adults’ bodies take longer to process alcohol, and this often puts them over the drink-driving limit without realising. They may believe they’re within the limit, but they may not be safe to drive - even the next morning.
The safest option is always to avoid drinking alcohol altogether when driving that day or the next.
Signposting to further support
If someone is concerned about their own drinking, or someone else’s, the next step is to direct them to further support.
This might not always be an alcohol or drug treatment service. You may find that people disclose other issues, and could benefit from other types of support.
For that reason, it’s important that your team is ready to share the contact details of a wide range of local services. These could include:
- Alcohol counselling or detox services
- Counselling or detox services for other substances
- Support services for family and friends
- Mental health services
- Sexual abuse services
- Domestic abuse services
- Social cafes and groups for the isolated
- Housing and financial support services
- Local food banks
If you have serious concerns about someone’s health or alcohol use, advise them to see their GP.
If someone isn’t ready to attend a service, freebies like pens printed with contact details means they can approach the service when they feel ready.