supporting alcohol harm reduction in the workplace

Supporting individuals to monitor and reduce their alcohol intake

Don ShenkerAlcohol Health Network

Recovery Festival2nd July, 2015

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

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


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)


Proportion of drinking patterns – England


62% Low Risk

12% Abstain

17% Increasing Risk

5% High Risk

4% Dependent

7.1m people

1.6m people

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• 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?

‘Social’ drinking - a problem at work?


• 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


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

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


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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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


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


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


AHN Online Awareness Study findings


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

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


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



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

Thank you – please contact us!

Alcohol Health Network

[email protected]

www.alcoholhealthnetwork.org.uk

4th Floor, 17-23 Willow House, London SW1P 1JH

Tel. 020 3151 2420

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supporting alcohol harm reduction in the workplace

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