Brief Introduction to the World Health Organisation's AUDIT Tool: A

Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide

April 2016

Regan Jules-Macquet

Brief Introduction to the World Health Organisation’s AUDIT Tool: A Trainer’s Guide Page 1 of 30

CJCP © 2016 Creative Commons

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0

International License.

Telephone:

021 685 2659

http://creativecommons.org/licenses/by-nc-sa/4.0/




TABLE OF CONTENTS

TABLE OF CONTENTS ........................................................................................................................................ 2

TABLE OF FIGURES ........................................................................................................................................... 4

INTRODUCTION ............................................................................................................................................... 5

ABOUT THE CJCP .............................................................................................................................................. 5

INTRODUCTION TO THE TRAINING GUIDE........................................................................................................ 6

TRAINING OVERVIEW ............................................................................................................................................... 6

TRAINING OUTCOMES .............................................................................................................................................. 7

TRAINING OUTLINE .................................................................................................................................................. 7

FACILITATOR’S INSTRUCTIONS ......................................................................................................................... 9

USING THIS MANUAL ............................................................................................................................................... 9

EQUIPMENT & RESOURCES ....................................................................................................................................... 9

ICE-BREAKERS AND ENERGIZERS .............................................................................................................................. 10

FACILITATING LEARNING ......................................................................................................................................... 10

SESSION 1: INTRODUCTION ........................................................................................................................... 11

WELCOME TO THE TRAINING .................................................................................................................................. 11

HOUSEKEEPING MATTERS ....................................................................................................................................... 11

TRAINING EXPECTATIONS ........................................................................................................................................ 11

TRAINING OVERVIEW ............................................................................................................................................. 11

SESSION 2: BACKGROUND ............................................................................................................................. 12

INTRODUCTION ..................................................................................................................................................... 12

THE AUDIT TOOL ................................................................................................................................................... 12

DEFINITIONS......................................................................................................................................................... 13

EVIDENCE OF BENEFITS (BRIEF) ............................................................................................................................... 14

APPLICABILITY ....................................................................................................................................................... 15

REFLECTION AND REVIEW ....................................................................................................................................... 15

SESSION 3: CONTEXT...................................................................................................................................... 16

INTRODUCTION ..................................................................................................................................................... 16

THE SOUTH AFRICAN CONTEXT ................................................................................................................................ 16

EFFECTS OF ALCOHOL CONSUMPTION ON INDIVIDUALS, FAMILIES AND COMMUNITIES ...................................................... 16

THE DRINKER’S PYRAMID ........................................................................................................................................ 18

MODEL OF BEHAVIOUR CHANGE (BRIEF) ................................................................................................................... 19



SESSION 4: THE AUDIT TOOL .......................................................................................................................... 24

INTRODUCTION ..................................................................................................................................................... 24

THE TOOL ............................................................................................................................................................ 24

OPTIONS FOR USAGE ............................................................................................................................................. 24

STRUCTURE AND COMPONENTS ............................................................................................................................... 24

SCORING AND INTERPRETATION OF THE SCORING ....................................................................................................... 25


SESSION 5: INTERVENTIONS FOR ZONE 1 DRINKERS ...................................................................................... 26

INTRODUCTION ..................................................................................................................................................... 26

SUITABLE INTERVENTIONS ....................................................................................................................................... 26

A GUIDE TO LOW-RISK DRINKING HANDOUT ............................................................................................................. 26

HOW TO PREVENT ALCOHOL-RELATED PROBLEMS BROCHURE ....................................................................................... 26



INTRODUCTION ..................................................................................................................................................... 27



INTRODUCTION ..................................................................................................................................................... 28

EXISTING MATERIALS ............................................................................................................................................. 28



INTRODUCTION ..................................................................................................................................................... 28


SESSION 9: SUMMARY & REFLECTION ........................................................................................................... 29

INTRODUCTION ..................................................................................................................................................... 29

SUMMARY OF LEARNING ........................................................................................................................................ 29

EVALUATION ........................................................................................................................................................ 29

CLOSURE ............................................................................................................................................................. 29

BIBLIOGRAPHY ............................................................................................................................................... 30


TABLE OF FIGURES

FIGURE 1: HARMS CAUSED BY ALCOHOL CONSUMPTION .................................................................................................. 17

FIGURE 2: THE DRINKERS' PYRAMID .............................................................................................................................. 19

FIGURE 3: MODEL OF BEHAVIOUR CHANGE .................................................................................................................... 20

FIGURE 4: STAGES OF BEHAVIOURAL CHANGE ................................................................................................................. 20

FIGURE 5: THE STAGES OF CHANGE AND ASSOCIATED BRIEF INTERVENTION ELEMENTS ........................................................... 23

FIGURE 6: INTERVIEW VERSUS SELF-REPORT AUDIT ........................................................................................................ 24

FIGURE 7: AUDIT DOMAINS AND ITEM CONTENT ........................................................................................................... 24

FIGURE 8: AUDIT SCORING GRID ................................................................................................................................. 25


Brief Introduction to the World Health

Organisation’s AUDIT Tool: A Trainer’s Guide

INTRODUCTION

This guide provides instructions and content to trainers conducting training on integrating the World

Health Organisation’s Alcohol Use Disorders Identification Test (AUDIT) into service delivery

ABOUT THE CJCP

The CJCP is a South African research NGO working in the field of violence prevention and safety, in

South Africa and the region, with a particular focus on children and youth. The organisation has

extensive experience in the field of child protection and safety; child and youth victimization; online

child protection, risks and opportunities; and school violence. The organisation works both nationally

in South Africa, and regionally, and consults internationally.

Since its establishment in 2005, the CJCP has worked with a number of National and Provincial

government departments in South Africa, including the Departments of Basic Education,

Communications and Social Development, as well as the Presidency, to formulate evidence-based

policy on issues of child safety, both online and offline, and to develop appropriate implementation

frameworks and mechanisms for national and provincial policies and strategies. The organisation has

also worked with a number of regional governments and international agencies on issues of violence

against children, child safety and protection, and specifically child online safety. Specific examples

include the current development of a child online safety strategy for UNICEF Namibia, development

of a National Schools Safety Framework in 2014/15, and the development of a Children’s

Empowerment and ICT strategy with the South African Department of Communications. Further, the

CJCP is the South African implementation partner of Global Kids Online, an international extension of

the EU Kids Online project, in partnership with UNICEF Office of Research at Innocenti, and the London

School of Economics and Political Sciences (LSE). The CJCP is also leading a team of experts

undertaking a child online protection scoping and mapping study in five countries in the MENA region:

Tunisia, Algeria, Morocco, Egypt and Jordan; is providing technical assistance to UNICEF Namibia and

the Namibian University of Technology in exploratory research into child online protection and ICT

opportunities in Namibia; and is undertaking a scoping exercise on child online protection in Uganda.


The organisation has extensive experience in conducting both large scale epidemiological studies on

violence relating to children, best evidenced through the National Optimus Foundation Study on Child

Abuse, Violence and Neglect, a study of 10,000 children and adolescents; as well as smaller scale

qualitative and policy-oriented studies, including a comprehensive desktop study on violence against

children, undertaken for UNICEF South Africa and the national Department of Social Development, in

2011.

The organisation also designs and delivers intervention and training material for both government and

civil society, and regularly presents research on children and online safety at national and international

fora. The organisation has undertaken work in South Africa, the Democratic Republic of Congo,

Mozambique, Namibia, Kenya, South Sudan and Ethiopia.

INTRODUCTION TO THE TRAINING GUIDE

TRAINING OVERVIEW


Health Organisation’s Alcohol Use Disorders Identification Test (AUDIT) into service delivery. The

World Health Organisation’s AUDIT is a simple screening tool that has been extensively tested for

validity and reliability. The tool is in the public domain, as are the guides and manuals used to support

its use. This guide is to be used with the following documents:

1. Babor, T., Higgins-Biddle, J., Saunders, J., & Monteiro, M. (2001). AUDIT: The Alcohol Use

Disorders Identification Test: Guidelines for Use in Primary Care.

2. World Health Organisation. (2001). Brief Intervention for Hazardous and Harmful Drinking:

A Manual for Use in Primary Care. Geneva: World Health Organisation.

This training is designed to equip service providers with the necessary skills and knowledge to use the

AUDIT as an integral part of their screening, intervention planning and case management processes.

This training is suitable for the following practitioners:

1. Educators

2. Child and youth care workers

3. Social workers

4. Social Auxiliary Workers

5. Lay counsellors


TRAINING OUTCOMES

Outcome Description

Able to apply a basic model of behaviour change to case management

Able to apply the risk matching principle to intervention planning and case management

Able to select and use a range of tools and methods to assist clients in managing low to moderate

risk alcohol consumption

Able to use the Alcohol Use Disorders Identification Test (AUDIT) with clients

Knowledge of the definitions and relevance of the concepts of hazardous alcohol consumption

and alcohol dependence

Knowledge of the effects of hazardous alcohol consumption and alcohol dependence on the

individual, family and community

Knowledge of the risk matching principle and its application in work with clients

TRAINING OUTLINE

Session Topic Sub-Topics

1. Introduction Welcome to the training

Meet the facilitators

Housekeeping matters

Training expectations

Training overview

2. Background Definition of hazardous alcohol consumption

Definition of alcohol dependence

The AUDIT Tool

Evidence of benefits (brief)

Applicability

3. Context The South African context

Effects of hazardous alcohol consumption on individuals, families and communities

The Drinker’s Pyramid

Model of behaviour change (brief)

4. The AUDIT Tool

Options for usage

Structure

Components

Scoring and interpretation of the scoring

5. Interventions for Zone 1 Drinkers

Suitable interventions




Session Topic Sub-Topics



8. Interventions for Zone 4

What to do

9. Summary and Reflection

Summary of learning

Reflection


FACILITATOR’S INSTRUCTIONS

The following is recommended:

1. Two facilitators for groups than exceed 10 people

2. The facilitators must :

a. Have at least 2-3 years of facilitation experience

USING THIS MANUAL

This training has been developed to be as cost effective as possible. Other than refreshments, a venue

and the equipment and resources listed below, no additional costs are necessary.

The worksheets for the training are also available in a handbook on the CJCP website for download in

order to facilitate making copies. Each training participant receives his or her own handbook to keep.


Health Organisation’s AUDIT Tool into service delivery. This guide is to be used with the following

documents:

3. Babor, T., Higgins-Biddle, J., Saunders, J., & Monteiro, M. (2001). AUDIT: The Alcohol Use

Disorders Identification Test: Guidelines for Use in Primary Care.

4. World Health Organisation. (2001). Brief Intervention for Hazardous and Harmful Drinking:

A Manual for Use in Primary Care. Geneva: World Health Organisation.

The facilitator must have their own copy and have studied the above three manuals.

EQUIPMENT & RESOURCES

The following items are required to facilitate this training:

1. Attendance register

2. Flipchart stand

3. Flipchart paper (at least 1 full pack)

4. Flipchart pens (at least 8)

5. Prestik

6. Copies of the following handouts (one for each person):

a. Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary Care

b. The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care


ICE-BREAKERS AND ENERGIZERS

Ice-breakers and energizers are not included in the content of this training manual. Feel free to

introduce them at any point of the training programme. CJCP has developed a games, ice-breakers

and energizers manual that is available for download.

FACILITATING LEARNING

This training programme contains several activities that support the overall learning experience. It is

important that the facilitators extract as much learning as possible form these activities. This can be

done by closing each activity with a brief facilitated discussion by asking these questions:

What did you learn from this activity?

What was difficult about this activity?

How will you use what you learnt from this activity in your work?


SESSION 1: INTRODUCTION

WELCOME TO THE TRAINING

1. Welcome the trainees to the training workshop

2. Introduce the trainers for the workshop

3. Implement an introductory activity to assist the trainees with meeting one another

HOUSEKEEPING MATTERS

1. Hand out the attendance register and ask each person to fill in their details

2. Point out the location of the toilets

3. Give the times of the usual breaks, such as tea and lunch, as well as the time the programme

will end on this day.

4. Ask people to switch off their cell phones

5. Hand out copies of the workbook

TRAINING EXPECTATIONS

1. Explain to the group that they will now reflect on and discuss their expectations for the

training

2. Put up two pieces of flipchart paper on opposite walls

3. Write the following:

a. “My Expectations” on one paper

b. “My Fears / Concerns” on the second paper

4. Explain that the group will now write their expectations on the appropriate piece of

flipchart paper

5. If they find someone has already written what they wanted to, they can think of another

expectation or concern, if they like.

6. They should try not to repeat what is on the paper.

7. Hand out flipchart pens and pieces of blank paper to the group

8. When people have written their input, they must stick it on the relevant flipchart paper.

9. Give 5-8 minutes for this.

10. When the activity is finished, work through the expectations and explain whether or not

the training programme will address these expectations

11. Work through the fears / concerns paper, and discuss each one in terms of how it can be

addressed during the course of the training.

TRAINING OVERVIEW

1. Explain to the group that they will now look at an overview of the training programme.

2. Take the group through the training overview in their workbooks

3. When you have finished, ask the group if they have any questions about the training

programme structure.


4. When there are no further questions, move on to the next session.

SESSION 2: BACKGROUND

INTRODUCTION

1. Provide the group with a brief overview of the content of this session.

THE AUDIT TOOL

1. Handout the following handouts to the group:

a. Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary

Care

b. The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care

2. Explain to the group that they will first look at the history and context of the tool which forms

the basis for the training.

3. Explain that the Audit Tool stands for “Alcohol Use Disorders Identification Test”.

4. It is a test developed by the World Health Organisation for use as a screening tool.

5. Overtime, it was found that using the tool acted as an intervention itself, and today the

screening tool is used as a brief intervention.

6. Explain the following:

a. Brief interventions have become increasingly important components of programme

work because they are:

i. Effective

ii. Efficient

iii. Inexpensive

b. Brief interventions are intended to be slotted in between primary or early prevention,

on the one hand, and intensive treatment services on the other.

c. Brief interventions are an effective and efficient method of promoting health and

disease prevention within an entire population.

7. The Audit tool is intended to respond the three levels of risk:

a. Hazardous drinking

b. Harmful drinking

c. Alcohol dependence

8. The Audit tool is used:

a. As a brief intervention

b. As a screening tool that identifies which people can be referred to other more

intensive services, if need be


DEFINITIONS

1. Explain to the group that they will engage in an activity that focuses on defining the three

levels of risk-related alcohol consumption

2. Divide the group into 3-4 teams

3. Provide each team with flipchart paper and pens

4. Inform each team that they must develop a definition of each of the following risk levels:

a. Hazardous drinking

b. Harmful drinking

c. Alcohol dependence

5. Give the group 15 minutes.

6. Have each team present their definitions to the larger group

7. When this activity is complete, take the group through the following definitions from the

WHO:

Hazardous

Drinking

Hazardous drinking is a pattern of alcohol consumption that increases the risk

of harmful consequences for the user or others. Hazardous drinking patterns are

of public health significance despite the absence of any current disorder in the

individual user.

Harmful

Drinking

Harmful drinking refers to alcohol consumption that results in consequences to

physical and mental health. Some would also consider social consequences

among the harms caused by alcohol

Alcohol

Dependence

Alcohol dependence syndrome is a cluster of cognitive, behavioural, and

physiological symptoms.

A diagnosis of dependence should only be made if three or more of the following

have been experienced or exhibited at some time in the previous twelve months:

A strong desire or sense of compulsion to drink

Difficulties in controlling drinking in

Terms of onset, termination, or levels of use;

A physiological withdrawal state when alcohol use has ceased or been

reduced, or use of alcohol to relieve or avoid withdrawal symptoms

Pg. 5 of Audit Guidelines


evidence of tolerance, such that increased doses of alcohol are required

to achieve effects originally produced by lower doses;

Progressive neglect of alternative pleasures or interests because of

alcohol use;

Continued use despite clear evidence of harmful consequences.

EVIDENCE OF BENEFITS (BRIEF)

1. Explain to the group that the Audit tool has been reviewed for effectiveness and the following

has been found:

a. The AUDIT was developed and evaluated over a period of two decades

b. It has been found to provide an accurate measure of risk across:

i. Gender

ii. Age, and

iii. Cultures

c. The AUDIT was validated on primary health care people in six countries1

d. It is the only screening test specifically designed for international use

e. It is consistent with ICD-10 definitions of alcohol dependence and harmful alcohol use

2

f. A systematic review of the literature has concluded that the AUDIT is the best

screening instrument for the whole range of alcohol problems in primary care, as

compared to other questionnaires such as the CAGE and the MAST.

a. In comparison to other screening tests, the AUDIT has been found to perform equally

well or at a higher degree of accuracy,

b. Since the AUDIT User’s Manual was first published in 198930, the test has fulfilled

many of the expectations that inspired its development. Its reliability and validity have

been established in research conducted in a variety of settings and in many different

nations.

c. It has been translated into many languages, including Turkish, Greek, Hindi, German,

Dutch, Polish, Japanese, French, Portuguese, Spanish, Danish, and Flemish, Bulgarian,

Chinese, Italian, and Nigerian dialects.

1 Norway, Australia, Kenya, Bulgaria, Mexico, and the United States of America. 2 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO).



APPLICABILITY

1. Explain to the group that they will now look briefly at the kinds of people who may use the

AUDIT tool

2. The AUDIT tool can be used by any of the following as a brief screening and intervention tool

in any intervention setting:

a. Health care workers

b. Social workers

c. Social auxiliary workers

d. Development workers

e. Child and youth care workers

f. Lay counsellors

REFLECTION AND REVIEW

1. Ask the following questions

o What did you learn from this session?

o What was difficult about this session?

o How will you use what you learnt from this session in your work?



SESSION 3: CONTEXT

INTRODUCTION


THE SOUTH AFRICAN CONTEXT

1. Explain to the group that they will now look at the state of alcohol consumption in South Africa

a. The prevalence of alcohol use disorders amongst South African males is 10%, and for

women it is 1.5%

b. The prevalence of alcohol dependence amongst South African males is 4.2%, and

amongst women it is 0.7%

c. 52.2% of road traffic accidents involving males are caused by alcohol-related factors.

The same statistics for females is 11.6%

d. 47.7 % of deaths of males resulting from road traffic accidents are caused by alcohol

consumption. For female deaths, it is 16.2%.

e. Average alcohol consumption (litres per person per annum) in South Africa for both

genders is 11 litres. For males it is 18.4 litres and for females it is 4.2 litres. The

average for the rest of Africa is 6 litres per person per annum. 3

2. Summarise the above stats by having a general discussion using the following questions:

a. Do you think alcohol consumption is a problem in South Africa?

b. Are South African men and women affected in the same way?

c. What do you think contributes to these differences?

d. Do South Africans consume more alcohol, on average, than other African countries?

e. Why do you think this is the case?

EFFECTS OF ALCOHOL CONSUMPTION ON INDIVIDUALS, FAMILIES AND COMMUNITIES

1. Explain to the group that they will now look at the effects of alcohol consumption on

individuals families and communities

2. Divide the group into three teams

3. Give each team flipchart paper and pens

4. Allocate the topics to the following teams:

a. Team 1: Individuals

b. Team 2: Families

3 (WHO, 2014)


c. Team 3: Communities

5. Have each group brainstorm the effects of alcohol consumption on their topic

6. Remind them that they are focusing specifically on s alcohol consumption. Refer them to the

definitions reviewed in the previous session

7. Give them 15 minutes for this activity

8. Have each team present their findings to the larger group

9. When this activity has been completed, review the following content with the group

Figure 1: Harms Caused by Alcohol Consumption 4

4 (WHO, 2014)

Level Harms

Individual Neuropsychiatric conditions: o Alcohol use disorders o Epilepsy is another disease o Depression or anxiety disorders

Gastrointestinal diseases: o Liver cirrhosis o Pancreatitis (both acute and chronic)

Cancers: o Alcohol consumption has been identified as carcinogenic for

the following cancer categories Cancer of the mouth Nasopharynx Other pharynx and oropharynx Laryngeal cancer Oesophageal cancer Colon and rectum cancer Liver cancer Female breast cancer.

Intentional injuries: o Alcohol consumption, especially heavy drinking, has been

causally linked to suicide and violence

Unintentional injuries: o Almost all categories of unintentional injuries are impacted

by alcohol consumption. The effect is strongly linked to the alcohol concentration in the blood and the resulting effects on psychomotor abilities. Higher levels of alcohol consumption create an exponential increase in risk

Cardiovascular diseases: o Alcohol consumption has detrimental effects on

hypertension, atrial fibrillation and haemorrhagic stroke, regardless of the drinking pattern

Foetal alcohol syndrome (FAS) and preterm birth complications


THE DRINKER’S PYRAMID

1. Explain to the group that they will now look at what is called “The Drinker’s Pyramid

2. This is a diagram of the whole population, divided into categories of how they consume

alcohol

3. Refer the group to the diagram below.

Diabetes mellitus: a dual relationship exists, whereby a low-risk pattern of drinking may be beneficial while heavy drinking is detrimental

Infectious diseases: Harmful use of alcohol weakens the immune system thus enabling development of pneumonia and tuberculosis.

Family Injury to other individuals can be intentional, e.g., assault or homicide, or unintentional, e.g., a traffic crash, workplace accident or scalding of a child.

Neglect or abuse can affect, for example, a child, a partner or a person in the drinker’s care.

Default on social role can involve the drinker’s role as a family member, as a friend and/or as a worker.

Property damage can involve damage, for example, to clothing, a car or a building.

Toxic effects on other individuals include most notably foetal alcohol syndrome (FAS) and preterm birth complications

Loss of amenity or peace of mind can influence family members (including children), friends, co-workers and strangers, who may, for example, be kept awake or frightened by the actions of the drinker.

Community High costs of: o Hospitalizations o Ambulatory care o Nursing home care o Prescription medicines o Home health care

Damage to property from vehicle crashes

Arrests for being “drunk and disorderly”

Increased crime

Lost productivity due to absenteeism

Unemployment

Decreased output

Reduced earnings potential

Lost working years due to premature pension or death

Alcohol-attributable loss in workforce productivity can affect the economic viability of an entire community

Pg. 33 of Brief Intervention


Figure 2: The Drinkers' Pyramid

1. Ask the group to interpret what the pyramid means

2. When the group has finished discussing the meaning of the pyramid, summarise the

discussion as follows:

a. The majority of people do not drink alcohol

b. There are more low risk drinkers that high risk drinkers

c. People who have alcohol dependence are the smallest group.

d. The top two groups are the smallest of the four. Despite this, they cause the most

harm to others.

3. Ask the group why they think it would be useful to be able to differentiate between these four

groups, and be able to place someone in the correct category.

MODEL OF BEHAVIOUR CHANGE (BRIEF)

1. Explain to the group that they will now briefly review a simple model of behaviour change.

2. Ask the group why they think it is important to study a model of behaviour change.

3. Refer the group to the below diagram.

Probably alcohol dependence

High risk drinkers

Low risk drinkers

Abstainers


Figure 3: Model of Behaviour Change

4. Explain the content and structure of the above diagram with reference to the guide below.

Figure 4: Stages of behavioural Change 5

Stages of Behavioural

Change

Description of Stage

Pre-contemplation People in

this stage are:

Not necessarily thinking about changing their substance use;

Focused on the positive aspects of their substance use;

Unlikely to have any concerns about their use of psychoactive

substances;

May show resistance to talking about their substance use;

Unlikely to know or accept that their substance use is problematic;

Unlikely to respond to direct advice to change their behaviour but

may be receptive to information about the risks associated with

their level and pattern of substance use (if approached

appropriately).

Contemplation People in this stage are:

Thinking about cutting down or stopping substance use;

Ambivalent about their substance use when they may be able to see

both the good things and the ‘less good things’ about their

substance use;

Likely to have some awareness of the problems associated with

substance use and may be weighing up the advantages and

disadvantages of their current substance use pattern;

5 (Humeniuk, et al., 2010)

Pre-contemplation

Contemplation Preparation Action Maintenance



Change


Likely to respond to information about their substance related risks,

advice to cut down or engage in discussion about their substance

use (if approached appropriately).

Preparation People in the preparation stage are:

Intending to take action;

May vocalise their intentions to others;

Making small changes in their substance use behaviour;

Re-evaluating their current behaviour and considering what

different behaviour could offer them;

Becoming more confident and ready to change their behaviour;

Considering the options available to them;

Setting dates and determining strategies to assist change.

Action People in the action stage:

Have made the decision that their use of substances needs to

change;

Have commenced cutting down or stopping;

Are actively doing something about changing their behaviour;

Have cut down or stopped completely;

Are likely to continue to feel somewhat ambivalent about their

substance use and to need encouragement and support to maintain

their decision.

Maintenance People in the maintenance stage are:

Attempting to maintain the behaviour changes that have been

made;

Working to prevent relapse (the risk of relapse decreases with

time);

Focusing attention on high risk situations and the strategies for

managing these;

Best equipped when they develop strategies for avoiding situations

where they are at risk of relapse;



Change


Are more likely to remain abstinent if they receive reward, support

and affirmation.


THE STAGES OF CHANGE AND ASSOCIATED BRIEF INTERVENTION ELEMENTS

Figure 5: The Stages of Change and Associated Brief Intervention Elements

Stage Definition Brief Intervention Elements to be Emphasised

Pre-contemplation

The hazardous or harmful drinker is

not considering change in the near

future, and may not be aware of the

actual or potential health

consequences of continued drinking

at this level.

Feedback about the results of the

screening, and Information about

the hazards of drinking

Contemplation The drinker may be aware of alcohol-

related consequences but is

ambivalent about changing

Emphasize the benefits of changing,

give information about alcohol

problems, the risks of delaying, and

discuss how to choose a goal

Preparation The drinker has already decided to

change and plans to take action.

Discuss how to choose a goal, and

give advice and encouragement

Action The drinker has begun to cut down or

stop drinking, but change has not

become a permanent feature

Review advice, give encouragement

Maintenance The drinker has achieved moderate

drinking or abstinence on a relatively

permanent basis

Give encouragement







SESSION 4: THE AUDIT TOOL

INTRODUCTION


THE TOOL

1. Explain to the group that they will now study the AUDIT tool

2. Refer to the AUDIT interview tool handout and read through the tool as a group

OPTIONS FOR USAGE

1. Explain to the group that there are two ways to use the AUDIT tool: a. As a self-report questionnaire (AUDIT self-report) b. As an administered interview (AUDIT interview)

2. Explain that they will now look briefly at the pros and cons of each option. 3. Refer the group to the table below 4. Explain to the group that the tool will normally take between 2-4 minutes to complete

Figure 6: Interview versus Self-Report AUDIT

Advantages of Different Approaches to AUDIT Administration

Self-Report Questionnaire Interview

Takes less time

Easy to administer

Suitable for computer administration and scoring

May produce more accurate results

Allows clarification of ambiguous answers

Can be administered to people with low literacy levels

Allows seamless feedback to people and initiation of brief advice

STRUCTURE AND COMPONENTS

1. Explain to the group that they will now start exploring the AUDIT tool in detail 2. Refer the group to the diagram below

Figure 7: AUDIT Domains and Item Content

Domains Question

Number

Item Content

Hazardous

alcohol use

1

2

3

Frequency of drinking

Typical quantity

Frequency of heavy drinking

Pg. 16 of AUDIT Guidelines



Domains Question

Number

Item Content

Dependence

symptoms

4

5

6

Impaired control over drinking

Increased salience (conspicuousness) of drinking

Morning drinking

Harmful alcohol

use

7

8

9

10

Guilt after drinking

Blackouts

Alcohol-related injuries

Others concerns about drinking

SCORING AND INTERPRETATION OF THE SCORING

1. Explain to the group that they will now review how to score the AUDIT. 2. The score for each item is the number of the answer the person has given 3. The score for each item is added up to produce a total for all 10 questions. 4. Refer the group to the grid below

Figure 8: AUDIT Scoring Grid

AUDIT SCORE

AUDIT Zones Intervention Type

0 – 7 Zone 1 Alcohol education

8 -15 Zone 2 Advice

16 – 19 Zone 3 Advice Brief counselling

Continued monitoring

20 - 40 Zone 4 Referral to specialist for diagnostic evaluation and treatment








SESSION 5: INTERVENTIONS FOR ZONE 1 DRINKERS

INTRODUCTION


SUITABLE INTERVENTIONS

1. Explain to the group that they will now review the basics of suitable interventions for

abstainers and low risk drinkers

A GUIDE TO LOW-RISK DRINKING HANDOUT

1. Take the group through appendix A page 32-37 of the Brief Intervention manual.

HOW TO PREVENT ALCOHOL-RELATED PROBLEMS BROCHURE

1. Take the group through appendix B page 38-46 of the Brief Intervention manual.






Pg. 14-16 of Brief Intervention

Pg. 32 – 37 of Brief Intervention

Pg. 38 - 46 of Brief Intervention



INTRODUCTION

1. Explain to the group that appendix A and B of the Brief Interventions Manual also form part

of the Zone 2 interventions.

2. In addition to these two tools, the following information should be used to guide zone 2

interventions

3. Take the group through the content below.






Pg. 17- 22 of Brief Intervention



INTRODUCTION


EXISTING MATERIALS

1. Explain to the group that appendix A and B of the Brief Interventions Manual also form part

of the Zone 3 interventions.

2. In addition to these two tools, the following information should be used to guide zone 3

interventions








INTRODUCTION











SESSION 9: SUMMARY & REFLECTION

INTRODUCTION


SUMMARY OF LEARNING

1. Explain to the group that they will now review and summarise what they have learnt in the

training workshop.

2. Divide the group into 4 teams

3. Allocate flipchart paper and pens to each team

4. Have each team work as a group and develop a brief outline of what they have learnt in the

workshop that they can use in their work

5. Give 20 minutes for this activity

6. Have each team present their findings to the larger group (5 mins each)

EVALUATION

1. Explain to the group that they will now evaluate the training workshop

2. Hand out evaluation forms

3. Give 10 minutes for this activity

4. Collect the complete evaluation forms.

CLOSURE

1. Thank the group for their attention and participation

2. If certificates are issued as part of the workshop, explain when these certificates will be

available and how they will be distributed

3. Close the programme


BIBLIOGRAPHY

Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B. & Monteiro, M. G., 2001. AUDIT: The Alcohol Use

Disorders Identification Test:Guidelines for Use in Primary Care, Geneva: World Health Organisation.

Barbor, T. F.; Higgins-Biddle, J. C., 2001. Brief Intervention for Hazardous and Harmful Drinking: A

Manual for Use in Primary Care, Geneva: World Health Organisation.

Dybek, I. et al., 2006 May. The Reliability And Validity Of The Alcohol Use Disorders Identification Test

(AUDIT) In A German General Practice Population Sample. Journal of Studies on Alcohol or Drugs,

67(3), pp. 473 - 481.

Honeycutt , B., 2012. 10 Creative Ways to Form Groups, Raleigh: FLIP It Consulting .

Humeniuk, R. et al., 2010. The ASSIST-Linked Brief Intervention for Hazardous and Harmful Substance

Use: Manual for Use in Primary Care, Geneva: World Health Organisation.

Joubert, C., 2010. Applied Law for Police Officials. Third ed. Cape Town: Juta Law Publishers.

Matzopoulos, R. et al., 2013. The Injury Mortality Survey: A National Study Of Injury Mortality Levels

And Causes In South Africa In 2009, Cape Town: Burden of Disease Research Unit: South African

Medical Research Council.

Matzopoulos, R. et al., 2015. Injury-Related Mortality In South Africa: A Retrospective Descriptive

Study Of Postmortem Investigations. Bulletin of the World Health Organisation, Volume 93, pp. 303 -

313.

United Nations Office On Drugs And Crime, 2015. World Drug Report, Vienna: UNODC.

WHO, 2014. Global Status Report On Alcohol And Health 2014, s.l.: World Health Organisation.

World Health Organisation, 2010. Self-Help Strategies for Cutting Down or Stopping Substance Use: A

Guide, Geneva: s.n.

World Health Organization, 2010. The ASSIST Project - Alcohol, Smoking and Substance Involvement

Screening Test (V3.0), Geneva: s.n.

World Health Organization, 2014. Global Status Report On Alcohol And Health, Geneva: WHO.

Documents

Brief Introduction to the World Health Organisation's AUDIT Tool: A