Alcohol use in the aftermath of disaster - transcript

Hello everyone, my name’s Leanne Humphreys and today we’re speaking with Dr Kristi Heffernan.

Kristi is a clinical psychologist and a senior clinical specialist here at Phoenix Australia, as well as continuing with her clinical role in the community Kristi was a full-time psychology officer in the army. Who, as well as being a veteran of operations in the middle east and east Timor was responsible for the coordination and oversight of the psychology support services provided to the floods in Pakistan in 2010 as well as the 2011 Queensland floods.

Leanne: So today’s conversation relates to the topic of alcohol use in the aftermath of disaster. Hello Kristi how are you?

Kristi: Hi, I’m well thanks Leanne how are you?

Leanne: I’m very well. Thanks for joining us today.

Kristi: No problems.

Leanne: Kristi what are the main things that as health practitioners we need to be mindful of regarding alcohol use after disaster?

Kristi: I think one of the first things that springs to mind Leanne, is that we need to be mindful that it can be a really common thing that people use as a coping mechanism after a disaster so we know that disasters are inherently stressful events in people’s lives, and alcohol use is often the go-to when we get stressed. There’s often a build-up of tension in our bodies when we’re stressed and alcohol can really be effective as a relaxant when we are feeling that tension. So it’s important to be mindful that it is a possibility and quite common within the Australian population that alcohol can be used as a stress coping strategy.

One of the other things to be mindful of is that after a disaster the other usual coping strategies that we would use to reduce our stress or just cope with day-to-day life might not actually be there. So, it might actually be that you know the walks that we would usually go on, or the activities, the sporting activities, the exercise opportunities may not be there.

Leanne: That, that bush walk track might not be accessible.

Kristi: Yes totally. And even the motivation then to go on the bush track, that certainly does not look the same as it used to. The gyms might not be accessible or as available, the social opportunities that we would use for managing stress may not be available to us either. So it’s important to be mindful that then alcohol might be the go-to strategy.

Leanne: Yes.

Kristi: As health practitioners we just really want to be aware of that possibility.

Leanne: Okay, okay.

Kristi: And I guess that’s even in not just in the short term, not just in the immediate aftermath after a disaster, but in the sort of more medium to long term as well. So we’re talking a year, a couple of years post disaster that alcohol might be used as this sort of regular coping strategy, that you know just increases in its intensity and severity over time.

Leanne: And I guess that kind of taps into what we know about recovery after disaster. Communities can take a long time to rebuild so the stresses that people are having to battle often on a daily basis continue for quite some period of time don’t they?

Kristi: Yes, that’s right. It can be months, sometimes years before communities can recover. And throughout that recovery process you’re right, there’s you know, there’s, I think people do their best and I think we sort of can encourage people to use their natural recovery processes in that time.  And people are doing their best but it is also the case that alcohol use can be used to, to cope with that.

Leanne: That’s a really good question then. The next question really is about when does it become a problem? How do we know we’ve kind of tipped over from something that’s understandable, manageable, reasonable, into a problem?

Kristi: Yes it’s a really great question. We know through being able to regularly monitor how much we’re drinking. So you know there are Australian guidelines for the use of alcohol, and I think we need as health practitioners we need to regularly be talking to our clients about what those recommended guidelines are. And you know in Australia it’s 10 standard drinks a week. So no more than that in terms of healthy drinking. So you know I think we can start to then monitor the extent of the problem by asking people to record how many standard drinks they’re having a week.

Leanne: Yes, yes.

Kristi: And if  they’re drinking to excess, you know drinking a lot more than 10 standard drinks a week, and if their levels of drinking then start to become problematic as well, or risky. You know so problematic in terms of you know it’s preventing them from being able to engage in their normal activities around the home, at work, you know they’re not actually socializing like they used to either. So it’s really starting to get in the way of their normal functioning. That’s when it’s starting to become a problem and/or when it’s starting to get really risky. So it’s starting to lead to behaviours where people are becoming unreliable or putting their own health and safety at risk and the safety of others as well. Then you know that’s when alcohol is becoming risky and getting problematic.

Leanne: Yes okay so as health practitioners what are the things that we can do, you’ve already kind of talked about assessment.  Can you elaborate on that a little bit and then talk a bit more about what it is that we can do as practitioners?

Kristi: Yes absolutely. I think one of the first things as a health practitioner is to be regularly checking in with your client about alcohol use, and regularly assessing as you said. So it’s about having just a few brief questions to ask people, and you know we’ve got those on our website around you know really nice brief succinct ways to assess for people’s alcohol use. We’ve also got the simple, but also validated tools on the website that people can use. The audit and assist, they are fabulous tools to be able to engage with engage with clients and then gauge their alcohol use as well. So they’re the things that I think are really important.

One of the things that also, I will say about alcohol use. It’s very common across the community to under report the amount of alcohol.

Leanne: Yes.

Kristi: So while the order and assist are really great in being able to identify levels of drinking, one of the things as a health practitioner is just to be keeping in the back of your mind I guess, about you know maybe the possibility that those scores on those tests might be lower than what is the actual kind of truth. But just being mindful of this, and just helping clients and establishing trust, establishing rapport and helping clients to be as honest with you as they can.

Leanne: And being non-judgmental.

Kristi: Yes absolutely, non-judgmental. I mean I think after a disaster for people to resort to alcohol use as a coping strategy is an understandable I guess, kind of way of operating. So being non-judgmental about that.

Leanne: It’s also very much part of our culture in a lot of ways.

Kristi: Isn’t it yes, it is yes very much part of the Australian culture. And you know socializing is often about having a drink with your friends. So you know being mindful of that I guess as well. It’s really very important after a disaster to encourage people to use all of their social supports and stay connected with the people around them. When I say use all their social supports to actually remain connected, like I said, and still be surrounding yourself with people who provide a level of support in the community. So in doing that, I guess we’ve also got to be encouraging people to remain connected. But also being mindful too about that as an opportunity for people to be drinking as well.

Leanne: Okay, so you’ve spoken about us as practitioners, as health practitioners, being aware that increased alcohol consumption is a possibility, about assessing for that, about using some validated tools, encouraging connections. What’s the evidence with regards to the use of interventions? Where should be we be looking as practitioners regarding interventions?

Kristi: Yes it’s a great question. I think what the evidence points to is that providing people with some good psycho-education around alcohol use is the first step. So there’s some great information about this again on the website but psycho education, and that really just covers off on the health risks associated with alcohol us, in the short term but also in the long term. And also the impact that alcohol use might have on people’s longer-term mental health. You know particularly in the aftermath of a disaster where traumatic reactions are really common. So yes there’s some really good ways to sort of educate people about the health risks, but also the long-term psychological risks I guess of alcohol use. And you know in the short term it might be used as a as a useful way to relax but actually what we know about alcohol use is it is a depressant, and so that it can lead to, you know, if people have got emerging issues around depression or anxiety, most alcohol use can exacerbate that.  So I think it’s important to provide a bit of psycho-education around that.

It’s also important to provide brief interventions. The world health organization has a really nice useful reference for managing alcohol use in primary care, and so they talk through some really great brief interventions that can be provided, and these are simple strategies that can be used, even in single sessions, sometimes if you’ve only got one session with a person you know those brief interventions can still really be useful.

Leanne: Yes.

Kristi: So you know I would encourage health practitioners that you know, even if you don’t feel as though you’ve got a lot of time. I think those brief interventions can really work. And highlighting with people that have some risky use I think goes a long way. And just planting the seed as well about how alcohol use can be getting in the way of their normal functioning. And ways that they can problem solve around even just minor ways to reduce their alcohol consumption can have a huge impact on their social, occupational functioning. But also their psychological function.

The other intervention that is really useful and has some good evidence around it, particularly when it comes to alcohol and substance use, is motivational interview.

Leanne: Yes

Kristi:  Motivational interviewing is a really great, simple technique, to use to actually help people make some simple changes around their alcohol use.  So really encourage people to have a health practitioners to have a look at that. It doesn’t involve a whole lot of time to become sort of familiar with all of the motivational interviewing techniques. You don’t have to be a guru at it, you just need to be  aware of some of the simple ways to use motivational interviewing to encourage change, in terms of reduction of alcohol use. That’s the main area.

Leanne: Fantastic, yes that’s really helpful. Thank you very much. And so for people who are interested in exploring some of the topics that Kristi’s raised, we have a lot of references and links to those tools on the page.

Thanks very much Kristi.

Kristi: Thank you.