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Brief Alcohol and Drug Interventions

Brief interventions are short, one-on-one counseling sessions which are ideally suited for people who drink in ways that are harmful or abusive.

Unlike traditional alcoholism treatment, which lasts many weeks or months, brief interventions can be given in a matter of minutes, and they require minimal follow-up. The goals of brief interventions differ from formal alcoholism treatment. Brief interventions generally aim to moderate a person’s alcohol consumption to sensible levels and to eliminate harmful drinking practices (such as binge drinking), rather than to insist on complete abstinence from drinking – although abstinence is encouraged.

A “binge” is a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 gram percent or above. For a typical adult this pattern corresponds with consuming five or more drinks (male), or four or more drinks (female) in about 2 hours.) Reducing levels of drinking or changing patterns of harmful alcohol use helps to reduce the negative outcomes of drinking, such as alcohol-related medical problems, injuries, domestic violence, motor vehicle crashes, arrests, or damage to a developing fetus.

Exactly what constitutes a “brief intervention” remains a source of debate. Brief interventions typically consist of one to four short counseling sessions with a trained interventionist (e.g., physician, psychologist, social worker). Moyer and colleagues looked at 34 different studies and found that people who received brief interventions when they were being treated for other conditions consistently showed greater reductions in alcohol use than comparable groups who did not receive an intervention.

People seeking treatment specifically for alcohol abuse appeared to reduce their alcohol use about the same amount, whether they received brief interventions or extended treatments (five or more sessions). These findings show that brief interventions can be an effective way to reduce drinking, especially among people who do not have severe drinking problems requiring more intensive treatment.

The appropriate intervention depends on the patient – that is, on the severity of his or her problems with alcohol and whether he or she uses tobacco or other drugs, or has a co-occurring medical or psychiatric problem.

The choice of intervention also is based on the clinical setting, the clinician’s skills and interest, and time constraints. A brief intervention usually includes personalized feedback and counseling based on the patient’s risk for harmful drinking. Often, simply providing this feedback is enough to encourage those at risk to reduce their alcohol intake.

Brief interventions may include approaches such as motivational interviewing that are designed to persuade people who are resistant to moderating their alcohol intake or who do not believe they are drinking in a harmful or hazardous way. Motivational interviewing encourages patients to decide to change for themselves by using empathy and warmth rather than confrontation. Clinicians also can assist patients by helping them establish specific goals and build skills for modifying their drinking behavior.

SCREENING: THE FIRST STEP

People who would benefit from brief interventions may be identified through routine medical screenings, such as during a visit to a primary care physician. Standardized screening instruments exist that are specifically designed to identify alcohol use disorders.

Though not as common, a person also might be identified during a hospital stay when lab tests reveal he or she has an alcohol-related health problem (such as liver disease). Screening might take place after an arrest for driving under the influence or during a visit to an emergency department (ED) as a result of alcohol-related injuries.

Though not as common, a person also might be identified during a hospital stay when lab tests reveal he or she has an alcohol-related health problem (such as liver disease). Screening might take place after an arrest for driving under the influence or during a visit to an emergency department (ED) as a result of alcohol-related injuries. Or screening might identify a woman who could benefit from a brief intervention during a prenatal visit to her obstetrician. All of these settings represent opportunities for clinicians and others who offer brief interventions to work with people who may be particularly receptive to advice to alter their drinking.

ADMINISTERING THE INTERVENTION

Seeking treatment for problems with alcohol can be potentially embarrassing, stigmatizing, and inconvenient, taking time away from work or family responsibilities. Brief interventions give patients a simple way to receive care in a comfortable and familiar setting. Because they are brief, they can be easily incorporated into a variety of medical practices. Moreover, these approaches offer a lower cost alternative to more formal, specialist-led, alcoholism treatment.

Typically a non-specialist authority figure who the patient may already trust or feel comfortable being treated by—such as a physician, a nurse, or physician’s assistant in a primary care setting, or nurse or physician’s assistant on a medical unit—delivers the brief intervention.

Supplemental handouts may be provided to patients during the intervention, including pamphlets, manuals, or workbooks to reinforce the strategies offered during the session. Clinicians also can follow up at a later date, either in person or through the mail, to provide additional assessment and further motivate the patient to achieve the goals set during the initial meeting. If the brief intervention does not motivate the patient to reduce alcohol consumption, clinicians can recommend more intensive treatment.

Many of the challenges involved in administering brief interventions –  such as finding the time to administer them in busy doctors’ offices, obtaining the extra training that helps staff become comfortable providing interventions, and managing the cost of using interventions may be overcome through the use of technology. Patients may be encouraged to use computer programs in the doctor’s waiting room or at home, or to access the intervention through the Internet, which offers privacy and the ability to complete the program at any time of day.

 

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