Brief intervention

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Brief intervention can often be referred to as screening and brief intervention (SBI) or, in England, identification and brief advice (IBA). Brief interventions are a technique used to initiate change for an unhealthy or risky behaviour such as smoking, lack of exercise or alcohol misuse. This page primarily describes brief interventions as applied to alcohol. As an alcohol intervention it is typically targeted to non-dependent drinkers, or drinkers who might be experiencing problems but are not seeking treatment. [1] It is an approach which aims to prevent the acceleration or impact of alcohol problems, and/or to reduce alcohol consumption. It can be carried out in a range of settings such as in primary care, [2] emergency or other hospital departments, [3] criminal justice settings, [4] workplaces, [5] online, [6] [7] university/college settings, [8] [9] and other settings.

Contents

Brief intervention includes 'screening' or 'identification' whereby a person's drinking risk level is assessed using a validated tool such as the Alcohol Use Disorders Identification Test (AUDIT). This is then followed by some degree of feedback on this assessment. Alcohol Brief Interventions can be brief, such as delivered in a single session, or extended with multiple components or designed to be used multiple times.

It works in two ways:

FRAMES

For alcohol misuse, the following elements have been identified as particularly important, and forming the acronym FRAMES: [10]

Motivational interviewing

Brief interventions are based on motivational interviewing techniques.

Motivational interviewing is a technique which aims to be both non-judgmental and non-confrontational. Its success depends largely on the presentation of objective feedback based on information provided by an individual. The technique involves acknowledgement that individuals who attend a counselling session, assessment or prevention program may be at different levels of readiness to change their alcohol consumption patterns, including:

The technique attempts to increase a person's awareness of the potential problems caused, consequences experienced, and risks faced as a result of patterns of alcohol consumption. As feedback is presented, the clinician or program provider may foster the development of discrepancies between the perception that someone has of themselves and the reality of that person's situation.

This technique acknowledges that people may come to a counseling session, an assessment, or a prevention program at different levels of readiness to change their drinking behavior. Some people may have never thought of making changes in their drinking, others may have thought about it but not taken steps to change it, some may be actively trying to cut down, and others may have already cut down, and succeeded in maintaining reduced consumption. Motivational Interviewing attempts to address the specific issues that people are facing at any particular stage.

In short, the strategy seeks to prompt individuals to think differently about their use of alcohol and ultimately consider what might be gained through change.

Feedback

When the assessment is complete, people receive personalized feedback about their alcohol consumption and related behaviors. For instance, 'feedback' highlights that the person's drinking may be placing their health at risk, and is above recommended consumption guidelines. In groups (e.g., a social fraternity or sorority), feedback can be given based on data collected from group members prior to an intervention program. Some researchers have used mailed feedback after collecting data on a questionnaire such that no face-to-face interaction actually occurs.

Skills training

Skills training programs develop skills for consuming alcohol in a safer way. One of the limitations of information-only programs is that they may raise awareness and information about the effects of a substance, but leave the individual to make behavioural changes themselves.

Skills training programs can work well with motivational interviewing techniques, as skills training programs work to provide the individual with the skills to make these changes in their drinking behavior, as the motivational interviewing simultaneously works to make the individual aware of their behaviour.

In doing so, they provide harm reduction strategies for those who choose to drink. This means that moderate drinking goals may also be considered, recognising that any steps toward safer alcohol consumption are steps in the right direction. Consequently, while abstinence may be the optimal outcome for some people, skills for drinking in a way that will minimize harm can be considered if abstinence is not viewed as realistic, attainable, or attractive. For example, blood alcohol concentration level estimation training enables people to set limits for moderate goals that are unique to their gender, weight, and time spent drinking. Teaching practical strategies for reaching these limits, such as spacing one's drinks, pacing oneself, alternating alcoholic and non-alcoholic drinks, consuming food before drinking and drinking for promote success.

Evidence

A range of systematic reviews published by Cochrane have described a small to medium effect size showing change in primarily alcohol use as a result of these interventions. For example in a recent review of primary care patients including 69 studies, moderate quality evidence was found that brief interventions could reduce alcohol consumption in hazardous or harmful drinkers. [11] Digital brief interventions were found to be similarly effective with again moderate quality evidence that online brief interventions targeting alcohol reduced drinks per week by three standard drinks. [12] Whilst these reviews are robust, they are limited in their ability to summarise change because many of the studies are not measuring the same outcomes in the same way. One review found that in 405 trials, there were 2641 separate outcomes measured in 1560 different ways. [13] When diverse outcomes are used, data is hard to bring together in a meta-analysis and there are problems with differing views on what shows whether an intervention shows Effectiveness or Efficacy. [14] Others have sought to improve the field by creating a Core Outcome Set which can reduce the size of the problem of differing outcomes by creating an international standard for all BI evaluations through the International Network on Brief Interventions for Alcohol & Other Drugs.

Related Research Articles

<span class="mw-page-title-main">Alcoholism</span> Problematic excessive alcohol consumption

Alcoholism is the continued drinking of alcohol despite negative results. Problematic use of alcohol has been mentioned in the earliest historical records, such as in ancient Egypt and in the Bible, and remains widespread; the World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016. The term alcoholism was first coined in 1852, but alcoholism and alcoholic are stigmatizing and discourage seeking treatment, so clinical diagnostic terms such as alcohol use disorder or alcohol dependence are used instead.

<span class="mw-page-title-main">Substance abuse</span> Harmful use of drugs

Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.

<span class="mw-page-title-main">Alcohol abuse</span> Misuse of alcoholic beverages resulting in negative consequences

Alcohol abuse encompasses a spectrum of unhealthy drinking behaviors which range from consuming more than 2 drinks per day on average for men, or more than 1 drink per day on average for women, to binge drinking or alcohol use disorder.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.

<span class="mw-page-title-main">Transtheoretical model</span> Integrative theory of therapy

The transtheoretical model of behavior change is an integrative theory of therapy that assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual. The model is composed of constructs such as: stages of change, processes of change, levels of change, self-efficacy, and decisional balance.

The social norms approach, or social norms marketing, is an environmental strategy gaining ground in health campaigns. While conducting research in the mid-1980s, two researchers, H.W. Perkins and A.D. Berkowitz, reported that students at a small U.S. college held exaggerated beliefs about the normal frequency and consumption habits of other students with regard to alcohol. These inflated perceptions have been found in many educational institutions, with varying populations and locations. Despite the fact that college drinking is at elevated levels, the perceived amount almost always exceeds actual behavior. The social norms approach has shown signs of countering misperceptions, however research on changes in behavior resulting from changed perceptions varies between mixed to conclusively nonexistent.

Alcohol education is the practice of disseminating information about the effects of alcohol on health, as well as society and the family unit. It was introduced into the public schools by temperance organizations such as the Woman's Christian Temperance Union in the late 19th century. Initially, alcohol education focused on how the consumption of alcoholic beverages affected society, as well as the family unit. In the 1930s, this came to also incorporate education pertaining to alcohol's effects on health. For example, even light and moderate alcohol consumption increases cancer risk in individuals. Organizations such as the National Institute on Alcohol Abuse and Alcoholism in the United States were founded to promulgate alcohol education alongside those of the temperance movement, such as the American Council on Alcohol Problems.

Motivational interviewing (MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. It is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it is more focused and goal-directed, and departs from traditional Rogerian client-centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than engaging in non-directive therapeutic exploration. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing this goal. MI is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship.

Alcohol has a number of effects on health. Short-term effects of alcohol consumption include intoxication and dehydration. Long-term effects of alcohol include changes in the metabolism of the liver and brain, several types of cancer and alcohol use disorder. Alcohol intoxication affects the brain, causing slurred speech, clumsiness, and delayed reflexes. Alcohol consumption can cause hypoglycemia in diabetics on certain medications, such as insulin or sulfonylurea, by blocking gluconeogenesis. There is an increased risk of developing an alcohol use disorder for teenagers while their brain is still developing. Adolescents who drink have a higher probability of injury including death.

Motivational therapy is a combination of humanistic treatment and enhanced cognitive-behavioral strategies, designed to treat substance use disorders. It is similar to motivational interviewing and motivational enhancement therapy.

<span class="mw-page-title-main">College health</span> Health of individuals enrolled in college

College health is a desired outcome created by a constellation of services, programs and policies directed at advancing the health and wellbeing of individuals enrolled in an institution of higher education, while also addressing and improving both population health and community health. Many colleges and universities worldwide apply both health promotion and health care as processes to achieve key performance indicators in college health. The variety of healthcare services provided by any one institution range from first aid stations employing a single nurse to large, accredited, multi-specialty ambulatory healthcare clinics with hundreds of employees. These services, programs and policies require a multidisciplinary team, the healthcare services alone include physicians, physician assistants, administrators, nurses, nurse practitioners, mental health professionals, health educators, athletic trainers, dietitians and nutritionists, and pharmacists. Some of the healthcare services extend to include massage therapists and other holistic health care professionals. While currently changing, the vast majority of college health services are set up as cost centers or service units rather than as parts of academic departments or health care delivery enterprises.

<span class="mw-page-title-main">Binge drinking</span> Form of excessive alcohol intake

Binge drinking, or heavy episodic drinking, is drinking alcoholic beverages with an intention of becoming intoxicated by heavy consumption of alcohol over a short period of time, but definitions vary considerably.

Epsychology is a form of psychological intervention delivered via information and communication technology. epsychology interventions have most commonly been applied in areas of health; examples are depression, adherence to medication, and smoking cessation. Future applications of epsychology interventions are likely to become increasingly more common in information, organization, and management sciences.

<span class="mw-page-title-main">Cannabis use disorder</span> Continued use of cannabis despite clinically significant impairment

Cannabis use disorder (CUD), also known as cannabis addiction or marijuana addiction, is defined in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and ICD-10 as the continued use of cannabis despite clinically significant impairment.

Motivational enhancement therapy (MET) is a time-limited, four-session adaptation used in Project MATCH, a US-government-funded study of treatment for alcohol problems, and the "Drinkers' Check-up", which provides normative-based feedback and explores client motivation to change in light of the feedback. It is a development of motivational interviewing and motivational therapy. It focuses on the treatment of alcohol and other substance use disorders. The goal of the therapy is not to guide the patient through the recovery process, but to invoke inwardly motivated change. The method has two elements: initial assessment battery session, and two to four individual therapeutic sessions with a therapist. During the first session, the specialist stimulates discussion on the patient's experiences with substance use disorder and elicits self-motivational statements by providing feedback to the initial assessment. The principles of MET are utilized to increase motivation and develop a plan for further change; coping strategies are also presented and talked over with the patient. Changes in the patients behavior are monitored and cessation strategies used are reviewed by the therapist in the subsequent sessions, where patients are encouraged to sustain abstinence and progress.

Relapse prevention (RP) is a cognitive-behavioral approach to relapse with the goal of identifying and preventing high-risk situations such as unhealthy substance use, obsessive-compulsive behavior, sexual offending, obesity, and depression. It is an important component in the treatment process for alcohol use disorder, or alcohol dependence. This model founding is attributed to Terence Gorski's 1986 book "Staying Sober."

Community reinforcement approach and family training (CRAFT) is a behavior therapy approach in psychotherapy for treating addiction developed by Robert J. Meyers in the late 1970s. Meyers worked with Nathan Azrin in the early 1970s whilst he was developing his own community reinforcement approach (CRA) which uses operant conditioning techniques to help people learn to reduce the power of their addictions and enjoy healthy living. Meyers adapted CRA to create CRAFT, which he described as CRA that "works through family members." CRAFT combines CRA with family training to equip concerned significant others (CSOs) of addicts with supportive techniques to encourage their loved ones to begin and continue treatment and provides them with defences against addiction's damaging effects on themselves.

Linda Carter Sobell, Ph.D., ABPP, is the President's Distinguished Professor at Nova Southeastern University (NSU) in Fort Lauderdale, Florida. She is a professor of clinical psychology, addiction specialist, co-director of NSU's Guided Self-Change clinic, a Motivational Interviewing Trainer, and is board-certified in cognitive and behavioral psychology.

Guided self-change (GSC) treatment has been accepted by American Psychological Association Division 12, Society of Clinical Psychology, as an empirically supported treatment.

Screening, Brief Intervention and Referral to Treatment (SBIRT) is a model that encourages mental health and substance use screenings as a routine preventive service in healthcare.

References

  1. ↑ National Institute for Health and Clinical Excellence. PH24. Alcohol use disorders—preventing harmful drinking: guidance. 2010. http://guidance.nice.org.uk/PH24/Guidance/pdf/English
  2. ↑ Bertholet, N., Daeppen, J. B., Wietlisbach, V., Fleming, M., & Burnand, B. (2005). Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Archives of internal medicine, 165(9), 986-995. doi:10.1001/archinte.165.9.986
  3. ↑ Pedersen, B., Oppedal, K., Egund, L., & Tønnesen, H. (2011). Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review. BMC surgery, 11(1), 26.https://doi.org/10.1186/1471-2482-11-26
  4. ↑ Newbury-Birch, D., McGovern, R., Birch, J., O'Neill, G., Kaner, H., Sondhi, A., & Lynch, K. (2016). A rapid systematic review of what we know about alcohol use disorders and brief interventions in the criminal justice system. International Journal of Prisoner Health. 12(1): 57-70. https://doi.org/10.1108/IJPH-08-2015-0024
  5. ↑ Schulte, B., O’Donnell, A. J., Kastner, S., Schmidt, C. S., Schäfer, I., & Reimer, J. (2014). Alcohol screening and brief intervention in workplace settings and social services: a comparison of literature. Frontiers in psychiatry, 5, 131. https://doi.org/10.3389/fpsyt.2014.00131
  6. ↑ Boumparis, N., Schulte, M.H.J. & Riper, H. Digital Mental Health for Alcohol and Substance Use Disorders. Curr Treat Options Psych 6, 352–366 (2019). https://doi.org/10.1007/s40501-019-00190-y
  7. ↑ McCambridge, Jim; Bendtsen, Marcus; Karlsson, Nadine; White, Ian R.; Nilsen, Per; Bendtsen, Preben (November 2013). "Alcohol assessment and feedback by email for university students: main findings from a randomised controlled trial". British Journal of Psychiatry. 203 (5): 334–340. doi:10.1192/bjp.bp.113.128660. PMC   3814613 . PMID   24072758.
  8. ↑ Samson, J. E., & Tanner-Smith, E. E. (2015). Single-session alcohol interventions for heavy drinking college students: A systematic review and meta-analysis. Journal of studies on alcohol and drugs, 76(4), 530-543. https://doi.org/10.15288/jsad.2015.76.530
  9. ↑ McCambridge, Jim; Bendtsen, Marcus; Karlsson, Nadine; White, Ian R.; Nilsen, Per; Bendtsen, Preben (November 2013). "Alcohol assessment and feedback by email for university students: main findings from a randomised controlled trial". British Journal of Psychiatry. 203 (5): 334–340. doi:10.1192/bjp.bp.113.128660. PMC   3814613 . PMID   24072758.
  10. ↑ Bien, Thomas H.; Miller, William R.; Tonigan, J. Scott (1993). "Brief interventions for alcohol problems: a review". Addiction. 88 (3): 315–336. doi: 10.1111/j.1360-0443.1993.tb00820.x . ISSN   0965-2140. PMID   8461850.
  11. ↑ Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, Daeppen JB, Saunders JB, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews 2018, Issue 2. Art. No.: CD004148. DOI: .
  12. ↑ Kaner EFS, Beyer FR, Garnett C, Crane D, Brown J, Muirhead C, Redmore J, O'Donnell A, Newham JJ, de Vocht F, Hickman M, Brown H, Maniatopoulos G, Michie S. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community‐dwelling populations. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD011479. doi:10.1002/14651858.CD011479.pub2.
  13. ↑ Shorter GW, Bray JW, Giles EL, O’Donnell AJ, Berman AH, Holloway A, Heather N, Barbosa C, Stockdale KJ, Scott SJ, Clarke M. The variability of outcomes used in efficacy and effectiveness trials of alcohol brief interventions: a systematic review. Journal of studies on alcohol and drugs. 2019 May;80(3):286-98.
  14. ↑ Shorter GW, Heather N, Bray JW, Berman AH, Giles EL, O’Donnell AJ, Barbosa C, Clarke M, Holloway A, Newbury-Birch D. Prioritization of outcomes in efficacy and effectiveness of alcohol brief intervention trials: international Multi-Stakeholder e-Delphi consensus study to inform a core outcome set. Journal of studies on alcohol and drugs. 2019 May;80(3):299-309.
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