Rehab 4 Addiction

Do you know someone who has a problem with substances, but won’t admit it? Do you think they would benefit from a brief intervention?

If so, you’ve come to the right place. In this page, we’ll go through what brief interventions are and what they aim to achieve. We’ll also discuss who they are for, how they are delivered, and how effective they are.

What is a brief intervention?

A brief intervention is a short conversation about substance usage, which lasts between 5 and 20 minutes. It aims to make someone think about their substance usage, and whether it could be harming them.

It also tries to get the person to change their behaviour, for example by cutting down their intake.

Brief interventions are normally aimed at people with drinking problems. However, they can also be used for other substance abuse problems.

They can be delivered in most institutional settings. That includes hospitals, schools and emergency departments. The most common setting for a brief intervention is a clinical one.

During a brief intervention, the doctor will ask the patient a few questions about their relationship with substances. They will then give them information based on their answers.

For instance, a typical question might be: ‘How many units of alcohol do you consume a week?’ Depending on the answer, the person giving the intervention can give information and advice.

Many people do not know the level of damage that their drinking is causing them. They may resent their doctor telling them what to do. However, if the intervention is done in a non-judgmental way, it can be very beneficial. This is backed up by several studies. We will look at a few of these later on in this page.

Brief interventions and ‘SBIRT’

Brief interventions are part of the ‘SBIRT’ screening process. SBIRT stands for ‘Screening, Brief Intervention, and Referral to Treatment’.

SBIRT is an approach for reaching those with substance abuse problems early. It aims to prevent minor substance abuse problems from becoming more serious.

It places an emphasis on screening people to learn the severity of their substance usage. It also recommends brief interventions being conducted as soon as possible.

Finally, it suggests that those with severe substance abuse problems be referred for treatment. This means that people get quick and professional help before their addiction gets out of control.

What’s the point of a brief intervention?

You might think that problem drinkers are unlikely to change their behaviour just because someone tells them to. People with substance abuse problems tend to create barriers, so that they are immune to any sort of change.

But if that advice comes from a doctor, and is based on medical fact, it can have more of an impact.

In Addiction Medicine, Noeline Latt points out that ‘15-30% of patients seen in general practice or the general hospital setting have an underlying alcohol use disorder’.

However, she says that ‘less than one-third of these are diagnosed.’ [1] This suggests that there is a lot to be gained by doctors actively screening for substance abuse problems.

We also know that addictions become more difficult to treat the longer they go on. Brief interventions can prevent substance abuse problems from developing into more serious issues.

Latt suggests that doctors should ask at least one question of their patients about their drinking. For example, ‘How often do you have more than six standard drinks in a night?’. This screens for binge drinking. Binge drinking is a hallmark of alcohol use disoder.

By making this common practice, people will grow used to their doctors asking them about their drinking habits. They will also become more conscious of how much they are drinking. This will to help to raise awareness in the UK about the dangers of heavy drinking.

Who could benefit from brief interventions?

Brief interventions are normally aimed at people with minor alcohol abuse problems. That’s because they try to stop addictions from becoming more serious.

For example, a student who regularly binges on alcohol might be a good target for a brief intervention. They may not realise they are damaging their body.

Similarly, a pregnant woman who is drinking during pregnancy might benefit from a brief intervention. She may not know about the dangers of foetal alcohol syndrome.

Brief interventions for those who are alcohol dependent

Heavier drinkers are not typically the targets of brief interventions. Brief interventions normally try to stop someone’s drinking problem before it becomes more severe. However, brief interventions can be used for those who are alcohol dependent.

Latt argues that brief interventions for those with serious drinking problems should be used to prompt discussion. They should also aim to get them into more treatment. She says that brief interventions alone are not enough for a person who is alcohol dependent. More action needs to be taken in these cases.

What are the main components of brief interventions?

The acronym ‘FLAGS’ gives a good breakdown of what a brief intervention should contain.

‘FLAGS’ stands for:

  • Feedback: on problems experienced
  • Listen: to readiness to change
  • Advice: unequivocal advice to change drinking
  • Goals: negotiate goals
  • Strategies: discuss practical methods for achieving goals [2]

In more detail:

  • Feedback means giving the patient information. In this care, information about the effects that alcohol abuse might be having on their mind, body and relationships. Feedback needs to be done in a calm, neutral way. This gives it the best possible chance of having an impact. Examples of feedback could include telling a patient about liver diseases, or insomnia. So many health problems are caused by alcohol abuse. A patient might have a health problem which they don’t realise is caused by their alcohol abuse. For example, someone who suffers from insomnia might not know that this is linked to alcohol abuse. Similarly, many people self-medicate for mental health issues with alcohol. They may not realise how harmful this can be
  • Listen to what the patient says, and whether they are open to change. It is important to be receptive and tread carefully in this sort of context. It may be that the patient has not discussed these issues with anyone else
  • Advice should be clear and useful. Clinicians should focus on the positive effects that cutting down on alcohol (or quitting altogether) can have. These effects range from better sleep to improved fitness, to better mental health, to saving money
  • Goals: It’s important to make some targets during a brief intervention. An example of a goal might be to cut down to within the recommended weekly alcohol limits
  • Strategies: For someone who drinks socially, it can be hard to imagine giving up alcohol. Alcohol is so woven into their normal life that abstinence seems impossible. That’s where practical advice and strategies for cutting down come into play. Some good strategies include: drinking non-alcoholic beer, alternating alcoholic drinks with non-alcoholic ones, and having smaller drinks. The doctor should ask the patient when they normally drink alcohol. They should offer tips on how to manage these situations without drinking

Screening

In a medical setting, doctors can screen patients for alcohol abuse problems. This can be done using a questionnaire or using blood tests.

Questionnaires don’t need to include lots of questions. Hospital staff can give them out to inpatients. This raises the chances of detecting alcohol abuse problems in the general population.

Blood tests, such as GGT, are actually less effective than most questionnaires. According to Latt, GGT detects 30% of heavy drinkers, whereas questionnaires such as the AUDIT test detect around 75%.

Where can brief interventions be delivered?

This page has mainly focused on brief interventions in a medical setting, but they can be delivered in other places too. Below, we list some of the main places where a brief intervention can take place:

  • Accident and Emergency: 30 per cent of people in emergency departments have some sort of alcohol dependency problem. This means that there are lots of people who could benefit from a brief intervention. Not only that, but many of these people will be in A&E because of a drinking-related accident. Alcohol abuse is a very common factor in violent incidents and car crashes. Doctors should take this opportunity to ask about people’s levels of drinking or drug abuse. They can then deliver a brief intervention if needed. People may be more receptive if they have just had an accident due to drinking
  • Primary Care: According to statistics, 20 per cent of people in primary care have an alcohol dependency issue. Less than half of these get diagnosed. GPs should ask you about your alcohol consumption as often as they can. This may be the most regular point of contact between people and their doctors, so doctors should make use of it
  • Education: A huge proportion of students drink in excess. This presents an opportunity for brief interventions. If a student approaches a teacher or mentor with problems, it would be wise to ask them about their alcohol consumption
  • Prenatal Care: Drinking can pose a risk to an unborn child. Mothers with alcohol dependency problems need to be informed about this. They could be endangering the life of their child. A prenatal setting gives a good chance to tell women about the threat of foetal alcohol syndrome
  • The Criminal Justice System: Similar to in A&E, you are bound to find many people with alcohol and substance abuse problems in police stations and courtrooms. The police and council workers should make people aware of the damage alcohol and drugs causes to their health

The key to brief interventions during a consultation

For brief interventions to work, they need to be done in a respectful, non-judgmental way. If done wrong, they could backfire, causing the patient to lose trust in their doctor, or feel like their situation is hopeless.

We believe that the best way to handle this issue is to make brief interventions a normal feature of consultations. When you go to the doctor, they should ask you about your lifestyle. By normalising this, brief interventions become more effective.

As a doctor or medical practitioner, you may find it useful to have some questions prepared for brief interventions.

Here are some you might try:

‘What do you know about…?’ (e.g. government drinking guidelines, effects of alcohol on the liver, etc.)

‘Would you mind if we talked about…?’ (e.g. your drinking habits).

‘How often do you…?’ (e.g. binge drink, go over the recommended daily allowance, etc.)

Here are some more general points to keep in mind:

Remember that your patient gets to decide how they want to treat their body.

Try to keep your comments as objective as possible. Rather than saying: ‘I think you should do this…’, say things like ‘Drinking in excess can lead to…’

Don’t be surprised when your patient expresses ambivalence. For many, drinking a lot of alcohol is considered normal. Your job is to use medical facts to alert your patient to the risks of their lifestyle.

How effective are brief interventions?

In this final section, we’re going to look at a few facts and figures about brief interventions. These statistics show that brief interventions are effective. They make a strong argument for brief interventions being used more often in a range of contexts.

One review, by Dr Lucy Platt, looked at a range of trials of ABIs (Alcohol Brief Interventions). Dr Platt found that ‘ABIs play a small but significant role in reducing alcohol consumption.’ Furthermore, she found that nurses who delivered ABIs had a big impact. [3]

Another study, by Anne Moyer and John W. Finney, looked at 24 reviews of ABIs. It found that ‘brief alcohol interventions delivered in primary health care settings were effective in reducing harmful and hazardous drinking’. [4]

Final thoughts

Over the next few years, it would be good to see brief interventions become more common. As we have discussed in this page, they are suitable for a range of contexts.

At Rehab 4 Addiction, we believe that brief interventions have a big role to play in identifying problem drinkers before they become properly addicted. If handled correctly, they can be very effective.

Not everyone is at the point where they need rehab. Brief interventions are a good way of preventing people from reaching that point.

References

[1] Addiction Medicine, by Noeline Latt, Katherine Conigrave, John B. Saunders, E. Jane Marshall and David Nutt. (OUP, January 2010).

[2] Addiction Medicine, p. 93.

[3] https://bmjopen.bmj.com/content/6/8/e011473

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401596/