How to do brief intervention

Remember...Brief intervention should be:

– Short

– Evidence based

– Structured around a conversation

– Collaborative

– Person-centred

– Non-judgemental

(The Scottish Govt. 2015)

So... let’s take an opportunistic BI

• About 5-10 minutes

• Within a conversation

• On equal terms

• Based on the service user’s perspective

• Not preachy!

Brief intervention for alcohol (NHS Scotland, 2015)

• The practice delivery for brief intervention is guided by the acronymn FRAMES:

Feedback – tell them about the risks of their current level of alcohol use.

Responsibility – reinforce any decision to change (or not) lies with the

service user.

Advice – based on facts about their drinking, offer simple and direct advice

to the service user re impact on them and offer your advice to change.

Menu – provide them with a menu of options for behaviour change.

Empathetic interviewing – consider their perspective; be non-judgemental.

Self-efficacy – encourage the person to believe they can change.

NHS Scotland (2015)• NHS Scotland is ahead of other UK nations with strategies to

reducing alcohol harm.

• Their simple strategy for practice is:

1. Raise the issue – ask about drinking.

2. Screen for harmful use and give brief feedback on the

harmfulness.

3. Listen for signs of readiness to change.

Use open questions

• These encourage the person to explore the issue. For example:

– What do you understand about binge drinking?

– How much do you know about the harm to the liver?

– What do you understand about the reason you are in

hospital/arrested/have a health issue?

– What do you think is sensible use of alcohol?

Empathetic interviewingUse questions and feedback in a positive way rather than preaching or judging. For example:

– I know it isn’t easy talking about these things but it’s important to discuss the extent to which you may have damaged your liver through your drinking.

– It is likely that there may be changes in your liver with a history of alcohol use like yours.

– You may have damaged your liver by drinking too much.

Which is better?

Emphasising responsibility and motivational interviewing• It is important that the person feels they are able to change, but also

that they are the only ones who can really make that change. • It is important to encourage optimism and hopefulness to motivate

people to change:

– It is important for you to choose how you want to reduce your drinking – what do you think would suit you best?

– Some people find a drinking diary helpful – do you think that might suit you or is there another way you would like to monitor your intake?

Listening for motivation to changeThis is connected to the ‘stages of change model’ (see How to talk about substance use).

You should be listening for the person:

– Contemplating change

– Planning change

– Putting change into practice

– Attempts to maintain change

Listening for motivation to change

For example:

– I’m more careful about my drinking but I still struggle when I’m with mates.

– I tried abstinence for a while but there was that party ...

– I thought I should tackle my stress levels first

– I should really cut down my drinking

• Which one is which stage of change?

•(they are in reverse order to above)

Motivating – enhancing confidence, options and self efficacy

If someone appears to be contemplating change, this is an opportunity to help them develop their motivation and ability to make the change.

• Reward positive statements and contemplation.• Encourage the person to weigh up pros and cons of

change – focus on the positive ones!• Keep the door open – with options – better if they

generate them themselves. • Build confidence – identify the areas in which they

have already achieved success, e.g. being willing to talk to you about it, spending time thinking about change, making previous attempts to change.

Examples of responses

If someone stated: ‘I should really cut down my drinking’, you have a number of ways to respond:

– Reward – ‘it’s good that you understand that this is important’

– Pros & cons – ‘what concerns you most about your drinking?’ (this also highlights the main motivator)

– Options (self-generated) – ‘what ways of cutting down do you think might work for you?’

– Build confidence – ‘you told me that you have succeeded once for a while – that shows you can do it!’

References• NHS Scotland (2015) Delivering an ABI: Process, screening tools and guidance

notes. Edinburgh, NHS/Health Scotland. Available at: http://www.healthscotland.com/uploads/documents/3273-rimary%20care%20cribsheet.pdf

• The Scottish Government (2015) Local Delivery plan Standard: Alcohol Brief Interventions National Guidance: 2015-16. Edinburgh, NHS Health Scotland.