Unlike traditional alcoholism treatment, which focuses on helping people who are dependent on alcohol, brief interventions—or short, one-on-one counseling sessions—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 followup.

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 drinking1), rather than to insist on complete abstinence from drinking—although abstinence may be encouraged, if appropriate (1).

(1 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 (2).

Brief interventions typically consist of one to four short counseling sessions with a trained interventionist (e.g., physician, psychologist, social worker).

Moyer and colleagues (2) 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 (1).

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 (3) 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.

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.

(For specific information on screening in a variety of settings, see Alcohol Alert, Number 65, “Screening for Alcohol Problems.”)

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 (1).

Typically a nonspecialist 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 (1).

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.

An Update—New Clinician’s Guide

In 2005, NIAAA released Helping Patients Who Drink Too Much: A Clinician’s Guide, featuring new guidelines on screening and brief intervention for primary care and mental health practitioners. It offers a simple screening method—a single question about heavy drinking days—and includes the AUDIT screening tool, both in English and Spanish, as a self-report option. To order, see below.
 
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 (4,5).

Another potential tool for administering interventions is “video doctor technology,” in which an actor–doctor asks health questions in an interactive computer program. Pilot results of this program indicate that although users reported they would be most comfortable consulting with a doctor in person, they responded positively to the “virtual” doctor intervention, which was accessible even to those with little computer experience (6).

PUTTING RESEARCH INTO PRACTICE

Research shows that brief interventions can decrease alcohol consumption, and they work in a variety of populations—younger and older adults, men and women (7).

Interventions that involve repeated contact generally are more effective than single-contact interventions (7).

A review of studies reported that intervention participants reduced their alcohol consumption an average of 13 percent to 34 percent compared with a control group (8).

In addition, a recent analysis concluded that brief interventions may reduce mortality rates among problem drinkers by an estimated 23 to 26 percent (9).

The following sections examine the use of brief interventions in a variety of settings.

Although the basic interventions may be similar, there are specific things to keep in mind when tailoring interventions to specific audiences and settings.

Primary Care Settings—In one study, about 20 percent of primary care patients reported levels of consumption that exceeded the limits recommended by the National Institute on Alcohol Abuse and Alcoholism (10). Simple interventions offer clinicians an ideal strategy for getting these patients the help they need.

Brief intervention in primary care can be simple and short—ranging from only a few questions (with appropriate responses)—or more extensive, including referral to a substance abuse specialist (11,12).

Clinicians with limited time may want to use a basic intervention for all patients who use alcohol above the recommended limits; patients who do not respond to the basic intervention can be referred to an alcohol treatment specialist at the followup visit.

The most basic level of brief intervention consists of a simple statement or two. The clinician states that he or she is concerned about the patient’s drinking, that it exceeds recommended limits and could lead to alcohol-related problems, and the clinician advises the patient to cut down or stop drinking.

Another brief intervention, which was studied extensively in Project TrEAT (Trial for Early Alcohol Treatment, a large-scale clinical trial conducted in primary care practices), involves two brief face-to-face sessions scheduled 1 month apart, with a followup telephone call 2 weeks after each session.

Patients participating in this intervention reported reduced alcohol use, fewer days of hospitalization, and fewer emergency department visits compared with control-group patients.

This intervention may be especially useful with patients who are experiencing alcohol-related problems but who do not necessarily need to be referred to an addiction treatment specialist and may not need to stop drinking completely. This intervention was found to be effective up to 4 years later (13).

Patients who have clear symptoms of alcohol abuse or dependence also may benefit from brief interventions in the primary care setting. Referral to a specialist for alcoholism treatment is a key component of this type of intervention. These interventions typically are more intense; the goal is abstinence from alcohol, not merely cutting down on drinking (11).

Despite evidence that brief interventions are useful in primary care settings, these short counseling sessions are not routine practice. One survey of primary care physicians found that although most (88 percent) reported asking their patients about alcohol use, only 13 percent used standard screening instruments (14).

A survey of primary care patients revealed that more than 50 percent said their primary care physician did nothing about their substance abuse; 43 percent said their physician never diagnosed their condition (15).

A number of strategies have been suggested to help physicians make use of screening and brief interventions in their practices, including using group education strategies to hone clinicians’ skills with role-playing and other counseling tactics (16); providing performance feedback (17); offering training to all clinic members (18,19); providing financial incentives to staff (20); and offering training using credible experts (21).

Continued at
http://pubs.niaaa.nih.gov/publications/AA66/AA66.htm