Here in the UK, we’re undergoing what experts refer to as an addiction crisis, with thousands of people suffering from severe substance-related problems.
This increase in heavy drinkers and illicit drug users has been especially prevalent since COVID-19, with lockdown fuelled binges leading to unwelcome habits.
While each person’s substance use story is different, many victims can agree in wishing that their risky alcohol or drug consumption was treated earlier.
It’s this focus on harm reduction and catching an addiction early on that led to brief interventions being used.
A brief intervention [1] is, as the name suggests, a short counselling session that aims to help patients realise that they have a Substance Abuse Disorder.
From here, they’re more likely to accept that they need help to change, preferably in a medical setting.
While also utilised in cases of poor diet and lack of self-care, brief interventions are considered most effective when used in the context of drug or alcohol-related problems [2].
This single-session method is designed to be short-lived but with long-term impacts and is usually conducted by a professional with targeted intervention training.
Depending on the needs of the individual, planned interventions can take place in clinical settings, rehab clinics, or somewhere familiar and comfortable such as their home.
Loved ones can discuss the exact location and time with their social worker, psychiatrist or doctor, and they’ll be happy to accommodate.
Why are they Effective?
Since brief interventions became more widely used in formal treatment for addiction, healthcare providers have worked to optimise their success.
From the psychotherapeutic methods employed, to the follow-up care given to patients, there are many reasons why brief interventions are effective harm-reduction methods.
The first point to note is that, while family members may try to intervene themselves, professionally-led brief interventions are a powerful way of getting someone into treatment.
Recent studies have shown [3] that, when performed by a medical authority figure such as a doctor, especially if that figure is someone known to the individual, interventions are more effective.
Furthermore, brief interventions often include follow-up services that have been proven to boost success rates.
After a counsellor has helped their patient identify a current or potential substance abuse disorder, they’ll provide continued guidance. This means reaching out to patients in the days or weeks following their session, either via phone or email.
This additional support can provide further encouragement to seek speciality care and keep the individual’s motivation to change high.
Healthcare providers give patients a menu of options for treatment [4] following their intervention, reading materials, or resources such as group therapy.
This can help accelerate the recovery process and give people access to avenues of treatment they might not have known about previously.
Another reason behind the efficacy of brief interventions is the use of Motivational Interviewing (MI) methods during the session. Motivational Interviewing techniques are patient-orientated and include expressing empathy, listening reflectively, and remaining calm if met with resistance.
A clinician using motivational interventions will listen carefully and ask open-ended questions to encourage autonomy. Rather than forcing the topic of abstinence, they’ll instead help the patient realise how substance use is getting in the way of their value and goals [5].
By helping them reevaluate their personal goals, it becomes easier for the affected person to see that substance abuse patterns are hindering rather than helping them.
Who’s the Ideal Candidate For a Brief Intervention?
One of the most concerning myths surrounding addiction and problematic substance use is that you have to hit rock bottom to access the treatment process.
In reality, methods like brief interventions are used to help people make meaningful changes before they have a diagnosable addiction.
Those who are already alcohol dependent [6] or who have a diagnosable drug use disorder typically won’t benefit from brief interventions: instead needing speciality care.
They’ll have gone beyond the stage where talking to a professional leads to reductions in drug use, and are often streamlined to residential rehab clinics.
With this in mind, the ideal candidate for a brief intervention will be anyone with more minor substance misuse problems.
They might not realise the extent to which they’re damaging their body or might be in complete denial about their consumption and the effect it’s having.
These individuals are more likely to have retained the self-awareness needed to change their behaviour, sans medical intervention.
For example, brief interventions are beneficial for someone who binge drinks weekly or occasionally drinks to excess (having 5 or more drinks in one session).
In these cases, a quick counselling session can remind them of the negative impacts drinking has on their physical and mental health [7]. This applies to cases of occasional drug abuse, too, especially for those who are unaware of the addictive potential illicit substances carry.
Another example of someone who should receive a brief intervention is an individual who has recently become pregnant and drinks to excess.
They might not be aware of the dangers of foetal alcohol syndrome and the risks that their drinking behaviour poses to their unborn child. As such, brief interventions are often carried out by professionals at pre-natal clinics, who are armed with knowledge and resources.
Even if someone isn’t addicted to drugs or alcohol, they may have recently suffered an incident that occurred as a result of substance use.
For instance, someone may have suffered an injury after a night of drinking or drug abuse. They might have been arrested for driving under the influence, or similarly hazardous behaviour while intoxicated.
Attending a counselling intervention at a time referred to as a “teachable moment” can be pivotal in someone’s road to recovery.
Events such as getting in trouble with the law or sustaining an injury are often shock-inducing and can provide moments of clarity all by themselves. But with the added help of a brief intervention, dependent users can cement their motivation to change.
The Screening, Brief Intervention, and Referral to Treatment (SBIRT) Approach
This three-part approach is an effective model for delivering treatment or catching a substance use disorder in its early stages.
As a comprehensive structure for harm reduction, SBIRT [8] is used by many primary care practices, rehab centres, psychiatrists, and doctors all over the world.
As the first part of the acronym suggests, clinicians start the process by identifying someone’s risk level: using screening tools to achieve this.
If someone is seeking help for harmful drinking, the AUDIT questionnaire is utilised, whereas problems with illicit or prescription drugs are assessed using CAGE-AID or similar tools.
Depending on their score and severity, they’ll either require (a) no further care, (b) Brief Intervention, or (c) Immediate Referral to Treatment.
Those who come out of the assessment process with a suspected SUD often bypass the brief intervention process and are instead admitted for inpatient rehab.
But for those believed to have a mild or moderate problem, a brief intervention is the logical next step.
An intervention program might be enough on its own to instil change, but if problems remain, the final part of SBIRT comes into play: Referal to Treatment [9]. This involves contacting primary care providers to achieve positive outcomes.
What are the Components of a Brief Intervention?
Despite sessions being shot at between 15-60 minutes, a brief intervention has a few key points it should address to ensure the patient leaves feeling motivated to change.
The components of a brief intervention have been fine-tuned over the years: informed by cognitive behavioural approaches and the MI techniques briefly discussed earlier.
It can also be described as the FRAMES approach, an acronym for Feedback, Responsibility to Change, Advice, Menu of Treatments, and Empathy.
1. Feedback
In the first part of a brief intervention, clinicians will ask their patients to describe their substance use habits in as much detail as they feel comfortable sharing.
This helps counsellors build an overall picture of the individual’s unique situation and allows them to provide personalised feedback: a key part of every brief intervention.
Oftentimes, individuals requiring a brief intervention won’t have heard feedback from someone who isn’t a friend or loved one. As such, it’s crucial to feel heard and receive the honest opinion of someone non-judgemental, sympathetic, and knowledgeable.
Depending on where the brief intervention is being carried out (in the patient’s home or a clinical setting), feedback usually follows the initial screening process.
For example, those with suspected Alcohol Use Disorders or problem drinking may take the AUDIT [10] test at the beginning of the intervention.
Designed to gauge someone’s severity or the level of care needed, the Alcohol Use Disorder Identification Test (AUDIT) is a simple test consisting of 10 questions.
These include “How often do you have a drink containing alcohol?”, to which the respondent chooses a frequency that is matched to a score (e.g. 2 or 3 times per week gives a score of 4).
After the test, someone’s score is added up to indicate a corresponding severity level. Similar tests for illicit drug users exist too, such as The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).
This covers not only alcohol, but also opioids, cannabis, amphetamine-type stimulants, cocaine, and nicotine.
Therefore, part of the feedback section of behavioural interventions will consist of telling the patient their results.
Clinicians will tell them whether or not they’ve tested positive for heavy substance use, before discussing the risks associated with this behaviour.
2. Explaining the risks of continued use
While this might at first sound like a lecture, brief interventionists aim to discuss the risks of continued use in a non-judgmental, relaxed manner.
After all, it’s crucial that the individual feels at ease throughout the intervention, and that they’re not being pressured into an avenue of sobriety.
Interventionists will emphasise both the physical and mental risks of continued use: making sure to explain why these problems may occur rather than listing possible symptoms.
Many risky drinkers or dependent users don’t fully realise the dangers of injury and/or disease associated with their substance use. With this in mind, a counselling intervention must cover possible ramifications without using scare tactics.
For instance, if someone is drinking or using drugs to reduce anxiety or low mood, an interventionist might explain that doing so will worsen their mental symptoms.
They can then go on to explain research surrounding substance-induced cognitive issues, and the wide range of other symptoms that can occur [11]. These include paranoia, insomnia, and drug-induced psychosis in serious cases.
Similarly, interventionists might choose to highlight the physical risks posed by substance dependence. They might explain that continuing down a path of long-term substance use can cause worrying medical conditions. Studies on alcohol and drinking habits have revealed an increased risk of liver disease, cardiovascular disease, and kidney failure.
If relevant, any myths related to alcohol should be dispelled, such as the benefits of red wine or low-level drinking having no ill consequences. In this way, brief interventions for substance abuse can be a powerful educational force that can lead to larger reductions in consumption.
3. Explaining the benefits of moderation/abstinence
While it’s essential to cover the dangers posed by severe alcohol or drug use, an equal amount of time should be spent highlighting the benefits of sobriety or moderation.
A brief intervention for substance use should frame the treatment process positively, as the health benefits of sobriety have been widely documented.
Interventionists often utilise the MI principle of asking open-ended questions at this stage. They might try to elicit positive responses by asking “What do you think might be some benefits of cutting back on your drinking/drug use?”.
This will hopefully open up a discussion and help the individual think of some benefits without input from their therapist.
As the benefits of sobriety are far-reaching, this part of the intervention can cover an array of topics and studies on alcohol or drug use.
Someone free from substance abuse disorder has a lower risk of medical conditions, will feel better mentally, have greater economic freedom, and much more.
Especially in cases of severe alcohol or drug dependence [12] interventionists will acknowledge that though sobriety is a challenging goal, the results are well worth the journey.
Aside from the mental and physical benefits, a reduction in alcohol consumption or drug use leads to healthier relationships.
Brief interventions often explore the social freedom that is experienced upon ceasing alcohol consumption or drug use.
Although individuals might not be manoeuvring in the same social circles as those who enjoy regular substance use [13], they’re able to build more lasting, meaningful relationships. This might mean reconnecting with friends and family members or creating new bonds by taking up healthier hobbies.
4. Developing an Actionable Plan
After the initial phases of a brief drug or alcohol intervention, therapists will work with the patient to develop a plan of action. This could be considering treatment options [14], looking for primary care providers, or creating a tapering schedule to suit their needs.
Many interventionists collaborate with patients to fill in a change plan template: encouraging them to record their goals and reasons for change in a way that’s tangible.
These templates include sections for handling potential roadblocks and temptations to use: providing a resources section to record the people/organisations who can help.
Another part of the action stage in a brief intervention is arranging follow-up care and assessing the individual’s motivation levels.
For example, someone might have high levels of motivation but be surrounded by other substance abusers in their home environment. In these cases, the interventionist may arrange future counselling sessions.
5. Aftercare
Even if their counsellor is pleased with their patient’s motivation levels and response to the intervention, aftercare is still necessary [15]. In many cases, there will be a follow-up phone call of between 5-30 minutes depending on the unique situation.
This can improve motivation and remind patients that what they discussed during the intervention carries over into the real world outside primary care settings.
Another form of aftercare that’s recommended for moderate substance users is a series of Motivational Enhancement Therapy (MET) sessions.
As you can probably tell by the name, this therapy method borrows principles from its counterpart Motivational Interviewing (MI), with some crucial additions to boost longevity.
While MI therapists don’t attempt to convince patients that change is in their best interest, MET sessions involve receiving direct advice based on scientific findings.
This can provide a more concrete structure to someone’s motivation, allowing them to build sobriety goals based on scientific findings.
For instance, a MET therapist might use clinical guidelines as a framework for sessions, referring to complete abstinence vs moderation in cases of hazardous drinking.
If You Need Help, Now’s the Time to Reach Out
After reading this guide on brief interventions in addiction treatment, you might have a feeling that this process could benefit someone you love.
It’s common for people with alcohol issues or drug dependency to justify their actions to the ones they love, which is why professional interventions are so effective.
To schedule intervention sessions for a loved one or find out more about the treatment process, you can reach out to our expert team [16] at 0800 326 5559.
We help countless individuals every year by connecting them with primary care facilities and supporting them on the road to recovery.
References
[1] Conduct a Brief Intervention: Build Motivation and a Plan for Change Conduct a Brief Intervention: Build Motivation and a Plan for Change | National Institute on Alcohol Abuse and Alcoholism (NIAAA) (nih.gov)
[2] Drugs, Brains, and Behaviour: The Science of Addiction https://books.google.com.vn/books?id=n-OeI0fPx38C&printsec=frontcover&dq=substance+addiction&hl=en&sa=X&ved=2ahUKEwjk_Ynan639AhWDsVYBHQm3AoM4ChDoAXoECAUQAg#v=onepage&q=substance%20addiction&f=false
[3] Planning and Implementing Screening and Brief Intervention
for Risky Alcohol Use Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use (cdc.gov)
[4] Ending Discrimination Against People with Mental and Substance Use Disorders, The Evidence for Stigma Change https://www.google.co.th/books/edition/Ending_Discrimination_Against_People_wit/j6PKDAAAQBAJ?hl=en&gbpv=0
[5] DSM-5 Criteria for Addiction Simplified https://www.addictionpolicy.org/post/dsm-5-facts-and-figures
[6] Dynamic Pathways to Recovery from Alcohol Use Disorder: Meaning and Methods https://books.google.co.th/books?id=rA9NEAAAQBAJ&printsec=frontcover&dq=alcohol+use+disorder&hl=en&sa=X&ved=2ahUKEwiR0MKsrLf5AhWT3jgGHaDmAb0Q6AF6BAgCEAI#v=onepage&q=alcohol%20use%20disorder&f=false
[7] Co-occurring Mental Illness and Substance Use Disorders: A Guide to Diagnosis and Treatment https://www.google.co.uk/books/edition/Co_occurring_Mental_Illness_and_Substanc/vkQ4DwAAQBAJ?hl=en&gbpv=0
[8] The Screening, Brief Intervention, and Referral to Treatment (SBIRT) Screening, Brief Intervention, and Referral to Treatment (SBIRT) | SAMHSA
[9] The Addiction Solution: Unravelling the Mysteries of Addiction Through Cutting-Edge Brain Science https://books.google.co.th/books?id=_HlQfxWyJogC&printsec=frontcover&dq=valium+addiction&hl=en&sa=X&redir_esc=y#v=onepage&q=valium%20addiction&f=false
[10] Alcohol Use Disorders Identification Test (AUDIT) Alcohol Use Disorders Identification Test (AUDIT) (auditscreen.org)
[11] Substance Withdrawal Syndrome https://books.google.com.vn/books?id=KexyPgAACAAJ&dq=withdrawal+symptoms&hl=en&sa=X&redir_esc=y
[12] Alcohol Detox: The Guide to Safely Clean Up Your Lifestyle, Detoxify & Maintain Healthy Body Without Drugs https://www.google.co.uk/books/edition/Alcohol_Detox/JrLpzgEACAAJ?hl=en
[13] Innovations in the Treatment of Substance Addiction https://www.google.co.th/books/edition/Human_connection_as_a_treatment_for_addi/B1CqEAAAQBAJ?hl=en&gbpv=0 https://www.google.co.uk/books/edition/Innovations_in_the_Treatment_of_Substanc/vzbzuAEACAAJ?hl=en
[14] Ok Rehab: Drug Addiction – Signs & Symptoms https://www.okrehab.org/drug/drug-addiction-signs-symptoms/
[15] Modern 12 Step Recovery: Alcoholics Anonymous for the 21st Century https://www.google.co.th/books/edition/Modern_12_Step_Recovery/44kszgEACAAJ?hl=en
[16] Ok Rehab: Help For Myself https://www.okrehab.org/help/myself/
