Brief Interventions In Addiction Treatment

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Brief Interventions In Addiction Treatment

Brief interventions provide a smart way for practitioners in the health field to screen for substance use.

They also offer poignant information and advice that can prevent an addiction developing.

Considering the government reported 976,425 alcohol-related hospital admissions in England in 2019, this type of intervention can be especially useful when implemented in A&E departments.

They are, however, also used by addiction specialists working in rehab clinics.

What Is A Brief Intervention?

Brief interventions are used across the substance misuse field and typically consist of a 5-20 minute evidence-based, structured conversation.

It’s led by a professional, such as a doctor, counsellor, social worker, or drug and alcohol worker.

One of the main aims is to get people to think about their substance use.

Brief interventions are especially effective at addressing alcohol use but are also used in relation to drug use.

These interventions are used to raise awareness of the effects of substance use with a careful emphasis on the harm that can occur.

There is a focus on the benefits of changing drinking or drug-using habits during the conversation.

According to the World Health Organisation, brief interventions should be “personalised… supportive [and] nonjudgmental”.

The professional needs to be open-minded and compassionate for the intervention to be successful.

They should ask questions and then offer information linked to what the person says.

This might, for example, focus on the negative effects of drinking 30 units a day.

Brief interventions were first used in the 1950s and 1960s in Boston and London.

Professionals worked with patients to emphasise the fact that if they continued to drink as they were there was a much higher risk of addiction developing.

During this time, it was acknowledged that for some people a reduction in drinking (rather than cessation) was a suitable outcome.

Where Are Brief Interventions Held?

Brief interventions are carried out in a wide range of settings in both the health sector and also in other areas.

• A&E – According to the NHS there were an estimated 1.3 million admissions to A&E in 2020 in England that were alcohol-related. One might argue that it is imperative for screening and brief interventions to take place here, as patients could be more receptive while experiencing the negative repercussions of alcohol.
• Primary care/local GP – Here, doctors are encouraged to normalise discussions around alcohol use. Doing so is shown to be effective at supporting people to reduce their alcohol use.
• Schools/colleges/universities – Many students experiment with drugs and binge drink alcohol, which makes it an opportune moment to hold a brief intervention.
• Prenatal care – This is imperative as it supports safety around fetal development and supports the needs of the mother around reducing substance use.
• Rehabilitation clinics – Both private and council-funded clinics provide brief interventions to patients while taking into account where they are in the cycle of change.

Brief Interventions As A Part Of SBIRT

Brief interventions are used commonly as part of SBIRT.

SBIRT stands for Screening, Brief Interventions and Referral to Treatment.

Professionals screen patients to decipher the severity of a person’s substance use.

This is usually done through questionnaires.

Usually, a brief intervention is used where a person’s substance use is considered mild in an attempt to prevent long-term addiction developing.

They are, however, used in some settings with patients who have developed addiction, but are adapted to suit individual needs.

After screening, the professional would then refer those who are considered to have developed a moderate to severe habit to a treatment facility.

The Aim Of A Brief Intervention

The main aim of brief intervention is to reduce the risk of harm from using substances.

It’s extremely beneficial to screen people in hospitals for non-dependent substance use, as many aren’t diagnosed.

Doing so can improve future outcomes as alcohol and drug use can be caught before severe addiction develops.

Screening more often also helps to raise questions related to a patient’s alcohol use.

This can emphasise unhealthy drinking habits and support people to actively become aware of what they are consuming and how it affects their health.

Many patients find that receiving information from a professional that is based on scientific facts can be very motivating in instigating a change in substance-taking behaviours.

Brief interventions For Severe Addiction

In relation to alcohol dependency, while it may be too late to stop severe addiction, brief interventions are great at prompting conversation and encouraging people towards treatment and rehabilitation.

The Five Components Of Brief Interventions

There are a few different frameworks that are used by professionals leading a brief intervention.

Two of the most common go by the acronyms FRAMES and FLAGS, which are quite similar.

The elements of FRAMES:

• Feedback – The professional offers information or feedback based on the patient’s answers during their screening. This might include how the substance will affect physical and mental health in the future, or social outcomes linked to relationships, work and life goals. The professional will ask the person how they feel about this knowledge. An example might include how alcohol causes organ failure or how cannabis is linked to psychosis, and what the patient feels about this.
• Responsibility – This will be based on what the person says about whether they want to change their alcohol or drug use and how they feel about doing so. Careful consideration will be given to where the person is in the cycle of change. The conversation could be about recognising viewpoints, resolving ambivalence or removing barriers to accessing rehab services.
• Advice – Part of the conversation will be focused on the benefits of reducing use or abstaining, such as improved immunity, well-being and mental health.
• Menu of options – This is where the professional encourages the patient to take responsibility and encourages their motivation to change. They might develop a record of alcohol use across a week, or create a plan of alternative healthy activities to replace drinking sessions. Goals are set which are intended to be practical and achievable – some may be linked to a reduction in how much the person drinks, for instance. Strategies should be useful, such as including drinking alternatives (i.e. non-alcoholic beer, or opting for smaller glasses of wine).
• Empathy – This is linked to the professional who should remain non-judgmental, empathic and will adopt reflective listening techniques.
• Self-efficacy – This is where the professional encourages the person’s self-confidence to adopt and maintain healthy change. There is an emphasis on using the patient’s own knowledge and resources to strengthen their resolve and commitment to change.

FLAGS is also used as a framework for brief interventions and stands for Feedback, Listen, Advice, Goals and Strategies.

It is very similar to FRAMES.

Brief Interventions At Rehab Clinics

Brief interventions are widely used at private rehab clinics.

They’re integrated within treatment programmes by specially trained staff.

Oftentimes, as a resident, a person might not be aware that an intervention is occurring as they can take place quite casually as a conversation.

Staff will offer residents tailored information in relation to the substances they use, including the outcomes linked to use and the potential impact on their health if they change these habits.

This tends to work nicely in unison with other more intense psychotherapies, such as Cognitive Behavioural Therapy and alternative therapies such as yoga, art therapy and meditation.

The brief interventions that take place might happen as a one-to-one or within a group context.

Brief Interventions And The Cycle Of Change

Those who enter rehab for treatment usually have severe addictions.

As such, they’ll be at the “action” point of Prochaska and DiClemente’s model of change.

The rehab staff use this information to guide how they lead residents through the brief intervention.

For instance, a person in the first stage of change – precontemplation – might be given information to be aware of risks around alcohol and drug use, whereas a person in the action stage – who you would find at a rehab clinic – would be supported to develop steps to change.

The stages of Prochaska and DiClemente’s model of change are:

• Precontemplation
• Contemplation
• Determination
• Action
• Relapse
• Maintenance

Final Thoughts

While brief interventions can be really effective for some people who come into contact with professional teams, it needs to be remembered that they are not for everyone.

This is an approach that’s especially useful for people who haven’t yet developed addictive habits, and for those who have developed an addiction, it’s an approach that is more effective for people in the “action” stage of change.

The benefits, however, are invaluable thanks to the fact that people in health care and educational settings can use brief interventions to prevent future addictions forming.

As such, they are an integral part of substance misuse treatment.

For more information about brief interventions or to begin your own recovery journey today, reach out to our team for a confidential and entirely free discussion.