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Brief Intervention

Brief interventions are patient-centered discussions that explore an individual’s motivation to change behavior. They are appropriate to perform when adolescents are experiencing mild to moderate problems associated with their substance use. In medical settings, brief interventions are typically delivered by clinicians or behavioral health professionals during the same visit in which the patient completed a screening tool. School-based interventions are sometimes delivered by school counselors or peers.

Brief interventions have been endorsed by the American Academy of Pediatrics (AAP) and the U.S. Surgeon General as a method for reducing adolescent substance use.

Below is a video that gives an example of how a brief intervention can be performed with an adolescent patient:

Health professionals often have limited time to perform a brief intervention during a patient visit. The video above illustrates a four-step model can guide the conversation:

 

 

Raise the subject

Asking permission to discuss a patient’s substance use conveys a message that the health professional would like to have a conversation together, rather than embarking on a one-sided lecture. Raising the subject in this way also helps establish a sense that the patient’s concerns and wishes are central to the conversation. If the patient gives permission, it’s good to start with asking them, in their own words, to describe their substance use. This will provide information that may not have been disclosed on the screening tool.

Provide feedback

The patient deserves to know the facts concerning their substance use, regardless if they want to change their behavior. Facts such as: the risks posed by their use, any connections between their use and current health problems or consequences, and the reasons why it’s best for adolescents to abstain from using drugs and alcohol. How feedback is delivered can dramatically affect how an adolescent receives the feedback, so it’s important to demonstrate empathy during this step. This step is particularly important for adolescents who are not currently motivated to change their behavior at all, as it provides them with information that might create some discrepancy in how they view their use and how it is viewed from a health perspective.

Enhance motivation

Like adults, adolescents use alcohol and drugs for positive reasons, so it’s important to ask (and reflect back) what they perceive as the pros and cons of their use. Recognizing when the cons of a behavior begin to outweigh the pros is what can lead to behavior change. Readiness to change can be quickly assessed by using the readiness ruler: “On a scale from 1-10, with 1 being not at all ready and 10 being very ready, how ready are you to change any aspect of your drinking?” Asking why they chose that number rather than something lower encourages the patient to verbalize what motivation does exist to change, even if they picked a low number. Verbalizing motivation to change has been shown to increase motivation. 

Negotiate plan

If the patient seems ready enough to make a positive change with their drinking or drug use, the next step is to ask, “so what would that look like for you?” Patients may come up with a variety of plans to change their behavior, which may or may not achieve your recommendation, such as: cut back on how often I drink: cut back on how much I drink on days when I do drink; never drink and drive; a trial period of not drinking; stop drinking entirely; or get help from someone with my drinking. Discussing a plan can build self-efficacy by avoiding being argumentative. It can also help clarify the patient’s goals. Giving advice with the patient’s permission, and expressing optimism in his or her intent to change is also helpful. Remember to re-state your recommendation at the end and suggest follow-up if the patient is willing to come back.

Stage of Change

 

 

 

The goal of the brief intervention is to help patients move to the next stage of change. When we describe the spectrum of patient responses to hearing a recommendation of changing their substance use, the Stage of Change model is frequently cited. People typically move through these stages in order before they reach Action. Behavior change is a rarely a discrete single event. Behavior change has come to be understood as a process of identifiable stages through which patients pass. Health professionals can enhance the progression through these stages by employing brief interventions.

References:

  1. The Yale Brief Negotiated Interview Manual (2005) Gail D`Onofrio, Michael V. Pantalon, Linda C. Degutis, David Fiellin, Patrick G. O’Connor, Yale University School of Medicine