The brief intervention is an opportunity for the provider to initiate a short conversation with an adolescent that encourages healthy choices and the reduction of risks from substance use. Brief interventions can help establish positive rapport between provider and patient, building a trusting relationship. ALL students screened should receive some sort of brief response or intervention. Based on the results of the screening tool, the provider can respond in a number of ways, including anticipatory guidance, brief advice, and brief intervention.
- Anticipatory guidance. Adolescents reporting no substance use should receive anticipatory guidance, a form of positive reinforcement acknowledging their healthy choices and offering brief education around why those choices matter. Evidence supports that a few positive words from a provider reinforcing an adolescent’s decision to abstain from substance use can delay the onset of use. Further delaying the initiation of substance use reduces the risks of short-term harm to the adolescent, as well as the likelihood of experiencing a substance use disorder later in life. SBHCs are uniquely situated to offer this type of guidance, given that many of the adolescents they see will not yet have initiated substance use.
- Brief advice. Adolescents reporting occasional use of substances without associated consequences should receive brief advice. Giving clear, non-judgmental medical advice to abstain, paired with summarizing the negative health effects of use, has been shown to help adolescents decrease their use or abstain from use. Brief advice should be delivered using principles of motivational interviewing, recognizing personal strengths and positive attributes of the adolescent.
- Brief intervention. Adolescents who experience a consequence related to substance use, but are not likely experiencing a moderate or severe substance use disorder, can benefit from a brief intervention. During a brief intervention, providers should employ patient-centered change talk as opposed to directive, prescriptive talk, and should also use principles of motivational interviewing. Brief interventions explore adolescents’ motivations to change their behavior related to substance use, whether that is to decrease use, abstain, or reduce their harm from use.
A number of brief intervention models have demonstrated efficacy towards decreasing adolescent substance use. All of them employ principles of motivational interviewing, and are designed to help the professional guide a conversation with the adolescent. The four-step model below is derived from the Brief Negotiated Interview, originally developed by Gail D’Onofrio, M.D., Ed Bernstein, M.D., Judith Bernstein, M.S.N., Ph.D., and Steven Rollnick, Ph.D.
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 with patient, 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 him or her to describe the substance use. This will provide information that may not have been disclosed on the screening tool.
Share information: Patients deserve 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 he or she picked a low number. Verbalizing motivation to change has been shown to increase motivation.
Identify plan: If the patient seems ready enough to make a positive change with drinking or drug use, the next step is to ask, “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.
- Christina’s brief intervention video
- BI videos
- BNI-ART Institute
- School-Based Health SBIRT Quick Guide Brief Intervention from the California Alliance
- Jim’s one-page reference sheets (modeled after these: https://www.sbirtoregon.org/clinic-tools/)
- Research on Brief Intervention
- Motivational Interviewing for Adolescent Substance Use: A Review of the Literature https://pubmed.ncbi.nlm.nih.gov/22958865/
- Boosting a Teen Substance Use Prevention Program with Motivational Interviewing https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496395/