Brief Intervention Brief Intervention Brief Intervention has a

Brief Intervention

Brief Intervention • Brief Intervention has a number of different definitions but usually encompasses: – assessment – provision of education, support and motivation – referral • Brief Intervention has been demonstrated to be particularly effective in the general practice setting. Brief Intervention

Did You Know? • As little as 5 minutes of advice from a GP can have a significant impact on drinking • Lengthier interventions may not increase benefits in non-dependent drinkers • 5% of smokers will quit as a result of brief intervention (vs. controls) • In the general practice context intervention is typically provided at point of detection. Brief Intervention

Brief Interventions are Ideal… For: • GPs and non-specialist workers • patients with problems of intoxication or regular use • patients with less severe dependence. When: • there isn’t a lot of time. Brief Intervention

Brief Interventions are Effective (1) • BIs are proven for alcohol and tobacco • Evidence of efficacy is mounting for illicit and licit drugs • Clinical experience shows many users are open to help • BI can increase motivation and treatment utilisation even when the patient is dependent. Brief Intervention

Brief Interventions are Effective (2) • Brief Interventions are clinically and cost effective • Brief Interventions are most effective when implemented early – e. g. , when patient is consuming at hazardous or harmful levels but not dependent • Clinical experience shows that many people respond positively to offers of assistance to reduce harmful drug use patterns. Brief Intervention

Treatment Success in Dependence O’Brien, C. & Mc. Lellan, A. (1996) Brief Intervention

Some Medical Conditions Compliance and Relapse (<12 months) O’Brien, C. & Mc. Lellan, A. (1996) Brief Intervention

Key Principles of FRAMES • Feedback • Responsibility • Advice • Menu of options • Empathy • Self-efficacy Brief Intervention

Brief Intervention Issues for GPs Include: • some ‘less positive’ results (more than just the ‘odd’ one) • the need for reinforcement of interventions • concern that more severe problems tend to require more intensive treatment • time pressures associated with large workloads • lack of financial and perceived intrinsic rewards (although this is changing). Brief Intervention

Brief Intervention Components • • Brief assessment/ screening Feedback and patient information Goal setting/ short-term objectives Self-help information Harm reduction strategies Relapse prevention Follow-up appointment or linking to an appropriate service • Positive alternatives. Brief Intervention

Brief Interventions • Brief intervention is likely to enhance skills to: – delay decision to use – distract from craving – decide whether to use at all • Review ‘pros’ and ‘cons’ of use • Reinforce reasons for wanting to cut down or stop • Encourage patient to make informed decision • Discourage long-term regular use • Supportive pharmacotherapies may assist. Brief Intervention

Taking a Drug History Taking a patient history is a brief intervention. An AOD history includes identifying: • patterns of use (quantity, frequency) • drug type, strength, route of administration • pattern of polydrug use • whether the pattern is typical • the usual social and physical environment of use • triggers for use. Brief Intervention

Brief Intervention Costs Little An evaluation of the ‘Drink-less’ Brief Intervention for Alcohol found that: • intervention cost $212–$688 per GP (incl. recruitment, training, support) • counselling patients cost approx. $20/patient • trained GPs counselled 3 times the number of patients than controls • estimated cost of each life year saved was $581–$653 • this cost ‘per life year saved’ compares favourably with other interventions (e. g. , mammography screening or smoking prevention which cost between $6, 300 and $75, 000) Note: the Drink-less intervention took approx. 5 minutes per GP per patient Wutzke et al. (2001) Brief Intervention

Brief Intervention Is Not Suitable When… • patients have additional psychological/psychiatric issues • patients are severely dependent • patients have very poor literacy skills • patients are cognitively impaired. Brief Intervention

The 5 ‘A’s of Brief Intervention • Ask all patients if they use psychoactive drugs (both licit and illicit) • Assess the patients’ willingness to alter their pattern of use (if appropriate) • Advise all patients of potential harms associated with their particular pattern of use • Assist patients in accordance with their readiness to change • Arrange for the next consultation or referral. Brief Intervention

Brief Intervention for Non-dependent Use • People who are not dependent tend to respond best to Brief Interventions (BIs) – the majority of patients are non-dependent, and they account for much of the harm relating to intoxication and regular use – BIs are well suited for ‘at risk’ and hazardous patterns of use • BIs can range from a few minutes to a few hours • BIs are ideal for primary care settings • BIs can reduce alcohol consumption by 30– 40%. Brief Intervention

Brief Intervention Components (1) • Assess current use and related problems – provide feedback • Conduct a (mini) motivational ‘type’ interview • Impart accurate information, gentle advice and encourage goal setting (with regard to harm minimisation strategies) • Discuss relapse prevention and maintenance strategies (e. g. , problem-solving techniques). Brief Intervention

Brief Intervention Components (2) • Use self-help manuals. These contain core features of brief intervention • Monitor progress Intensive treatment is recommended for those with: • severe dependence • acute physical and/or severe psychological issues • cognitive impairment/poor literacy • few social supports. Brief Intervention