1. Brief Intervention

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

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

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

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

10. 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).

11. 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.

12. 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.

13. 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.

14. 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.

15. 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)

16. 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.

17. 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.

18. 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%.

19. 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).

20. 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.