Brief Interventions for Alcohol: Recovery Can Start in Your Doctor’s Office

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Who Answers?

You may think of an “intervention” is a gathering of concerned friends, family, and professionals. However, brief interventions for alcohol use have been used for decades to help your primary care doctor and other non-specializing medical professionals screen for alcohol addiction. ¹

Alcohol Screening

If you raise concerns or report certain symptoms, your provider may ask you to complete an alcohol use disorder screening. Alcohol use disorder is the formal way that mental health professionals classify the symptoms and behaviors associated with problematic alcohol use.

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Who Answers?

Three of the most common tools are the following.

1. CAGE Questionnaire

The CAGE Questionnaire is composed of 4 questions that form the acronym in its name:²

1. Anyone has suggested you should cut down your alcohol use?
2. You have ever been annoyed by other’s criticism of your alcohol use?
3. Ever you have felt guilty about your alcohol use?
4. Ever you needed an eye-opener (i.e., drink upon waking)?

2. Fast Alcohol Screening Test

The Fast Alcohol Screening Test (FAST) was developed as an abbreviated AUDIT tool.³ It includes questions about:³

• The number of drinks per occasion
• The inability to remember events and behavior after alcohol use
• Failed obligations due to drinking
• If anyone has encouraged you to cut down or stop alcohol use

3. Alcohol Use Disorders Identification Test

The Alcohol Use Disorders Identification Test (AUDIT) is a 10-question self-report measure that includes questions on:^1,4

• How often you drink alcohol
• How much you drink per day during the weekend
• How much you drink per day during the week
• If you or someone else has been injured by your drinking

These screenings do not diagnose alcohol use disorder, but can indicate whether help for alcohol misuse is needed, including whether a referral to a mental health professional who can diagnose alcohol use disorder is needed.

Alcohol Screening and Brief Intervention

After your provider has administered an alcohol screening tool, they use the results and determine your level of risk for an alcohol use disorder and the need for further evaluation.

Typically, alcohol screening and brief interventions are combined. The screening tool dictates which type of brief intervention is used.

Depending on the alcohol screening score, the brief intervention may have a different focus.¹ For example, for a person who scores lower on the AUDIT screening (e.g., scores between 0 and 7), the intervention includes:¹

• Education about alcohol, alcohol misuse, and alcohol use disorder
• Encouragement to keep their existing low-risk to moderate alcohol use behaviors
• Handouts and brochures about the risks of alcohol misuse

Brief Intervention

The development and research of brief interventions began approximately 60 years ago. In the 1980s, the World Health Organization (WHO), created brief interventions in response to an ongoing concern about substance misuse. The WHO encouraged primary care physicians to begin making alcohol prevention strategies part of how they care for their patients.⁵

How Are Brief Interventions Used?

Screening and brief interventions (SBI) are an important and necessary tool utilized worldwide.⁵

Brief interventions are designed to make advice and counseling widely available to:⁵

• Minimize risk
• Avoid problems related to uncontrolled alcohol and drug use
• Manage problems related to uncontrolled alcohol and drug use
• Refer individuals to other specialized providers as needed

Brief interventions can be a scripted discussion based on either individualized or universal preventions.¹ Brief interventions are a way to seize an opportunity to improve public health.⁵

The key focus of a screening and brief intervention is to:^{1, 6}

• Identify a potential problem
• Assist in motivation for behavioral change
• Suggest or recommend a course of action that can support behavioral change

These brief interventions were originally developed to be and/or include a:⁵

• Screening tool
• Basic or advanced model for advice
• Non-specific counseling experience

What Happens in a Brief Intervention?

Brief interventions are delivered in a shortened timeframe designed to promote behavioral change.⁶

Typically, brief interventions last 15-45 minutes and can be implemented by a number of providers.¹ Ideally, the provider will spend approximately 5 minutes conducting a screening tool and about 20 minutes providing counseling and advice.⁵ Brief interventions should last no more than an hour.⁶

The technique of motivational interviewing has quickly dominated the brief intervention and alcohol counseling movement. It is used to help you think about alcohol counseling.⁵

Providers implementing brief interventions talk about your concerns as well as your options and inviting you to discuss it further. Your provider will not restrict their support to simply supporting your self-regulation (e.g., reducing or quitting alcohol use) but will provide material that can help you change how you think about your alcohol.⁵

Many brief interventions use the acronym “FRAMES” to develop and conduct their interventions. FRAMES stands for:^{1, 7}

• Feedback—Feedback refers to the provider explaining the results of the screening tool(s) to you.
• Responsibility—Your provider keeps in mind and reminds you that you have the choice and responsibility for changing your behavior.
• Advice—Your provider offers exposure to information about the potential consequences of your alcohol use, as well as education and advice on reducing and stopping alcohol use.
• Menu of options—Your provider gives you a set of strategies to empower you to modify your behavior, if you choose to and when you are ready to.
• Empathy—Empathy is an instruction to your provider to ensure that the provider presents you with an understanding of the difficulties you are facing without confrontation or moral judgement.
• Self-efficacy—Your provider helps you recognize and trust your own internal resources, your own self-efficacy.

Who Implements a Brief Intervention?

Brief interventions can be implemented in various settings, such as an emergency room or primary care office.⁶

Brief interventions can vary in:⁶

• Structure
• Target population
• Providers
• Intervention philosophy

For example, the screening tools used for adolescents and adults are different. Specific research has been conducted on which tools should be used in a brief intervention screening and intervention for college students since this is a unique population. Studies show that, like the general adult population, college students respond best to the AUDIT screening tool.⁸

Providers who implement brief interventions include:⁶

• Physician or general practitioner
• Primary care clinician
• Behavioral health specialist
• Other clinician/interventionist

How Effective Are Alcohol Screening and Brief Intervention?

Research has found that brief interventions are effective in the reduction of alcohol consumption. Brief interventions in primary care settings are moderately effective in reducing alcohol usage compared to individual who receive no intervention. Furthermore, brief interventions can help reduce the harmful and dangerous use of alcohol.¹

Setting

Brief interventions appear to be well-suited and cost-efficient in several general medical settings to address unhealthy substance use, especially for individuals who were not directly seeking alcohol addiction treatment.⁶

Brief interventions do appear to be more effective in primary care offices than in a hospital or emergency department. This difference is likely due to various expectations of relationship in these locations. You have a longer and more trusting relationship with your primary care physician than with an emergency room provider.⁶

Demographics

Brief interventions and short-term counseling-based interventions can be as effective as extensive-counseling intervention.¹ Importantly, demographic characteristics did not appear to successfully predict who may or may not benefit from interventions in one study.¹

Some researchers argue brief interventions may be best developed and utilized for individuals at high risk for alcohol misuse (e.g., those who score high on the AUDIT).¹

Brief interventions that provide advice and incorporate decisional balance with goal setting exercises have shown to be helpful with adolescents, but may not have the same positive effect among young adults.⁶

Type

Research suggests that the effectiveness of brief interventions can depend on the:⁶

• Specific intervention (e.g., brochures vs open dialogue)
• Clinician
• Method of delivery

The average amount of time providers spend in a brief intervention during patient interactions is approximately 26 minutes.⁶

In-person interventions appear to be more effective than remote or virtual interventions.⁶ The most common provider is a behavioral specialist, and the most common types of brief interventions are:⁶

• Providing personalized feedback
• Prescribing specific advice and suggestions
• Providing information booklets
• Collaborating in goal setting exercises

Importantly, booster sessions incorporating brief interventions were also associated with a reduction of alcohol usage.⁶

A number of studies have also shown the use of personalized feedback interventions and computer-delivered interventions can positively influence the decrease of alcohol consumption as well.⁹

How Will Brief Interventions Change in the Future?

Current research suggests there is no longer support that brief interventions alone can significantly and meaningfully contribute to the promotion of public health.⁵

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Who Answers?

Brief interventions are focused on individuals rather than societal influences. Researchers believe there need to be population-level interventions as well.⁵

Future interventions may begin to account for how societal influences change alcohol use, for example:⁵

• Stereotypes about alcohol and people who drink alcohol
• Expectations regarding recreational and social alcohol use
• Alcohol use policies and inebriation laws
• Ideas about how big a problem has to be in order to constitute an “issue with alcohol”
• Targeted alcohol advertising in certain demographics

Evidence indicates that individuals are more concerned about current problems related to alcohol rather than the long-term risks. Therefore, clinicians need a wide repertoire of brief interventions that they can utilize with patients.⁵

If you are interested in learning about alcohol addiction treatment options, please call 800-948-8417 Who Answers? to speak with a treatment specialist.

Resources

1. Ferreira, M., & Sartes, L. (2021, November 30). Effectiveness of brief intervention for alcohol use: A randomized trial. International Journal of Mental Health and Addiction.
2. Ewing, J. (1984, October 12). Detecting alcoholism. JAMA, 252(14), 1905-1907.
3. Hodgson, R., Alwyn, T., John, B., Thom, B., & Smith, A. (2002). The fast alcohol screening test. Alcohol and Alcoholism, 37(1), 61-66.
4. Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction, 88, 791-804.
5. McCambridge, J. (2021). Reimagining brief interventions for alcohol: Towards a paradigm fit for the twenty first century? Addiction Science & Clinical Practice, 16(41).
6. Tanner-Smith E. E., Parr N. J., Schweer-Collins M., & Saitz R. (2021, October 14) Effects of brief substance use interventions delivered in general medical settings: a systematic review and meta-analysis. Addiction, 2021(1), 1-13.
7. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to change (2nd ed.). New York: Guilford Press.
8. DeMartini, K., & Carey, K. (2012). Optimizing the use of the AUDIT for alcohol screening in college students. Psychological Assessment, 24(4), 954-963.
9. Steinka-Fry, K., Tanner-Smith, E., & Grant, S. (2015). Effects of 21st birthday brief interventions on college student celebratory drinking: a systematic review and meta-analysis. Addictive Behaviors, 50, 13-21.