Brief Intervention
Brief intervention comprises a single session, or sometimes multiple sessions, of motivational discussion focused on increasing insight and awareness regarding substance use and motivation toward behavioral change. Brief intervention can be used as a stand-alone treatment for those at-risk, as well as a vehicle for engaging those in need of more intensive specialized care.
Manuals and Training
(1) Motivational Interviewing
http://motivationalinterview.org/
(2) Alcohol Screening and Brief Intervention for Trauma Patients: COT Quick Guide
A guide to assist Level I and II trauma centers incorporate alcohol screening and brief intervention as part of routine trauma care.
(3) Alcohol Screening and Brief Intervention Curriculum
Free web-based training curriculum geared toward generalist clinicians and developed by the Boston Medical Center.
(4) Brief Counseling for Marijuana Dependence: A Manual for Treating Adults
(5) Helping Patients Who Drink Too Much: A Clinician’s Guide
(6) Ensuring Solutions to Alcohol Problems
SBI Implementation Guide for Hospitals
(8) BNI ART Institute
The 5A’s
The 5 A’s approach is a brief, goal-directed way to more effectively address tobacco use with patients with the goal of meeting tobacco users’ needs in terms of readiness to quit. Altogether, the 5 A’s may take 1 to 5 minutes, depending on a provider’s clinical setting and roles. The 5 A’s do not need to be applied in a rigid manner, and an entire office/clinical staff may be involved to support tobacco users.
1. Ask: About tobacco use every time
This is essential for identifying the patient’s tobacco use, and some settings include inquiring about tobacco use as part of vital signs like blood pressure. Ask patients about their current and past smoking patterns.
2. Advise : Urge tobacco users to quit
Advising the patient to quit should be done in a clear, strong, and personalized manner. Urge every tobacco user to quit. Expect ambivalence. Be willing to listen non-judgmentally to his/her concerns about quitting tobacco use.
3. Assess: Determine willingness to make a quit attempt
Assess how ready the patient currently is to quit tobacco use. Readiness rulers (i.e., "On a scale of 1 to 10, where 10 is very ready, how ready are you to quit smoking?”) and Stages of Change assessments are useful in addressing the extent to which a person is ready to change, which can change from visit to visit.
4. Assist: Provide help to move the individual toward a successful quit attempt
Former Tobacco Users (Action or Maintenance)
For those who have successfully quit using tobacco, you can Assist by affirming their success to support self-efficacy, and discussing any challenges to staying quit and methods to prevent relapse.
Current Tobacco Users with High Readiness to Quit (Preparation or Action)
You can Assist by helping him/her develop a personalized quit plan with a quit date and offer an array of effective treatment options:
- Medications and Nicotine Replacement Therapy (when medically advisable - consider pregnancy, other medications, allergies, etc.)
- Your local health department's cessation services programs
- Individual or group smoking cessation programs
Current Tobacco Users with Low Readiness to Quit (Precontemplation or Contemplation)
You can Assist by enhancing willingness or motivation and ability or confidence through these methods:
- Offer personalized, relevant feedback about the importance of quitting
- Explore the individuals’ perceived pros and cons of smoking and quitting
- Discuss the 5 R’s of quitting tobacco use as follows
5. Arrange: Follow-up contact
Follow-up is most helpful to do it within the first weeks of a quit date and can be either in person or via telephone. During this call encourage the individual to remain quit. Discuss any obstacles and how to overcome them. Congratulate success for those who have been able to quit. For those who continue to use tobacco, repeated use of the 5 A’s and 5 R’s is important for supporting motivational changes over time to move toward Action for quitting tobacco.
Some providers and settings prefer to use abbreviated forms of the 5 A’s model, such as Ask Advise Refer, which focuses on referring patients to national tobacco quitlines