Brief interventions and the million-dollar question

CrossCurrents

“When was the last time you had more than five drinks (if male, four if female) in one day?” That’s the single question that studies have found to be an effective screening tool that opens the door for clinicians to discuss a client’s problematic drinking.

Brief interventions

Brief but effective screening tools are crucial to detecting and treating alcohol problems, given that only one in three people with alcohol problems seek treatment, according to a 2003 study by the Centre for Addiction and Mental Health (CAMH) in Toronto. More than 34 randomized controlled trials in the United States have found that alcohol screening and brief interventions are effective in decreasing consumption in people with problematic drinking. These brief interventions usually involve counselling in five or fewer standard office visits. The meetings involve providing straightforward information about the negative costs of alcohol use and practical advice on how to reduce or stop drinking.

Front-line professionals, particularly those working in primary care, such as a family doctor or nurse, are well-positioned to detect problems because they are often the first point of contact and may have an established relationship with patients. Primary care providers are also important on the continuum of care because once treatment is finished with another provider, they play a key role in recovery and relapse prevention.

It may not be realistic to expect a busy physician to take more than 10 minutes with a patient, but even acknowledging the problem with the patient is beneficial, and nursing staff can follow up, notes Montreal addiction psychiatrist Dr. Juan Negrete. “What happens with many alcoholics is that the first professional contact they have is with a general physician,” says Negrete. “The short intervention could be for that doctor to notice the problem, to identify it and to simply tell the patient, ‘You cannot carry on. You must do something about this.’ Even if the doctor doesn’t do anything else, in many cases, that itself has a positive effect.”

Family health teams have a promising role to play in screening, treatment and referral, but so far, most have difficulty providing this sort of service, according to Dr. Peter Selby, clinical director of Addiction Programs at CAMH. He says that inadequate training and the lack of appropriate remuneration and practice standards within these emerging models of care must be addressed: “We have to educate teams about how effective they can be using brief interventions and medications to treat alcohol dependence,” he says. He adds that we need to leverage the skills of all members of the interprofessional team and apply incentive models to facilitate these changes, much like has been done to promote the management of diseases like diabetes.

 

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