BRIEF INTERVENTIONS
There are two stages:
STAGE ONE:
IDENTIFICATION OF A PROBLEM
Problem substance users can be identified by use of the CAGE questionnaire (Section A2). This has a high sensitivity (pick-up rate); if there are two or more positive responses to the four questions, then it is advisable to proceed to the counselling intervention.
STAGE TWO:
5-10 MINUTES DISCUSSION
using counselling skills
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- FEEDBACK
So,you say your difficulty getting to work on time may be related to alcohol. - RESPONSIBILITY
Well, only you can make the decision to stop drinking for the next two weeks. - ADVICE
Yes, I recommend you stop drinking for two weeks, to see if that makes a difference. - MENU OF OPTIONS
If this turns out to be too hard, we can consider other options such as AA or referral to the specialist team. - EMPATHY
I know this will be hard for you because you feel alcohol helps you relax, and I'm concerned about the amount of stress you have. - SELF-EFFICACY
Considering how difficult you find this, I'm impressed by your willingness to consider a change.
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The FRAMES approach utilises best practice for the delivery of substance misuse-related brief counselling interventions. Confrontational styles tend to be ineffective (Miller W et al, 1993). Rather, the themes of effective counselling are to 'Roll with Resistance', to avoid confrontation, and to lead the patient towards making their own decisions.
For drinkers, a combination of this approach with feedback on GGT levels has been shown to be effective (Nilssen O, 1991):
- Identify alcohol problem with the
CAGE questionnaire. - Use FRAMES counselling approach.
- Take blood for GGT.
- Book second appointment for one
month’s time.
- Discuss the most common reasons for an
elevated GGT, including alcohol, within
the FRAMES approach.
- Ask the patient to consider the reasons for
their raised GGT.
- Take a second GGT, and mail the result
to the patient.
- Plan to review in one year.
Further components may be built in such as making a list of drinking/drug using cues, keeping a drinking/ drug use diary, signing a drinking/drug using agreement, dispensing written self-help materials.
Next page .. DO BRIEF INTERVENTIONS WORK?
The above information is copyright of Dr Bruce Trathen MBBS MRCPsych (2006). ISBN 0-9545164-0-0. The author grants permission for these guidelines to be downloaded, copied and distributed freely, but does not grant permission for their sale.
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