How to make brief interventions a natural part of consultations
Brief interventions take a supportive, non-confrontational approach, which empowers the patient to recognise the risks associated with their drinking patterns, the benefits of reducing intake, and motivates them to adjust their lifestyle. By including alcohol consumption in routine assessment and management in a range of consultations, including chronic disease management, it can become a natural part of the consultation. When time is an issue, it is worth reinforcing your message by handing the patient written advice to take-away and read before returning for their next appointment.
Opening questions you could use
You might find it helpful to have an armoury of opening questions and comments to help you to raise the subject with your patients. Motivational interviewing principles have been shown to be effective, but they are counterintuitive to much traditional medical training.
Some of the principles include:
- Respect the patient’s ability & responsibility for determining what’s best for themselves,
- Don’t try to persuade, cajole, scare - that is likely to have negative impact
- Ambivalence is to be expected, and is at the core of patient resistance to change
- It’s THEIR job to articulate their ambivalence
- It’s yours to elicit, clarify, and resolve that ambivalence.
Here are some ideas for questions to include3:
“Do you mind if we spend a few minutes talking about…?”
“A lot of people are concerned about changing their drinking patterns…”
Identifying patient’s level of motivation:
“Are you interested in learning more about…?” “What do you know about the benefits of sticking to moderate levels of drinking?”
Exploring patient health beliefs:
“What do you know about the (CMO guidelines/impact of alcohol on your health etc)?” or “What do you know about how your alcohol intake affects your health (or a specific health concern the patient has)?”
Follow up with advice on health risks, if possible tailored to patient’s responses.
Once the patient has identified a health impact, gauge the patient’s priorities:
“On a scale of 1 – 10, with 10 being the most important, how important is it for you to reduce your alcohol levels?” “How do you feel your life or health would improve if you moderated your drinking?”
“What barriers do you think there might be to you achieving this?”
“What practical ways can you think of to overcome any barriers?” (you might prompt the patient here if, for instance, they have identified social events or their social life as a barrier by asking whether enlisting help of friends or family, or adjusting their social schedule to remove the habit of drinking every night, might help).
Open ended questions:
“What do you feel would happen if you do not change your drinking patterns?”
With practice, delivering interventions will become easier for you and your colleagues
Some practitioners may feel that it is futile to discuss alcohol with their patients, believing that many people don’t want to change their drinking patterns. It is important to remember that people’s motivation to change is not fixed – the techniques employed in brief interventions are designed to increase a person’s willingness to change.
As you and your colleagues become more comfortable and confident, broaching the subject and having structured conversations about alcohol harm becomes easier.