Brief Interventions

Steps in Brief Interventions

Although the specific practices of brief interventions vary with the presenting issues and the setting, the Center for Substance Abuse Treatment and most professionals agree that any brief intervention consists of five basic steps: introducing the issue; screening, evaluating, and assessing; providing feedback; talking about change and setting goals; and summarizing and reaching closure. In initiating the brief intervention, the clinician introduces the substance use issue in the context of the individual's health. The aim is to raise concern about substance use in a nonthreatening manner while acquainting the individual with the focus [Page 140]and intent of the session. This step also gives the clinician the opportunity to begin establishing rapport with the individual and to gain the individual's permission to proceed. Introducing the issue is followed by screening, evaluation, and assessment of the substance use and substance-related consequences experienced by the individual. A wide variety of well-validated screening and assessment tools are available to clinicians, some of which are designed to give a reasonably accurate picture of the severity and sequelae of use without requiring a lengthy history.

Once the clinician has this information, he or she is in a position to provide feedback to the individual. Feedback is neither diagnosis nor confrontation, neither of which is likely to be productive in the brief intervention setting. Feedback consists of a dialogue in which the clinician offers specific information and engages the individual in reflection on and response to the information. The intent of the session is best served if the clinician offers one concrete statement of feedback at a time, each time eliciting the individual's response. The clinician may also ask open-ended questions that allow the individual to broaden his or her understanding of the feedback.

Essential to the step of providing feedback is an assessment of the individual's stage of change with regard to his or her substance use. When an individual is seen in a brief intervention setting, he or she is most typically found to be in the precontemplation, contemplation, or action stage. By utilizing an understanding of the stages of change, the clinician can determine the individual's readiness to act on specific feedback, thus effectively preparing for the next step: talking about change and setting goals. The clinician's feedback and the individual's self-reflection and comments have set the stage to consider possible behavior changes with regard to substance use. If the individual is in precontemplation, the clinician might guide the discussion to helping the individual accept the connection between substance use and unwanted consequences. An individual in contemplation has likely made this connection and may see some benefit in change, but is ambivalent about moving forward into action; in this case, a desirable outcome is resolution of the ambivalence. If the individual is in action, the clinician might assist the individual in identifying and removing obstacles to success. Regardless of the stage of change, this discussion is meant to generate one or more goals that the individual is willing to implement.

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