Alcohol and other drug problems have come to be seen as public health issues that should be addressed far beyond the bounds of specialist addiction treatment. Most people with substance use disorders never get to specialist treatment, but do turn up regularly in health care, social service, employee assistance, and correctional systems. Such systems are now using brief on-site interventions as an alternative or to facilitate referral to specialist addiction treatment1.
Along with such opportunistic applications, brief interventions are also being included in the continuum of addiction treatment services. One reason is that a sizable proportion of patients complete only one or a few visits in specialist treatment, so brief interventions are front-loaded to ensure that these people are given something useful even if they subsequently drop out. Happily, such upfront brief interventions also appear to improve retention. Immediate brief intervention is a preferable alternative to just placing clients on a waiting list and is more likely to activate the person’s own change resources2.
Furthermore, brief intervention can be regarded as the entry point of stepped care, whereby the person is initially given short-term treatment. Many people respond relatively quickly to addiction treatment, whether it is of shorter or extended duration3. Those who do not respond favorably to brief intervention can then be offered additional treatment4.
Brief interventions usually comprise one to four visits, which may vary in length from 10 minutes to an hour or longer. Within this span of time, many different approaches could be taken. What, then, are the components of effective brief counseling? A review of this literature5 pointed to six common elements found in effective brief interventions for alcohol problems, summarized by the mnemonic acronym FRAMES:
- F: Feedback to the client of personally relevant information about his or her drinking and its consequences.
R: An emphasis on the client’s personal responsibility for change—that it is up to the individual to decide and choose what, if anything, to change.
A: Clear advice from the provider recommending behavior change.
M: A menu of options from which to choose, if the client should decide to pursue change.
E: An empathic counseling style that is respectful and supportive, listening to the client’s own concerns and perspective.
S: Encouragement of self-efficacy, that the client could be successful in changing.
These components are not specific to alcohol, of course, but are more general elements of a brief counseling approach to facilitate change. It recognizes the client’s autonomy, honoring personal choice and options. Clear advice is given within this context, that the person is (necessarily) free to follow or not. It focuses on the client’s personal reasons for change, both through individual feedback of assessment findings and by listening to the person’s own motivations, and it offers hope and encouragement.
Excerpted with permission from Treating Addiction: A Guide for Professionals by William R. Miller, Alyssa A. Forcehimes, and Allen Zweben. Copyright 2011 © The Guilford Press. http://www.guilford.com.
- Babor & Higgins-Biddle, 2000; 148 OPTIONS FOR ADDICTION TREATMENT Institute of Medicine, 1990; National Institute on Alcohol Abuse and Alcoholism, 2005; National Institute on Drug Abuse, 2010 [↩]
- e.g, Harris & Miller, 1990; McHugh et al., 2001 [↩]
- e.g., Anton et al., 2006; Project MATCH Research Group, 1998a [↩]
- Bischof et al., 2008; Smith et al., 2001 [↩]
- Bien, Miller, & Tonigan, 1993; Miller & Sanchez, 1994 [↩]