When to Use Brief Interventions vs More Treatment

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Type of interventions should be determined once the severity of a patient's alcohol use problem has been determined.

When Brief Interventions Are Indicated

Brief intervention typically consist of a single, short session of intervention during which a health care professional encourages the patient to consider why and how to quit or reduce drinking (CASAColumbia, 2012; BASAS, 2012). They are informational and motivational in nature, and work well in the primary care setting, but could be used in any setting. They are recommended to be used with people who are at risk for or who have alcohol use disorder. For patients who are at-risk drinkers, but who do not meet the criteria for alcohol use disorder, a brief intervention is often all that is needed.

When Brief Treatment Is Indicated

Brief treatment is an additional component of the Screening, Brief Intervention, and Referral to Treatment, or SBIRT, method that is included for patients with less severe substance use disorders who need more than just brief interventions (Agerwala & McCance-Katz, 2012). It is intended to motivate patients to change immediate risky substance use behavior (Agerwala & McCance-Katz, 2012)

Brief treatment differs from brief interventions in that it typically lasts up to an hour and consists of 5-12 sessions, whereas brief interventions last five minutes to an hour and involve 1-5 sessions (SAMHSA, 2014) Patients provided brief treatment typically have greater risk factors than do those referred to a brief intervention (SAMHSA, 2014). The patient may be given brief treatment by the provider who screens and identifies their problem, or they may be referred, often to a substance use counselor.

When Referral is Indicated

For patients with alcohol use disorder, patients with significant medical or psychiatric comorbidities, and at-risk patients for whom brief interventions have proven ineffective, the best option is typically referral to a substance abuse professional or program. This will give these patients access to procedures and therapies that are not usually feasible in primary care, including medically-assisted withdrawal (detoxification), psychosocial therapy, and self-help groups.

Practice Tip

Brief interventions should be performed on all patients, even if for just a few minutes, to explain treatment options and referral, if necessary.

View ReferencesHide References
Agerwala SM, McCance-Katz EF. Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: A brief review. J Psychoactive Drugs. 2012; 44: 307-317. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801194/ Accessed on: 2015-06-10.
CASAColumbia. An SBIRT Implementation and Process Change Manual for Practitioners. The National Center on Addiction and Substance Abuse at Columbia University. 2012. Available at: http://www.casacolumbia.org/sites/default/files/files/An-SBIRT-implementation-and-process-change-manual-for-practitioners.pdf Accessed on: 2015-03-19.
CDC. Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use A Step-by-Step Guide for Primary Care Practices . National Center on Birth Defects and Developmental Disabilities . 2014. Available at: http://www.cdc.gov/ncbddd/fasd/documents/alcoholsbiimplementationguide.pdf Accessed on: 2015-03-10.
SAMHSA. Screening, Brief Intervention, and Referral to Treatment (SBIRT). SAMHSA. 2014. Available at: http://www.samhsa.gov/sbirt Accessed on: 2015-03-20.