4 brief intervention for medical practitioners and health care workers

STEP 1 IDENTIFY your patient's current level of alcohol consumption.
(Refer to page 11, standard drinks and the concept of listing the patient's intake as a number of drinks per day or per week.)
The NHMRC has developed the following guidelines for classifying low risk, hazardous and harmful use of alcohol (Pols and Hawks, 1992).

Standard drinks per day





    Low risk    Hazardous    Harmful


Male    <<=4 5-6>6


Female    <<=2 3-4>4

Standard drinks per week

Low risk Hazardous Harmful
Male <<=28 28-42>42
Female <<=14 14-28>28

STEP 2 HELP your patient weigh up the costs and benefits of continued drinking.

STEP 3 HELP the patient identify the benefits of their current level of drinking.

HELP identify the current risks and/or benefits.

STEP 4 STRESS the benefits of reduced alcohol intake, for example:

• save money
• be less depressed
  
• have more energy
• sleep better
  
• stay younger longer
• live longer
  
• better relationships
• improved sex life
  
• reduced weight problems
• reduced risk of heart disease, cancer and accidents
  
• reduced legal problems
• reduced employment problems.

  STEP 5 ENCOURAGE your patient to cut down his or her drinking (or stop altogether if appropriate).

  STEP 6 NEGOTIATE appropriate goals with the patient. Small achievable goals will enhance the patient's self efficacy. Try to nominate:
  

• a daily average and weekly total
• a maximum number of drinks per person
  
• a number of alcohol-free days.

  STEP 7 IDENTIFY the situations in which the patient normally drinks heavily and the factors which will make it difficult to change this pattern (eg at parties, at dinner, after work, in particular social situations, when bored, when tired and/or stressed, etc.)

  STEP 8 UTILISE ways of coping without heavy drinking. In the immediate situation:
  

• substitute low or non-alcoholic drinks
• do something physical instead
  
• go for a drive
• go to the movies or watch television
  
• visit or telephone friends
• take a long hot bath
  
• resolve conflicts.
• In the longer term:
  
• start new hobbies, crafts or sport
• become involved in community activities
  
• find new interests, eg learn a language or musical instrument
• increase involvement with family and friends and develop more social contact.

  STEP 9 GOAL SETTING and progress monitoring are important parts of your role. Provide clear and non-judgemental information about reducing alcohol consumption. After agreeing on an appropriate goal with the patient, make your expectations clear and set a follow-up appointment.

  STEP 10 HELP and encouragement are vital. Change is possible but it requires direction and support. The involvement of another significant individual may provide further positive reinforcement, and necessary social support.

  STEP 11 REFER where necessary to an appropriate self-help organisation and/or treatment agency (refer Chapter 18, Community Support Services). Provide booklets and pamphlets to reinforce the information and advice you give.

  STEP 12 EXPECT a number of your patients to resume their previous level of use. Encourage them to try again. Identify any gains they made in their previous attempt to cut down their drinking and discuss strategies to deal with cognitive, social or environmental factors which may have facilitated their relapse.