Module 3 Brief Intervention. 3-2 Hhhh ADVISE APPROPRIATE ACTION FOLLOW UP - Supportive Care ASSESS...

Module 3

Brief Intervention

3-2

Hhhh

ADVISE APPROPRIATE ACTION

FOLLOW UP - Supportive Care

ASSESS

Academic Social Behavioral Medical

ASK

Quantity/Frequency Binge CAGE AUDIT

BriefInterventio

n

Motivational Interview

Referral

Step 1

Step 2

Step 3

Step 4

3-2

3-3

Public Health Paradigm

The primary goal of brief intervention is to: Reduce alcohol use to low-risk levels Encourage abstinence in persons who are

alcohol-dependent

3-4

Brief Intervention or Brief Talk Therapy

Commonly used by clinicians to talk to patients about health issues or medication compliance

Not unique to the alcohol field Designed for use in busy clinical settings Generally 5-10 minute duration

3-5

Brief Intervention or Brief Talk Therapy

(continued)

Includes motivational interviewing and Cognitive Behavioral Therapy (CBT) techniques

More clinician-centered than client-centered therapy

Clinician shares concerns with student and tries to convince student to decrease alcohol use

3-6

Brief Intervention or Brief Talk Therapy (continued)

Uses an empathic, non-confrontational style Offers patient choices Emphasizes patient responsibility Conveys confidence in patient's ability to

change

3-7

Conduct an assessment: “Tell me about your drinking.” “What do

you think about your drinking?” Provide direct clear feedback:

"As your doctor/therapist, I am concerned about how much you drink and how it is affecting your health."

Brief Intervention or Brief Talk Therapy (continued)

3-8

Establish a treatment contract through negotiation and goal setting:

"You need to reduce your drinking. What do you think

about cutting down to three drinks 2-3 times per week?“

Apply behavioral modification techniques:

"Here is a list of situations when students drink

and sometimes lose control of their drinking.”

Brief Intervention or Brief Talk Therapy

(continued)

3-9

Ask patients to review a self-help booklet and complete diary cards:

“I would like you to review this booklet and bring it with you at your next visit. I’d also like you to write down how much you drink on these diary cards.”

Set up a continuing care plan for nurse reinforcement phone calls and clinic visits.

Brief Intervention or Brief Talk Therapy (continued)

3-10

Brief Intervention Studies in College Students Marlatt et. al.

1998 348 heavy drinking college freshmen recruited at

the University of Washington Recruitment occurred via self-report questionnaire

completed by incoming students Intervention delivered by research staff No involvement of primary care clinicians Follow up at 6, 12 and 24 months

3-11

Brief Intervention Studies in College Students Marlatt et. al. 1998

(continued)

Intervention consisted of self-monitoring personalized feedback at year 1 mail feedback at year 2

Experimental group drank significantly less and had fewer self-reported consequences than the control group

3-12

Brief Intervention Trials Conducted in Young Adults Monte et. al. 1999

94 persons age 18 -19 recruited from hospital emergency departments based on an alcohol-related accident

Subjects randomized to brief motivational interview or standard care

Intervention consisted of a 30-60 minute motivational interviewing session with a counselor

Outcome - subjects randomized to the intervention group had fewer negative consequences, reduced drunk driving arrests, and fewer traffic violations

3-13

Project TrEAT Fleming, 2002

Trial of Early Alcohol Treatment 64 physicians, 17 sites 17,695 screened 1,705 assessed 774 enrolled (n=225 persons 18-30 years

old) 392 experimental 382 control

Follow-up: 12 months 723 (93.4%) 48 months 643 (83.1%)

Project TrEAT (continued)

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Project TrEAT (continued)

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Project TrEAT (continued)

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Project TrEAT (continued)

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48-Month TrEAT Data: Benefit-Cost Analysis

Treatment Control(n=392) (n=382)

Medical UseEmergency department visits 302 376*Days of hospitalization 420 664*

Motor Vehicle EventsCrash with fatalities 0 2Crash with non-fatal injuries 20 31Crash with property damage only 67 72Operating while intoxicated 25 25Other moving violations 169 177

*Adjusted to equate patient-years

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48-Month TrEAT Data: Benefit-Cost Analysis

Treatment Control(n=392) (n=382)

Legal EventsAssault/battery/child abuse 8 11Resist/obstruct officer/disorderly 8 6Controlled substance/liquor violation 2 11Criminal damage/property damage 2 1Theft/robbery 3 3Other arrests 5 9

48-Month TrEAT Data: Benefit-Cost Analysis Net Benefits & Benefit Cost

Ratios (1993 dollars)

Perspective Cost per Benefits per Benefit-cost Net BenefitP-value

patient patient ratio (95% CI) (95% CI)

Medical $166 $712 4.3 $546 0.08

(0.6, 8.0) ($-71, $1164)

Societal $205 $7,985 39 $7780 0.01

(excl. life yrs) (5.4, 72.5) ($894, $14,668)

Societal $205 $11,659 96 $19,439 0.17

(incl. life yrs) (-33, 225) ($-7165, $46,044)3-20

3-21

What We Know

Brief Intervention can reduce alcohol use for at least 12 months

Effect size is similar for men and women

Effects are similar for persons over age 18

3-22

What We Know (continued)

Reduction in utilization events

Cost savings

Improved health status

3-23

BI appears to reduce alcohol-related harmDecreased GGT levels (Kristenson, 1983; Wallace, 1988; Israel, 1996)

Decreased sick days (Kristenson, 1983)Decreased drinking and driving (Monti, 1999)Decreased scores on questionnaires regarding alcohol-related problems (Marlatt, 1998)

What We Know (continued)