COLLEGE OF NURSING

ALL INDIA INSTITUTE OF MEDICAL SCIENCE,

RISHIKESH

TOPIC : BRIEF INTERVENTION

SUBMITTED TO SUBMITTED BY
Dr Rajesh Kumar Mrs Sheetal Rohila
Associate Professor MSc Nursing Ist Year
AIIMS Rishikesh AIIMS Rishikesh
Subject Psychiatric Nursing
Topic Brief Intervention
Supervisor Dr. Rajesh Kumar
Student teacher Sheetal Rohila
Date 2-05-2025
Duration 1 hr
No. Of students 90
Method of teaching Lecture cum Discussion
Target Audience BSc Nursing 3rd year Students
Venue BSc Nursing 3rd year Classroom
Previous knowledge Students have general knowledge regarding brief intervention.
General Objectives
At the end of seminar, students will be able to do brief intervention.
Specific objectives
At the end of seminar, students will be able to;
• define brief intervention
• describe elements of motivation interviewing
• explain stages of change model
• enumerate indications of brief interventions
• describe format of brief interventions
• discuss elements of brief interventions
• demonstrate with the help of case vignette
• discuss strategy to deal with resistant client
• enlist advantages of brief intervention
• enumerate limitations of brief interventions
• enlist contraindications of brief interventions
• discuss efficacy of brief interventions in various substance use disorder.
• discuss barriers and facilitators to implementation
• discuss considerations for brief interventions in indian clinical setting
• describe application and utility of brief interventions in india
[Link] Time Specific Content Teaching AV Evaluation
objective learning Aids
process
1. 2 To introduce INTRODUCTION Lecture PPT
min the topic Brief intervention is a brief, structured conversation aimed at helping cum
individuals reduce risky behavior or improve health outcomes. discussion.
It is typically used for substance misuse, smoking cessation, or encouraging
healthier lifestyle choices. It include evidence-based and cost-effective
psychosocial practices that aim to address harms related to substance use,
leading to reduction in harmful use of substances. The key word here is
“brief”. Brief intervention generally takes as little as 5 to 15 minutes (in
addition to the time needed to establish rapport and engage with the person).

2. 1 To define DEFINITION Lecture PPT Define Brief

min brief • Brief interventions aimed at identifying current or potential problems cum intervention
intervention associated with substance use and motivate those at risk to change discussion
their substance use behavior. WHO

• Brief intervention (BI) is a structured, client-centred, non-

judgemental therapy by a trained interventionist using 1-4 counselling
sessions of shorter duration (typically 5-30 minutes)
Principle: Brief interventions are based on the harm-reduction principle,
which ultimately is aimed at making the person understand
• the problems associated with his/her pattern of substance abuse
• start modifying his/her behavior so as to reduce the harms occurring
due to substance use.
Approach: This intervention follows a patient-oriented approach. It is
usually applicable to patients who have inadequate insight into their
substance use and who consult with other medical specialties due to
complications from substance use.
 This intervention is not meant to systematically treat patients with severe
dependence, but to handle those who have been identified to have risky or
problematic substance abuse.
Given by: They can be delivered by a variety of appropriately trained
professionals, such as psychiatrists, physicians, and nurses.
They can target diverse populations who are considered at-risk (e.g.,
adolescents) and where opportunity is provided for promoting healthy
behaviors (e.g., patients admitted to medical wards).
3. 2 To explain MOTIVATION INTERVIEWING Lecture PPT Explain
min elements of Motivation interviewing is considered as a patient-centered counseling aimed cum elements of
motivation at enhancing the motivation of substance users to progress in their stage of discussion motivation
interviewing change. The elements used in motivational interviewing are best remembered interviewing
with the acronym DARES, as follows.

D: Developing discrepancy
It means to help the person see the discrepancy between where they are now
and where they want to be with their lives.
Strategies for menu of options
• Learn to identify high-risk situations for relapse/lapse and develop
coping skills to handle them
• Develop other productive social activities such as - hobbies, sports,
gymming, music
• Strengthen social support - associate with people who will help in
making a change in undesired behavior
• Read through self-help resources and gather information
• Maintaining a diary for substance use behavior
• Using money for other purpose rather than substance use
• Information regarding other counseling services related to substance
use
The discrepancy is about making the person consciously aware about
substance use being associated with consequences (and not only pleasure).
A: Augment ambivalence
 Substance users often have both types of thoughts – to continue the substance
taking behavior and to stop it for various reasons. However, such thoughts are
not in conscious awareness. Augmenting ambivalence aims to increase the
cognitive dissonance from the patient’s point of view, about the benefits and
harms of substance taking behavior using decisional balancing as an example
R: Roll with resistance
Patients are likely to show resistance, particularly when the therapist or
health-care provider preaches about substance cessation. They would have
encountered many situations when their friends and family would have
implored them to stop, and yet they continue. Hence, direct confrontation is
likely to lead to a patient becoming defensive or uncooperative. Thus, when
resistance is encountered from the patient, then it would be better to take a
non-confrontational approach and move the conversation to a different
direction.
E: Express empathy
It is important to acknowledge the patient’s current condition and empathize
with the fact that quitting substance use is not easy. The patient may not have
adequate reasons to quit or be able to engage adequate resources to quit.
Empathy with his/her condition might help to provide pragmatic suggestions
to help patients quit and abstain.
S: Support self-efficacy
Supporting self-efficacy of the patients has the advantage of strengthening
their self-confidence. This enables them to take measures themselves to bring
about change in the substance use behavior.
The processes involve reflective listening, shifting focus, using praise
statements to strengthen self-efficacy, and using open-ended questions,
especially when resistance is encountered.
4. 5 To explain STAGES OF CHANGE MODEL Lecture PPT Explain
min stages of Prochaska and Diclemente proposed the model of stages of behavior change. cum stages of
change It provides a framework to understand and assess “the readiness to change discussion changes
model substance use or other lifestyle behaviours”. Clients go through the discrete model
stages of change as proposed by the model described below.
Pre-contemplation (not ready for change)
In this stage, the individuals are unaware that their behaviour is problematic.
They neither have any worry about their substance use nor want to change it.
However, they are “receptive to information about the risks associated with
their level and pattern of substance use”. Providing information can
encourage them to recognize the risks of substance use and think about
reducing or stopping their use of substances.
Contemplation (getting ready for change)
People at this stage are beginning to recognize that their behavior is
problematic and are in an ambiguous situation regarding their substances use.
They may be willing to make a change but may not be sure of doing that or
may not know how to make a change. The intervention aims to inspire them
to discuss, explore, and resolve their ambivalence for change. A useful
approach to deal with the ambivalence is to think it in terms of ‘balance’. On
one side of the scale are the benefits to the patient of their current substance
use behavior and the costs associated with their change (reasons to stay the
same), while on the other side are the costs of current substance use and
benefits of change (reasons for change).
Change is not likely to happen until the reasons for change override the
reasons for no-change. The intervention aims to encourage them to have a
discussion and find their individual reasons for dropping or stopping their
substance use. A useful approach at this phase is to see the ambivalence about
substance use as a balance.
Preparation (ready for change)
In this stage, the individual intends to take action in the immediate future, and
may begin by taking small steps toward behaviour change.
Action (taking steps for change)
Individuals in this stage have made the choice that their substance intake
needs to be changed by refraining or reducing substance use. They need
encouragement and support to implement their decision. Interventions for this
stage include a series of strategies to identify situations in which they may be
 at risk for substance use and discuss solutions to handle such situations and
reduce or stop their substance use.
Maintenance (sustain their planned action)
In this stage, people make changes in their behaviour to sustain their planned
action and work to prevent a relapse. They need the confirmation that they
are doing a god job and strengthening of resolve to persist with the desired
behaviour. They can be assisted to avoid circumstances where they are at
possibility of relapse or to help them progress forward after a lapse of
substance use.
Relapse
It is the return from action or maintenance to an earlier stage. Most people
who try to make changes in their substance use behaviours will use the
substance again, at least for a while. These lapses may act as teaching
moments for maintaining abstinence from substances in future.

In the model of stages of behavior change, brief intervention is likely to be

useful for the precontemplation and contemplation stages.

5. 2 To INDICATIONS Lecture PPT Enumerate

min enumerate • The brief intervention aims to cater to a wide variety of persons with cum indications
indications of high-risk of problematic use of substances. discussion of brief
brief • It can even cater to those who are otherwise unsuitable for other types interventions
interventions of psychotherapy, for example, those with low motivation.
6. 2 To describe FORMATS OF BRIEF INTERVENTIONS Lecture PPT Describe
min format of Although there can be a wide heterogeneity in the formats or manner of cum format of
brief conduct of brief interventions, generally, such an intervention is described as discussion brief
interventions time-limited and has a specific goal. interventions
Goal: The goal is either to make the patient reflect on the substance use or to
agree for a referral to a specific treatment setting or helping the person to quit
or reduce substance.
 The goal would be tailored to the individual and the stage of change he/she is
in.
Time: The typical duration of a brief intervention session would be <15 min
in a single session, but alterations can be made in the form of longer duration
of sessions or splitting the agenda into two or more sessions.
In general, for the approach to be considered brief interventions, the
maximum would be 4 sessions of up to 30 min.
Setting: The setting can be diverse, either in a hospital, at the bedside, in an
office setting, or a community screening program. Thus, there can be a
considerable degree of variability in the way brief interventions are
conducted.
Not typically considered as Brief Interventions: These include brief
cognitive behavior therapies, brief humanistic and existential therapies, brief
psychodynamic therapy, brief family therapy, and time-limited group
therapy. These approaches have been developed as briefer versions of their
original psychotherapeutic interventions, but typically involve conduct over
several sessions by trained psychotherapists
7. 5 To discuss ELEMENTS OF BRIEF INTERVENTIONS Lecture PPT Discuss
min elements of The overarching goal of brief intervention is to make changes to substance cum elements of
brief taking behavior (either cutting it down or complete cessation). Certain discussion brief
interventions. elements of brief interventions are known by the acronyms FRAMES. interventions
These are not sequential, and elements often flow into one another.
• Feedback

The provision of personally relevant feedback (as opposed to general

feedback) is an important constituent of BI, and usually follows a
comprehensive evaluation of substance use and its associated complications.
It includes knowledge concerning the personal risks or harm and the
associated consequences with it. Feedback may also include a comparison
between the person's substance use patterns and its problems with the
standard pattern of use.
Many people are unaware that they are using substance at hazardous or
harmful levels. Hence, highlighting the risks associated with this pattern of
substance use can be a powerful motivator for change.

Example: “You’ve scored 16 on the AUDIT which indicates that you are at
high risk of harm from your current pattern of drinking…”

For instance, ‘feedback’ highlights that the person's substance use may be
placing their health at risk, and is above recommended consumption
guidelines.

• Responsibility
An important principle of intervention with substance users is to acknowledge
that they are responsible for their own behaviour and that they can make
choices about their substance use. Communicating with client in terms such
as, “Are you interested in seeing how you scored on this questionnaire?”,
“What you do with this information I’m giving you is up to you” and “How
concerned are you about your score?”, enables him to retain personal control
and also facilitate a direction for the intervention.
➢ Assessing their importance and confidence of taking steps
towards changes
The clients who actually want to change their substance use pattern need to
be ready, have will power and confidence to change. The willingness to
reduce or stop substance use is related to how important they believe this
change is and at the same time how confident they are to be able to do so.
Thus, “importance and confidence” need to be addressed as a part of the
intervention to encourage the change in behaviour.

➢ Importance Ruler
The importance ruler can be used at the commencement of BI to assist direct
intervention at the suitable phase of change or can be used during the
‘intervention’ as a means to encourage the patient to speak regarding
reasons for change. This ruler is comprised of gradations from zero to ten,
where zero is not at all significant and ten denotes extremely significant.
Substance users can be asked to rate the importance of changing their
substance use. Example: “On a scale of one to ten how important is it to
make a change in your behaviour (smoking)?” Query: “What makes it an 8
and not a 2?”

➢ Confidence Ruler
This ruler can be used with people who have agreed that it is important for
them to make a change or it can be used as an imaginary question to
promote them to talk about how they would make a change.

Example: “On a scale of one to ten how confident do you feel that you can
make a change in your behaviour?”

Query: “What would it take to move it up to an 8?”

• Advice

The important element of effective BI is to provide clear advice on how to

reduce the harm associated with continued use of the substance. Providing
insight into the benefits of reducing or stopping substance use not only
increases awareness of their substance use problems but also provides
reasons for changing their unwanted behaviour.

The advice can be summarized by providing a simple statement like, “The

best way you can reduce your risk is to cut down or stop completely”.

Examples: ‘The risky or hazardous drinking is associated more likely with a

fatal motor vehicle crash’. ‘Injection overdose of opioid leads to
unresponsiveness, progressive decrease in blood pressure and the heart rate,
ultimately leading to cardiac arrest’. ‘Researchers are now able to described
that cannabis may affect the typical brain development, earlier the age of
initiation of cannabis more adversely it alter brain structures that underlie
higher order thinking’.

• Menu of options

BI provides choices to reinforce the sense of personal control and

responsibility for making change, and may help to strengthen the attitude for
change. The various options for the persons include:

Keeping a diary for substance use (mentioning details such as where, when,
why, how much, with whom…).

➢ Identifying high risk situations and strategies to avoid them”.

➢ Identifying substitute activities instead of substance use such as
hobbies, exercises, sports, spending time with family”.
➢ Encourage the client to identify people who could provide support
and help for the changes they want to make”.
➢ Set aside the money they would normally spend on substances for a
specific purpose”.

• Empathy

A reliable part of efficient BI is compassionate and understanding approach

by the therapist delivering the intervention. It includes an accepting, non-
judgmental approach and tries to understand the client's point of view. The
use of labels such as ‘alcoholic’ or ‘drug addict’ is avoided. As opposed to
the confrontational approach, the approach here is of reflective listening and
empathetic understanding.
 Example: “I know this process can be confusing.” “I’m sorry to see that
you’re in this situation.” “I’d like to help you if I can.” “Let's see if we can
solve this together.”

• Self-efficacy
The final element of BI is to foster the persons' confidence to make changes
in their use of substances. It is particularly useful for obtaining self-efficacy
statements from clients, as they are likely to create what they are heard to
say. It is an important way to gather what has already been said and prepare
the client to move forward. Summarizing is an effective way of
communicating interest with the prospect of the client, recalling the
highlights of the discussion and preparing for further elaboration.
8. 3 To A case vignette describing the components of FRAMES PPT Give
min demonstrate example of a
with the help Mr JS was a 45 year old 12th pass married business man from a middle case vignette
of case socio-economic status living with his wife and two children. He was
vignette. referred from the department of Medicine for his chronic use of smoking
tobacco and alcohol. His liver function tests were deranged and chest X-ray
showed features suggestive of chronic obstructive pulmonary disease. He
visited de-addiction out-patient reluctantly after the third referral, as he
denied any problem related to substance use. However, for his tobacco and
alcohol use, he scored 16 and 25 respectively on ASSIST questionnaire,
reflecting use in the moderate and high-risk categories respectively.

The application of FRAMES techniques and Motivational strategies in his

case was as follow:

Therapist: Thank you very much Mr. JS that you have come to the de-
addiction centre and have completed the questionnaire with me. I appreciate
your willingness to discuss about your tobacco and alcohol use
(affirmation).
Mr. JS: Well, thank you! So, do you think, I need to be treated for my
condition? Frankly, I don't see any problem.

Therapist: Taking treatment is entirely your choice and I respect whatever

decision you deem suitable for you (Responsibility; also showing empathy
and respect for autonomy). You had already undergone some tests and
questionnaire based assessment. Would you mind me discussing the
implications of the results for your health? (once again putting the
responsibility on the client)

Mr. JS: No, I wouldn't.

Therapist: Thank you.

I have your liver function test and Chest X ray results. Your liver enzymes
are elevated by 3 times than normal and bilirubin level is high as well.
[Showing the client, the results with normal values] But the good thing is,
albumin and prothrombin time are normal. These tests indicate that although
you have an acute liver problem, perhaps there might not be any permanent
or irreversible damage and your liver function could recover completely.
The ASSIST score also suggests you are in the high-risk category for
alcohol use. In my opinion, the deranged liver function is majorly
contributed to by alcohol. [Personalized feedback]

Likewise, your chest X ray shows increased bronchovascular markings and

a tubular heart [showing the client, the x ray film] which suggest chronic
obstructive lung disease. The changes are at an early stage and not very
severe. To the best of my knowledge, these changes could be due to
smoking tobacco. [Personalized feedback]

[Give some time to the client to ponder over the findings]

Mr. JS: But I don't drink much. My uncle used to drink a bottle of Whiskey
everyday and he lived happily for ninety years!

Therapist: People react differently to different drugs. Some, like your uncle,
can tolerate higher amounts used over longer periods; other show signs of
harm with smaller amounts and over shorter periods.

Mr. JS: Ok.....I don't know......I never thought in this way.....it may be
worrisome.... if it causes all such problems (dissonance).

Therapist: Would you like to have information about how you can help
yourself with your risky substance use?

Mr. JS: Okay!

Therapist: Remember, the best way to avoid the substance related problems
is to not use them at all; if you cannot do that, then at least to cut down the
frequency and quantity of their use (Advice). It is not easy and needs a lot of
effort, but many people do it successfully and I think, you would be able to
do it (enhancing Self efficacy).

Mr. JS: Well, I don't know!

Therapist: Do you want me to suggest some steps?

Mr. JS: I don't see, why not?

Therapist: Well, these are the options which you might like to try:

1. Keep a diary for your substance use

2. Record time, place and circumstances of each substance use
3. Other people present while using substance
 4. Money spent in using substance
5. Identifying high risk situation and strategies to handle them
effectively
6. Identifying other options instead of substance use
7. Taking help of people to maintain change

Client: It sounds nice......I shall think over it

Therapist: By now you may be aware of the consequences of your

substance use. Should you have any more question, I would love to answer
those? (Address all the queries in empathetic and non-judgemental
manner). Many people find it reassuring to learn that they could take action
on their own to improve their health. I'm confident that you can follow the
advice and cut down or abstain completely from tobacco and alcohol use
(enhancing Self Efficacy). Ex. If you face any difficulty while trying these,
please call me/visit again so that we can discuss the issues.
9. 5 To discuss DEALING WITH RESISTANT CLIENTS Lecture PPT Discuss
min strategy to Client's resistance is a genuine concern. Failure to follow a therapist's cum strategy to
deal with instructions and resistant behaviors within treatment sessions, e.g., arguing, discussion deal with
resistant interrupting, denying a problem, and straying are the signs of resistance and resistant
client. these might predict a poor response to intervention. client.
Listen to clients, demonstrate a desire for mutual understanding, begin with
the simpler levels of reflection and advance as the relationship builds.
• Simple reflection - One strategy is simply to reflect what the client is
saying. This sometimes has the effect of extracting the patient's
response and stabilizing the situation. Example: “Focused on feelings
e.g. You’re angry about being sent here”
• Reflection with amplification – The therapist exaggerates or
amplifies what the client is saying to the point where the client is
likely to contradict it. There is a precise balance here, because
overdoing an exaggeration can elicit conflict with the therapist.
Example- client: “No. I just don't think I have a drug
 problem”.Therapist: “So as far as you can see, there really haven't
been any problems or harm because of your drug use”.
• Double-Sided Reflection: Sometime if the client offers a resistant
statement then it becomes important to reflect it back with other side.
Example, “You are not quite sure you are ready to make a change,
but you are quite aware that your drug use has caused concerns in
your relationships, effected your work and that your doctor is worried
about your health”.
Shifting Focus- Another strategy is to defuse the resistance offered by the
client by shifting their attention away from the problematic issue. Example-
Client: “But I can't just quit drugs. I mean all of my friends use them”!
Therapist: “You’re getting way ahead of things. I’m not talking about your
quitting here, and I don't think you should get stuck on that concern right
now. Let's just stay with what we’re doing right now - going through your
feedback - and later on we can worry about what, if anything, you want to do
about it”.
Roll with resistance (avoid argument)
When the person expresses resistance, the health worker must reformulate or
reflect it instead of opposing it. It is particularly important to avoid the
argument of change, since this puts the person in a position to argue against
it.
Open-Ended Questions
The client should do most of the conversation (“yes/no” questions should be
avoided); building the relationships and providing direction for change,
calling for “both sides of the coin.” The open-ended question allows the client
to create momentum for forward movement such as, “What makes you feel
that it might be time for a change?”
Affirming
It includes praise or statements of admiration and understanding that help to
generate a more encouraging environment. Affirming one's strengths and
efforts to build trust, while affirming one's self-motivating statements (or the
exchange conversation) foster willingness to change.
 Examples: “Thanks for coming today.” “I appreciate that you are willing to
talk to me about your substance use.” “You are obviously a resourceful
person to have coped with those difficulties.”
10. 5 To enlist ADVANTAGES OF BRIEF INTERVENTIONS Lecture PPT Enlist
min advantages There are several advantages of brief interventions which make this approach cum advantages
of brief appealing for implementation. discussion of brief
intervention • Versatility and Suitability -Brief interventions can be conducted in a intervention
variety of settings and thus, does not restrict the patient to report to a
specific location for therapy.
• Limited Time Duration- Limited time duration places less time
constraints on the therapist delivering this intervention. This is time-
saving and allows several patients to receive the intervention.
• Brief interventions can be integrated into routine assessments and can
be linked up to further care.
• It can be an effective approach in individuals who are not very
motivated to change their substance taking behaviors.
• A wide variety of professionals is able to provide this intervention.
This makes this approach amenable for scale-up.
• Even in patients with severe substance use, who need more intensive
interventions, brief interventions can be helpful in engaging them and
motivating them to seek more intensive treatments.
11. 1 To LIMITATIONS OF BRIEF INTERVENTIONS Lecture PPT
min enumerate Limited literature on sustained efficacy and continued search for outcome cum
limitations of measures (response to referral request or actual cessation of substance), as discussion
brief well as resistance to its use.
interventions
12. 1 To enlist CONTRAINDICATIONS Lecture PPT Enlist
min contraindi- • Patients who are currently in delirium or a confused mental state cum contraindi-
-cations of • Patients who are likely to have complicated withdrawals. discussion -cations of
brief • Patients who are currently agitated, actively suicidal, or have serious brief
interventions psychopathology are unsuitable for brief intervention. interventions
 However, merely having an additional psychiatric disorder along with
a substance use diagnosis (i.e., dual diagnosis) is not necessarily a
contraindication for brief intervention.
13. 3 To discuss EFFICACY OF BRIEF INTERVENTIONS IN VARIOUS Lecture PPT Discuss
min efficacy of SUBSTANCE USE DISORDERS cum efficacy of
brief Brief interventions have been tried for a variety of substance use disorders discussion brief
interventions and have shown some promise. There is strong evidence for the effectiveness interventions
in various of brief interventions in primary care for substance use disorders. in various
substance use Alcohol use substance
disorder. Brief interventions have probably been tried to the largest extent in the use disorder.
context of alcohol use disorders. In a meta-analysis conducted in 2002, 54
studies were included, which assessed brief intervention. The authors
classified the studies as those primarily including treatment-seeking
population, and those which had non treatment seeking samples. In non
treatment seeking samples, Brief interventions for substance use disorders
interventions were more effective than control conditions, with small to
moderate effect sizes. In treatment-seeking population samples, brief
interventions were no more effective than control conditions.
• The efficacy of brief motivation enhancement worked better on those
who were at risk drinkers rather than dependent drinkers.
• There are a few studies from India which have suggested a brief
intervention to be an efficacious modality for individuals with
problematic alcohol use, including in primary health-care setting,
community setting, and the workplace.

Tobacco use disorders

Brief intervention for tobacco cessation uses the principles of motivational
interviewing. A variant known as the 5As models (Ask at every visit, Advise
to quit, Assess readiness to quit, Assist with a quit plan, and Arrange a referral
to a specialist when required) has been in use to help tobacco users quit.
Studies are available from India suggested a brief intervention to be more
effective than simple advice for tobacco cessation.
 Cannabis use disorders
While some of the studies showed the efficacy of brief intervention, others
did not endorse its efficacy. A meta-analysis was not performed, limiting the
generalizability of the inferences.

Illicit substance use

The brief intervention has been attempted for illicit drug use as well. In a
three-arm randomized trial, participants with illicit substance use in primary
care were provided brief intervention, motivational interviewing, or no
intervention. At 6 months’ follow-up, it was seen that brief intervention was
not superior to no intervention for the outcome measure of self-identified drug
use in the past 30 days. A secondary analysis from the work also suggested
that brief intervention did not increase treatment-seeking subsequently.
Similar results were obtained for a randomized controlled study in the
emergency setting which used brief intervention for those with problematic
drug [Link], the role of brief intervention in illicit drug use remains
somewhat less promising as compared to its usefulness in reducing alcohol or
tobacco use.
14. 3 To discuss BARRIERS AND FACILITATORS TO IMPLEMENTATION PPT Discuss
min barriers and The barriers have been classified as being at the organization level, provider Lecture barriers and
facilitators to level, and at the patient level. cum facilitators
implement- Organization Level discussion to
-tation Include context of delivery, and primary care physicians and nurses (rather implement-
than specialists) were deemed suitable for brief intervention, while lack of -tation
managerial support and lack of financial incentives were found to be barriers
for implementation.
Provider’s Level
Perceived lack of knowledge and confidence in giving advice were deemed
as barriers. Clinical inertia in busy emergency setting was seen as another
barrier. Furthermore, lack of training and disinclination to ask about drinking
habits emerged as other barriers.
 Patient level
Women and those who were employed were less likely to be asked questions
related to drinking, and attendance to referral was better if arranged in a short
span of time.
15. 5 To discuss CONSIDERATIONS FOR BRIEF INTERVENTIONS IN THE INDIAN Lecture PPT Discuss
min considerat- CLINICAL SETTING cum considerat-
-ions for Health-care service approaches in India are different than in other parts of the discussion ions for brief
brief world. The clinical clientele is also inevitably different from other parts of the interventions
interventions world, due to differences in culture and societal values. Hence, the following in Indian
in Indian may be considered while delivering brief interventions in the Indian clinical clinical
clinical scenario. setting
setting 1. Patient inclination and psychological mindedness – Since brief
interventions are focused on the patient’s problems and are time-limited, with
constrained scope for introspection, the patient’s psychological mindedness
is not an issue. However, patient inclination (or resistance) to change behavior
may be encountered, which might lead to obstruction to flow of
communication
2. Doctor-pleasing – Indian patients are frequently likely to agree to what the
doctors say, and unlikely to express their dissent. This might lead to an
impression of brief intervention working well, although in reality, the person
might be report improvement merely in deference to the health-care
professional
3. The elderly patients – Younger health-care professionals might find it
difficult to discuss the problem of alcohol use in older patients, particularly
in recommending lifestyle changes among the elderly
4. The family intertwinement – Unlike in the West, family members are
closely associated in the provision of health care; and hence, the brief
intervention session may need to include them as well. However, this has the
potential of taking the focus away to a distressed and disparaging family
member who is waiting for an opportunity to ventilate feelings
5. Territorial boundaries in health care – Health-care systems often throw up
challenges when care provision is not integrated. A patient admitted to a
 medical and surgical specialty remains their specific dominion until consult
is sought for a particular reason. And the consult is often expected to be
limited to the question asked. Therefore, while providing brief intervention,
the referring physician/surgeon needs to be sensitized about the need for
referral, or better still, themselves trained in brief intervention
6. Workload – High patient loads and lack of adequate time for attending to
each patient may make implementation of brief intervention difficult. Health-
care professionals often triage their time and patient needs. If brief
intervention is lower on the list of priorities, then it is likely to be missed in
the busy clinical setting
7. Referral processes – Referral systems in the Indian setting (barring a few
places), is not well organized.
16. 3 To describe APPLICATION AND UTILITY OF BRIEF INTERVENTION IN Lecture PPT Describe
min application INDIA cum application
and utility of Keeping in mind the issues raised in the previous section, the following can discussion and utility of
brief guide the application of brief interventions in the Indian setting . brief
interventions • Setting: Brief intervention can be conducted in medical care settings, interventions
in India general psychiatric care setting, and in schools and colleges in India
• Focus substance: As of now, brief intervention should be limited to alcohol
and/or tobacco use disorders
• Personnel: Adequately trained personnel including physicians, psychiatrists,
psychologists, nurses, and social workers can implement brief interventions
• Link to treatment facilities: When the substance use severity is high, then
brief intervention should be linked to other treatment facilities.
The advantage of a brief intervention lies in its being a simple and easy to
implement intervention. Although busy workload and lack of privacy are
concerns, this type of intervention when conducted might lead to a health
promotion cascade, leading to improved health outcomes for self and
others.
17. 1 To conclude CONCLUSION Lecture PPT
min the topic Brief interventions are promising psychologically oriented, time-limited cum
counseling approaches that target high-risk substance users. The SBIRT adds discussion
 a component of screening and referral to specialist services when required.
Brief interventions can be carried out in a variety of settings, including
primary care and emergency departments. Research has largely focused on
alcohol use disorders, where brief interventions have shown benefits,
especially in the short-term. Those who are currently not seeking treatment
are likely to be benefitted the most. Being a cost-effective measure, and given
the ease of delivery by a variety of professionals, brief interventions have the
potential to be applied to large segments of the population in need. Certain
aspects of the delivery of this intervention would need careful consideration
when applied in the Indian health-care system.
18. 1 To discuss RESEARCH ARTICLE Lecture PPT
min research cum
article Brief interventions for alcohol problems: a meta-analytic review of discussion
controlled investigations in treatment-seeking and non-treatment-
seeking populations

Anne Moyer , John W Finney, Carolyn E Swearingen, Pamela Vergun

Brief interventions for alcohol use disorders have been the focus of
considerable research. In this meta-analytic review, we considered studies
comparing brief interventions with either control or extended treatment
conditions. We calculated the effect sizes for multiple drinking-related
outcomes at multiple follow-up points, and took into account the critical
distinction between treatment-seeking and non-treatment-seeking samples.
Most investigations fell into one of two types: those comparing brief
interventions with control conditions in non-treatment-seeking samples (n =
34) and those comparing brief interventions with extended treatment in
treatment-seeking samples (n = 20). For studies of the first type, small to
medium aggregate effect sizes in favor of brief interventions emerged across
different follow-up points. At follow-up after > 3-6 months, the effect for
brief interventions compared to control conditions was significantly larger
when individuals with more severe alcohol problems were excluded. For
studies of the second type, the effect sizes were largely not significantly
different from zero. This review summarizes additional positive evidence
for brief interventions compared to control conditions typically delivered by
health-care professionals to non-treatment-seeking samples. The results
concur with previous reviews that found little difference between brief and
extended treatment conditions. Because the evidence regarding brief
interventions comes from different types of investigation with different
samples, generalizations should be restricted to the populations, treatment
characteristics and contexts represented in those studies.

REFERENCES
• Mattoo SK, Prasad S, Ghosh A. Brief intervention in substance use
disorders. Indian Journal of Psychiatry [Internet]. 2018;60(8):466.
Available from:
[Link]
• Sarkar S, Pakhre A, Murthy P,Bhuyan D. Brief interventions for
substance use [Link] J Psychiatry 2020;62:S290-8
• Moyers [Link] j.w,swearingen brief interventions for alcohol
problems:a metaanalyic review a controlled investigation of treatment
seeking and non treatment seeking [Link] 2002