Social Work Practice in Health Care: The Need to Use Brief Interventions

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (2001), 14 million U.S. adults abuse alcohol and several million more are at risk of developing alcohol problems because of their drinking behaviors. Heavy drinking increases the risk of serious health problems, with the economic cost of problem drinking estimated to be $185 billion per year (NIAAA). Because individuals with alcohol problems are more likely to seek help from health care professionals than from alcohol treatment specialists (Bien, Miller, & Tonigan, 1993), it is imperative that social workers in health care settings be prepared to intervene. Although more than 7 percent of the U.S. population meets criteria for alcohol abuse or alcoholism (Grant et al., 1994), most people have problems that are considered mild to moderate (NIAAA, 2001), making it vital to intervene with individuals before the problems escalate to a level of alcohol abuse or alcoholism. Because traditional alcohol treatment approaches emphasize the need for abstinence, they are often inappropriate for and unsuccessful with people who have less severe alcohol difficulties (Zweben & Fleming, 1999). Therefore, alternative interventions that can be easily incorporated into social work practice in health care settings are needed. Findings from several meta-analyses have supported the success of brief interventions in helping clients reduce their level of drinking or as a means of facilitating treatment entry (Bien et al., 1993; Dunn, Deroo, & Rivara, 2001; Kahan, Wilson,& Becker, 1995; Poikolainen, 1999; Wilk, Jensen, & Havighurst, 1997). Brief interventions are now considered to have a valuable role in substance abuse treatment and the Consensus Panel of the Substance Abuse and Mental Health Services Administration has recognized them as an effective method for both treating some individuals and for motivating entry into more intensive treatment (Center for Substance Abuse Treatment [CSAT], 1999). In addition to representing a form of evidence-based practice, brief interventions are based on principles compatible with values of the social work profession and have the potential for use with diverse populations. Furthermore, brief interventions can be used to demonstrate the cost-effectiveness of social work services, which should be particularly appealing to those practicing in health care. DEFINITION OF BRIEF INTERVENTIONS Brief interventions are "time-limited, self-help, and preventive strategies to promote reductions in substance use in nondependent clients and, in the case of dependent clients, to facilitate their referral to specialized treatment programs" (Zweben & Fleming, 1999,p. 253). Interventions may be as short as five minutes, in which participants are given feedback regarding the consequences of heavy drinking and advised to reduce their consumption (Modesto-Lowe & Boornazian, 2000). Longer interventions may involve "motivational interviewing," which includes reflective listening on the part of the counselor, articulation of motivational statements by the client, full consideration of the client's ambivalence toward changing his or her risky behavior, and avoidance of client resistance (Dunn et al., 2001). The goal of any brief intervention is to motivate client change (CSAT, 1999; Fleming & Manwell, 1999) in a manner that recognizes the client's willingness to change, acknowledges the client as the "expert," and demonstrates respect for client decision making. Core elements of brief interventions are identified by the FRAMES acronym (Miller & Sanchez, 1994): * Feedback is given to the individual about personal risk or impairment. * Responsibility for change is placed on the participant. * Advice to change is given by the clinician. * Menu of self-help or treatment options is offered to the participant. * Empathic style is used by the counselor. …