• Brief interventions are a useful approach for reaching primary care patients who misuse alcohol.
  • The two goals of brief interventions are: abstinence for dependent drinkers and reduction in drinking for anyone considered to be at risk.
  • Effective brief interventions involve a combination of feedback/advice from the health provider and agreement and cooperation from the patient regarding drinking behaviors.
  • The CSAT and FRAMES approaches are two common, effective brief intervention strategies.
  • Patient resistance is the most common barrier to intervention.
  • Motivational Interviewing is patient-centered, meaning that the motivation to change comes from the patient's desire to do so.
  • Major forms of psychosocial treatment include cognitive-behavioral therapy, motivational enhancement therapy, and twelve-step facilitation.
  • Self-help groups are peer-led and often complement professional treatment.
  • Patients begin the stages of change before they recognize that they have a problem and reach the final stage when they are able to maintain the changes they wish to make.
  • It is normal for patients to need to "start over."
  • The main cause of withdrawal symptoms involves the physiological changes that occur in the body of a person who drinks excessively.
  • Substance abuse specialists include addiction psychiatrists, addiction counselors, and PCPs who are specially certified in addiction medicine.
  • Treatment for alcohol use problems is available in several settings, each of which is appropriate for different patients at different stages in recovery.
  • Monitor the treatment of alcohol use problems as you would other chronic conditions.
  • View relapse as a natural part of the recovery process, not as treatment failure.
  • Keep track of your patients' goals and supply appropriate feedback on their progress.
Dialogue with Melissa

Doctor: Melissa, it's good to see you for this second follow-up visit. How have you been since I saw you last?

Melissa: Really great! I told my husband about my relapse and he was really supportive.

Doctor: Very good to hear.

Melissa: He's been great in helping me with my recovery. He's a part of Al-Anon and the group is helpful with added motivation.

Doctor: This is very good news, Melissa. I'm so glad the support system you have has helped you reach a successful outcome.

Practice Tip

It is important to have a motivational point which the patient can focus on and create a behavioral change. Also, utilizing a support system such as Melissa has done with her husband and the support group as a whole allows her to have contact points in the situations where her motivation might have weakened.


Doctor: Melissa, you came to the office today because you noted a relapse.

Melissa: Yeah, it's made me feel really bad that I failed like this.

Doctor: You can't think of this as a failure, but instead just a temporary setback. You've come to seek help in getting yourself back on track and that's very commendable.

Melissa: I guess. It's just bad that I managed to get caught right back in the cycle of drinking again.

Doctor: It's difficult to completely cease alcohol consumption after having done it for so long, but it's not impossible. You managed to abstain for 6 months, which is an excellent start to recovery. Relapses can be a part of recovery.

Melissa: I guess I have to be prepared for some stumbling along the way.

Doctor: It is always helpful to be able to depend on others when going through recovery. You said you haven't revealed your relapse to your husband?

Melissa: I've been keeping it a secret because I'm afraid he will be disappointed in me.

Doctor: Family is an important social support system. While I understand your reluctance to share your relapse with him, it is important to be open and honest so that he can help you avoid a future relapse.

Melissa: I'll...try to tell him if you think it would help. He's been very supportive in the past.
Meeting Melissa Again


Remember Melissa? When she came in for her annual physical you discovered that she drank alcohol. Administering the CAGE revealed that she had considered cutting down before, but but she had never felt guilty for drinking. No one around her had suggested she cut down on her alcohol use either, but she admitted that she often hid her alcohol consumption levels from her husband.

Reason for Visit

After a brief intervention with her during the physical, Melissa embarked on a dedicated time period where she abstained from alcohol completely. She also told her husband about her alcohol use and sought his support in her recovery. She had been sober for 6 months. However, she was out celebrating with some coworkers last week and indulged. Now she feels like she is right back where she started from and she does not want to tell her husband about her relapse.


Subscribe to SBIRT Training RSS