II. Indication
-
Chemical Dependency
- Brief counseling by primary physician
III. Protocol: Example for Alcohol use
- Initial physician visit for 15 minutes
- Use Grading Scale for Alcohol Use
- What are drinking triggers for this patient?
- Review risks for this patient for continued use
- Set specific goals for Alcohol cessation or reduction
- Patient's personal responsibility
- Determine schedule for cutting back on use
- Make contract on determined goals
- Review methods
- Drinking diary
- Behavior Modification and coping techniques
- Patient Education handouts
- Resources (see below)
- Reinforce positive outlook and motivation
- Follow-up nurse phone call at 2 weeks for reinforcement
- Follow-up physician visit for 15 minutes
- Follow-up nurse phone call at 2 weeks for reinforcement
IV. Mnemonic: FRAMES
- Feedback: Specifically address concerns about use
- Concerned about how Alcohol is affecting your liver
- Responsibility: Emphasize that change is up to patient
- Only you can decide to make your life better
- Advice: Give specific goals you have for the patient
- I want you to be evaluated at a treatment center
- Menu: Offer alternatives to advice
- You could alternatively go to an AA meeting
- Empathy
- I know you find talking about this difficult
- Self-efficacy
- You deserve better - you can be better with help
V. Additional Measures
- Offering CD counseling reduces use for 6 months
VI. References
- Miller (2002) Motivational Interviewing, Guilford
- Blondell (2005) Am Fam Physician 71:495-502 [PubMed]