II. Indication

  1. Chemical Dependency
    1. Brief counseling by primary physician

III. Protocol: Example for Alcohol use

  1. Initial physician visit for 15 minutes
    1. Use Grading Scale for Alcohol Use
    2. What are drinking triggers for this patient?
    3. Review risks for this patient for continued use
    4. Set specific goals for Alcohol cessation or reduction
      1. Patient's personal responsibility
      2. Determine schedule for cutting back on use
      3. Make contract on determined goals
    5. Review methods
      1. Drinking diary
      2. Behavior Modification and coping techniques
      3. Patient Education handouts
      4. Resources (see below)
    6. Reinforce positive outlook and motivation
  2. Follow-up nurse phone call at 2 weeks for reinforcement
  3. Follow-up physician visit for 15 minutes
  4. Follow-up nurse phone call at 2 weeks for reinforcement

IV. Mnemonic: FRAMES

  1. Feedback: Specifically address concerns about use
    1. Concerned about how Alcohol is affecting your liver
  2. Responsibility: Emphasize that change is up to patient
    1. Only you can decide to make your life better
  3. Advice: Give specific goals you have for the patient
    1. I want you to be evaluated at a treatment center
  4. Menu: Offer alternatives to advice
    1. You could alternatively go to an AA meeting
  5. Empathy
    1. I know you find talking about this difficult
  6. Self-efficacy
    1. You deserve better - you can be better with help

V. Additional Measures

  1. Offering CD counseling reduces use for 6 months
    1. Crawford (2004) Lancet 364:1334-9 [PubMed]

VI. References

  1. Miller (2002) Motivational Interviewing, Guilford
  2. Blondell (2005) Am Fam Physician 71:495-502 [PubMed]

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