Brief interventions for disorders of substance use and addictive behaviours

Brief interventions use techniques such as motivational interviewing, in which the clinician helps a person reflect on the pros and cons of their substance use, gaming or gambling and to uncover their motivation to changeSim, 2009. Motivational interviewing questions for managing disorders of substance use and addictive behaviours provides examples of questions. The clinician can offer brief advice on options for next steps and work with the person to agree a plan.
Table 1. Motivational interviewing questions for managing disorders of substance use and addictive behaviours

Sim, 2009Sim, 2009

Brief version: The following questions can be used within a 5-minute discussion.

Question

Rationale

What do you like about your [substance use or behaviour]?

This question is unexpected as most patients would be expecting a lecture. It gives an opportunity to listen and build rapport and may give valuable information that helps to understand the context of the behaviour. It may also be important to consider how to replace this function if the behaviour were to stop.

What don’t you like about your [substance use or behaviour]?

This question is critical as it draws out the internal motivation for change.

[Add your own concerns if appropriate]

Add your own concerns about the behaviour if you believe this might help to tip the balance towards change and not increase resistance.

Briefer version: The following questions can be used within a 1- to 2-minute discussion.

Question

Rationale

On a scale of 1 to 10 where 10 is a lot, how much do you want to [change the substance use or behaviour]?

Patient usually pick a number higher than 2. Regardless of the answer, you can usually ask the next question.

Why so high; why is it not [a lower number]?

The patient tells you why they want to change (argues for change).

So what do you want to do about it?

The patient states how to move towards change. Aim to get a commitment to a plan, which might range from action to change, an agreement to return to discuss further, or an agreement for the issue to be raised again later.

Note:

Reproduced with permission from The Royal Australian College of General Practitioners from: Sim MG, Wain T, Khong E. Influencing behaviour change in general practice: Part 2 – Motivational interviewing approaches. Aust Fam Physician 2009;38(12):986–89. Available at www.racgp.org.au/getattachment/201f2425-e6e8-4965-83c5-9017a92d2ec8/Influencing-behaviour-change.aspx [Accessed 22 September 2022].

For more information about motivational interviewing, see:

  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice - Part 1 - brief intervention and motivational interviewing. Aust Fam Physician 2009;38(11):885-8. URL
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice - Part 2 - motivational interviewing approaches. Aust Fam Physician 2009;38(12):986-9. URL
  • a self-directed online course at Flinders University
  • the Insight website—this includes substance-specific brief motivational interviewing tools (available as tear-off forms, which can be ordered) with a takeaway summary.