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Review Article



Roshan Bhad

Senior Resident, Department of psychiatry, All India Institute of Medical Sciences, New Delhi, India.



The growing body of research suggests that the brief intervention is important psychosocial intervention tool not only for substance use disorders, but also other psychiatric disorders. This overview of role of brief intervention in psychiatry discusses the available evidence base, cost effectiveness and its implication for management psychiatric disorders. The paper presents review of available literature on the role of brief intervention in psychiatry. It also asserts that India presents a suitable and fitting ground for application of this psychosocial intervention and that Indian research in this area should be given priority.

Keywords: Brief intervention, Psychiatry, Psychosocial intervention


Psychological interventions are the important part of management of any psychiatric disorder. However, there are only some psychological intervention, which are evidence based and brief intervention (BI) is one of them.1)Brief intervention in simple word is a brief counseling, which aims at changing the specific behavior. Brief interventions typically consist of one to four short counseling sessions with a trained interventionist (e.g., physician, psychologist, social worker, nurse, health worker). Brief intervention (BI) emerged in the 1980s as a strategy to provide early intervention, before or soon after the onset of alcohol-related problems, with the aim of moderating drinking rather than promoting abstinence.2)

What is brief intervention?

Definitions of brief interventions vary. In the recent literature, they have been referred to as "simple advice," "minimal interventions," "brief counseling," or "short-term counseling." Brief interventions should not be referred to as an homogenous entity, but as a family of interventions varying in length, structure, targets of intervention, personnel responsible for their delivery, media of communication and several other ways, including their underpinning theory and intervention philosophy.(3,4) Basic goal of any substance abuse treatment is harm minimization due to substance abuse with ultimate goal of abstinence. The goal in Bi is flexible, ranging from moderation to abstinence and not necessarily abstinence in all the cases. Primary goal of BI is to raise awareness and based on that recommend change in behavior. Goals can differ according to settings, client’s level of consumption, and stage of recovery or readiness to change.(5)

Components of Brief intervention

Six critical elements for effective BI summarized in acronym FRAMES.(6)

a. Feedback- Feedback is given to the individual about personal risk or impairment.

b. Responsibility- Responsibility for change is placed on the participant.

c. Advice- advice to change is given by the provider.

d. Menu- Menu of alternative self self-help or treatment options is offered to the participant.

e. Empathy- Empathic style is used in counseling.

f. Self elf-efficacy or optimistic empowerment is engendered in the participant.

A brief intervention consists of five basic steps that incorporate FRAMES and remain consistent regardless of the number of sessions or the length of the intervention: Introducing the issues, screening, evaluating, and assessing, providing feedback, talking about change and setting goals, talking goals, summarizing and reaching closure. The application could be agency-based intervention; community based intervention or through self helps manuals. Psychiatrist are not needed for the application of Bi as it can be administered by professionals like Primary care physicians, Substance abuse treatment providers, Emergency department staff members, Nurses, Social workers, Health educators, Lawyers, Mental health workers, Teachers, Crisis hotline workers, student counselors, Clergy etc. Practically it can be administer by any professional possessing following essential skills  - an overall attitude of understanding and acceptance, counseling skill such as active listening and and helping to resolve ambivalence helping ambivalence, a focus on intermediate goals and working knowledge on stages of change. (5)

Application of brief intervention in Psychiatry

Brief interventions are useful in management of various psychiatric disorders like substance abuse & behaviors associated with that, chronic medical illness, pain management, HIV risk reduction, sex offenders eating disorder, dual diagnosis cases etc. Although, it has been primarily used in treatment of substance use disorders there is recent interest is application of BI in verity of chronic and debilitating psychiatric disorders.  Among substance use disorders it is evidence-based treatment for management of alcohol use in primary health care setting and for risky and young alcohol users. (5,7–10) Brief interventions have also been used in management of cannabis use disorders and tobacco use disorders successfully. (11–13) Similarly, brief intervention has found useful in psychosocial management of eating disorders, (14,15) self harm behaviors (16) depressive disorder (17) pain disorders including headache (18) and anxiety disorders. (19,20)

Effectiveness of brief intervention

At present there is definitive evidence for brief intervention in psychosocial management of substance use disorders, while for rest of the psychiatric disorders there is limited evidence to suggest effectiveness of BI. Numerous studies have reported that brief interventions delivered in primary care, self referred drinkers and substance abuse treatment settings are effective in reducing excessive drinking. The primary meta-analysis(21) included 22 RCTs and evaluated outcomes in over 5800 patients. At 1 year follow up; patients receiving brief intervention had a significant reduction in alcohol consumption compared with controls [mean difference: -38 g week (-1), 95%CI (confidence interval): -54 to -23]. Another met analysis (22) of 18 studies reveled that after approximately 12months of follow-up, students receiving BI showed a significant reduction in alcohol consumption (difference between means=-1.50 drinks per week, 95% CI: -3.24 to -0.29) and alcohol-related problems (difference between means=-0.87, 95% CI: -1.58 to -0.20) compared to controls. In a randomized controlled trial, 40 young cannabis users were given two-session brief intervention and compared with the 3-month delayed-treatment control condition. The intervention resulted in significantly greater reductions in measures like changes in days of cannabis use, mean quantity of cannabis used weekly etc. (23)  A Cochrane review of 74 trials concluded that standard, print-based self-help materials increase quit rates compared to no intervention, but the effect is likely to be small.(24) A randomized control trial studying cost effectiveness of brief physician advice (brief intervention) concluded that it is associated with sustained reductions in alcohol use, health care utilization, motor vehicle events, and associated costs. The cost benefit analysis suggested that for every $10,000 invested in early BI, there is a $43,000 saving in future heath care cost.  While, the cost benefit ratio was 5.6 at 12 month & 4.3 at 4 year for alcohol, there was 80% reduction in absenteeism rate. (25)

Indian perspective

Brief intervention (BI) is advantage for developing country like India, where there is the dearth of manpower resources and treatment centers to address mental health problem in huge population. However, use of brief intervention is under utilized and the research in this area of effectiveness of brief intervention is limited. Varma & Malhotra found that general physicians could make reliable assessment of alcohol related problems in patients in early substance use period. It was demonstrated that screening is possible at primary health center (PHC) level and a prevalence of 10% abuse of alcohol was obtained using screening instruments. (26) Similarly, a case control study from India to test efficacy of BI on mild to moderate alcohol abusers showed significant reduction in consumption of alcohol and improvement in quality of life. A WHO collaborative study on “Identification and Management of Substance use Disorder in Primary Care Setting” conducted in year 2002 also supported the efficacy of BI amongst alcohol and cannabis users.(27) At present there are hardly any studies from India on role of Brief intervention (BI) in psychosocial management of other psychiatric disorders.

Future direction

Major drawback of the studies on BI is poor quality control. In future there is need to conduct studies which mention description of adherence to BI guidelines, specification of training procedure, competency criteria and active ingredients of intervention should also be specified. Moreover, there is need to research on optimal responders characteristics in terms of severity, gender, motivation and other variables like education, age, social support, locus of control, co morbidity etc.


Brief intervention (BI) is a low cost intervention that can be applied to a large population suffering from or at risk of various psychiatric disorders. It is the evidence based psychosocial treatment for substance use disorders. For which effectiveness is established and has been found consistent across cultures and different setting, Outcome significantly better than no treatment & often comparable to those more extensive therapies. With a shift towards early intervention BI offers a suitable & encouraging effective option to be implemented as a part of routine care. Considering its huge potential as a psychosocial intervention, there is need to escalate use of BI as an intervention for psychosocial management of psychiatric disorders. And to achieve this goal it is imperative to fill research gap in the area of brief intervention (BI) in India.


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