FRAMES - brief intervention for risky or harmful alcohol consumption

Brief intervention for risky alcohol use can take place within the context of a typical consultation session following assessment or screening. Effective brief interventions need be no longer than 5-15 minutes in duration across 1-4 sessions. The format for an effective brief intervention typically involves certain elements which are conveyed by the FRAMES model [1].

Feedback of personal risks or impairment – provide the patient or client with a verbal report card based on the results of your assessment or their score on the AUDIT screen. Many people are unaware that they are drinking at hazardous or harmful levels and highlighting risks linked to current drinking patterns can be a powerful motivator for change.

“You’ve scored 16 on the AUDIT which indicates that you are at high risk of harm from your current pattern of drinking…”

Responsibility – emphasise that the decision to change drinking patterns or to continue drinking at the same level is the choice of the person alone. Acknowledgement of personal responsibility has been identified as a key factor in motivating behaviour change.

“Nobody can make this choice for you. It’s really up to you to make a change…”

Advice - deliver clear advice to change drinking behaviour. Simple yet expert advice from a medical professional is a potent element in a brief intervention.

“…yet as your [doctor, pharmacist, health care worker] I strongly advise you to limit your drinking or stop altogether to reduce the risks.”

Menu – provide a menu of strategies for changing drinking behaviours. Options include behavioural control (e.g. setting personal drinking limits and sticking to it; alternating alcoholic drinks with soft drinks; switching to low alcohol drinks; having regular alcohol-free days; identifying high risk situations for heavy drinking and creating a management plan; engaging in alternative activities to drinking).

Empathy – brief interventions emphasise the development of a therapeutic alliance in the context of a warm, reflective, empathic, and collaborative approach by the practitioner. A confrontational, directive, authoritarian, or coercive stance has no place in a brief intervention and is likely to undermine its effectiveness.

Self-efficacy – support the person's self-efficacy for change, and communicate a sense of optimism. De-emphasise helplessness or powerlessness.

“Many people successfully control their drinking or stop drinking all together. With the right support and information I’m confident that you will do it too”.

1. Bien, T., Miller, W.R., and Tonigan, J.S., Brief interventions for alcohol problems: a review. Addiction, 1993. 88(3): p. 315-336.