Psychosocial Interventions

Motivational interviewing

Motivational interviewing is a strategy of counseling for behavior change that elicits “change talk” from patients so that patients’ own motivation drives their plans to change. This approach is patient-centered, relies on empathy and self-efficacy, and avoids trying to “convince” patients to change.

Screening and brief interventions

Hospitalization poses a potentially powerful opportunity for providing interventions for patients with substance use disorders. Screening and brief intervention (SBI) is a tool that has mostly been validated in outpatient settings but that can be translated to inpatient settings. There is evidence that SBI can decrease tobacco and unhealthy alcohol use.

A recommended framework for the delivery of SBIs is the five As:

• Ask: screen for use, assess level of risk.
• Advise: supply direct advice about substance use, including recommendations to modify use and information on the personal substance use and related health effects.
• Assess: evaluate patient’s readiness to change behavior, evaluate severity of patient’s use, and provide more focused counseling based on patient’s current stage of change.
• Assist: partner with the patient to create a treatment plan with a focus on incorporating the patient’s goals. Motivational interviewing techniques that allow the patient to voice their reasons for changing behavior can be used during this step.
• Arrange: make follow-up appointments to patient’s primary care doctor, self-help groups such as AA and SMART Recovery, addiction specialist referrals as needed, and refer to social work or case management as per institution-specific practices to arrange linkages with outpatient substance use resources.

Harm Reduction

Harm reduction approaches to substance use management are aimed at decreasing negative consequences associated with substance use. This approach assumes that abstinence may not be feasible, so instead incorporates a range of strategies that makes use safer. This includes strategies such as needle exchange to supply clean needles to patients who inject drugs, distribution of the reversal agent naloxone to patients who use opioids to have available in the case of overdose, safe injection sites where patients who use opioids can inject in a monitored setting, managed alcohol programs where alcohol is given to patients with alcohol use disorder, and designated driver programs for patients who use alcohol.