Motivational interviewing is a direct assistance style centered on the patient, which aims to provoke a behavior change, helping to explore and resolve ambivalence. It is based on respecting the patient’s autonomy and compassion, collaborating with the patient, and evoking the reasons for the change in himself. To do this, try to express empathy, facilitate the appearance of discrepancies, move forward with resistance, and encourage self-efficacy. It is proposed to use specific interview tools to encourage patients to talk, explore their ambivalence about substance use, and clarify their reasons for reducing or stopping alcohol use. Specifically, ask open questions, use affirmation techniques of what the patient says, reflective listening, and summary techniques. In patients with risky consumption but without criteria for alcohol dependence syndrome, behavioral treatment should be considered. The intervention consists of medical advice aimed at changing the consumption pattern. This advice should be personalized and include five points for the brief intervention. The target population is the risk drinker (the threshold for intervention). We are talking about a risk drinker when alcohol consumption is 28 SDUs per week (4/day) for men and 17 SSUs (2.5/day) per week for women. Any degree of consumption is also considered a risk in the case of a family history of alcohol dependence. This risk threshold determines the intervention in PC since the estimate is that one in 10 patients has daily intakes greater than these amounts. Intensive consumption ( binge drinking) can be defined as consumption equal to or greater than 6 SDUs (men) or 4 SSUs (women) in a consumption session (usually 4-6 h). Although the clinical criterion of one or more times a month is usually used, it is well known that the risks of intensive consumption are significant even when this pattern is adopted sporadically, even once a year
In non-alcohol-dependent patients who do not want complete abstinence or do not meet the criteria, the reduction can be negotiated, reaching a consumption agreement in the low-risk range between 10g/ day in women and 20g/day in men 19. In any case, the idea that “alcohol, the less, the better” should always be transmitted. It must be clear that the person who consumes risk or even the one who makes a harmful consumption is not “yet” an “alcohol-dependent” to prevent this feeling of stigma. On the other hand, the allusion to the concealment of consumption is not valid for most cases of risky or harmful consumption, being a characteristic of dependent drinkers.
Risk Estimation To Modulate The Intervention
Various risk assessment strategies have been used, such as the simple quantification of consumption in units (UBE) or grams, the CAGE test, the MALT test, Etc. However, for two decades, numerous authors and institutions (the WHO, among others) have established that the AUDIT test is the most appropriate method to estimate the level of risk and adapt the intervention. Various authors have evaluated the reliability of the AUDIT. The AUDIT-C includes all three questions on alcohol use from the full 10-item AUDIT test). The study by García-Carretero et al. shows the validity and utility indices presented. Unpublished data indicate that the prevalence of risky consumption in PC using the AUDIT-C criteria ≥5 in men (≥4 in women) is around 11%. The percentage of individuals in the early phases of dependence has not been estimated in our country (AUDIT 15-19). Still, it could be hundreds of thousands, and these would be the target population for interventions from primary care. On the other hand, 8.8% of the adult population admits to consuming alcohol daily, and within this group, a part of the population is at risk. In contrast, others are at risk due to chronic intensive consumption (binge drinking). Although one usually speaks of a brief intervention in practice, it would be more correct to speak of “brief interventions.”There is great heterogeneity in everything related to the IB. For example, in the Swedish National Program, the BI took on average less than minutes; however, in England, the National Program, based on the SIPS study, recommends using between 5 and 10 minutes, while the Cochrane Collaboration defines the BI in primary care as an average time of 25 minutes. Three levels of BI intensity can be considered arbitrarily based on the duration and frequency of the interventions.…
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