G.  Provide Motivational Intervention
Renegotiate Treatment Plan

OBJECTIVE

Clarify and/or increase patient commitment to change.

Address barriers to, clarify, or promote patient readiness for rehabilitation goals.

ANNOTATION

1.        Establish treatment goals in the context of a negotiation between the treatment provider and the patient.

2.        Review with the patient results of previous efforts at self-change and formal treatment, including reasons for treatment dropout.

3.        Use motivational enhancement techniques reflecting the FRAMES model (see Miller & Rollnick, 1991; Miller et al., 1992).

·              Feedback: Provide personalized feedback based on patient report of alcohol-related harm.

·              Responsibility: Emphasize patient responsibility and freedom of choice for changing behavior.

·              Advice: Provide clear and direct advice about the importance of change and availability of help.

·              Menu: Acknowledge and discuss alternative strategies for change.

·              Empathy: Maintain a patient-centered approach and accurately reflect patient statements and feelings.

·              Self-Efficacy: Emphasize the role of patient self-efficacy in their ability to make needed change and convey optimism in their potential to be successful.

4.        Use empathic and non-judgmental (versus confrontational) therapist style.

EVIDENCE TABLE

QE = Quality of Evidence; R = Recommendation (See Introduction)