The more specific components of a brief intervention can be summarized by the acronym FRAMES. The following process is intended to guide you through the FRAMES model step by step, addressing each component in association with its “letter.”
Provide constructive, non-confrontational feedback about a patient’s degree and type of substance use based on information from structured and objective assessments.
- Acknowledge the patient’s risky behavior.
- Review the results of screening instrument (e.g. AUDIT/ASSIST).
- Discuss personal risks associated with current substance use patterns.
- Provide general information about substance related risks and harms.
- Link the patient’s presenting complaint to his/her substance use (when applicable).
- Compare patient’s substance use patterns and problems to similar people in the population.
Allow the patient to have an active rather than a passive role in changing his/her behavior and taking responsibility for changing.
Enable the patient to retain personal control over his/her behavior and its consequences:
- Ask for permission to talk about substance use, “I’d like to talk about…, would you be willing…?”.
- Do not impose personal views or goals on patient: be open and non-judgmental.
- Acknowledge that the patient is responsible for his/her own behavior and for making choices regarding their substance use.
- Re-state/re-affirm the patient’s choice of continuing or changing the behavior (e.g. “So, you’ve decided to X, is that right?”).
Share knowledge about substance use consequences in a gentle and respectful manner to encourage positive behavioral change.
- Listen to what type of information the patient is requesting and willing to receive.
- Advice should be simple, not overwhelming, and matched to the patient’s level of understanding and readiness, the urgency of the situation, and his/her culture.
- Provide educational (explaining information) or directive (giving suggestions) advice appropriately – by asking permission to do so.
- Increase awareness of personal risks by reviewing the medical, psychological, and social harms associated with continued use.
Menu of Options
Work with the patient to generate a range of alternative strategies to cut down or stop their substance use.
- Reinforce the patient’s control and responsibility.
- Elicit what has and has not worked for the patient in the past.
- Provide accurate information about each option.
- Discuss possible implications of choosing one particular path.
- Help the patient create a plan using one or more options.
- Provide supporting materials relative to the patient’s decision.
Exercise a warm, respectful, caring, committed, and active interest throughout the brief intervention session.
- Use reflective listening and listen attentively to each statement and reflect it back in different words so the patient knows you understand the meaning.
- Use open-ended questions.
- Create a safe environment that encourages free flow of information from the patient.
- Let the conversation unfold rather than direct it or interrupt it.
Self-efficacy (self confidence for change)
Eliciting self-efficacy statements from patients allows them to believe what they hear themselves say and ultimately provides confidence that they will be able to make changes in their substance use behavior.
- Believe in your patient’s ability to change.
- Foster hope and optimism by reinforcing the patient’s beliefs in their own capacities and capabilities.
- Identify patient strengths to build upon past successes.
- Affirm small steps that are taken and reinforce any positive changes.
The FRAMES bottom line: The best way to enable our patients to change their behavior is to allow them to play a role in determining what the change is and how it will be accomplished. This “buy-in,” coupled with your support that they can in fact implement the change, regardless of how big or small a change they choose, is often the difference between a successful substance use brief intervention and an unsuccessful one.