This relational model promotes collaboration between the health professional and a woman seeking care. Alcohol-dependent women can be resistant to change and should be referred to counsellors who can devote the time it takes to establish a collaborative relationship.
1. Raise the subject
“I’d like to take a few minutes to talk about alcohol use.”
2. Provide feedback
Express your concern that she is drinking at risk level. Expect her surprise. Reinforce low-risk drinking limits or abstinence.
Ask if she can see a connection between alcohol use and medical issues.
If yes, restate her answer. If no, make a connection using chief complaint, physical findings or consequences.
3. Discuss contraception
Assess contraception use and risk for unintended pregnancy. If at risk for pregnancy, discuss long-acting reversible contraception.
4. Assess readiness to change
Ask: “On a 0 – 10 scale, how ready are you to change any aspect of your alcohol use?”
If <10 ask “Why choose that and not a 10?”
If >5 ask “On a scale of 0-10, how confident are you that you can change your drinking?”
5. Enhance motivation
Discuss pros and cons of reducing/stopping drinking. Create discrepancy between continued alcohol use and her values that are threatened by consequences of drinking.
6. Negotiate and advise
Have her set a goal (e.g., reduce use to non-risk level) and list tactics she can use. Ask her to identify ways to build her confidence. Provide educational materials.
7. Arrange follow-up
Ask if she might need help meeting her goal. Set a short-term return appointment.
Ask if she was able to meet her goals. If yes, reinforce and support continued adherence. If no, acknowledge that change if difficult, address barriers, renegotiate goal, engage significant others.