Motivational Interviewing

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.

8. Follow-up

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.

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