Review Article
Andrew M. Rome
Abstract
Alcohol dependence is one of the major causes of morbidity and mortality in the world, although less than 0.1% of the population would be diagnosed as severely alcohol dependent requiring the support of specialist services. Most patients with alcohol use disorders are classed as ‘mild to moderate alcohol dependence’ and can be successfully managed in non-specialist settings using a combination of pharmacological and psychosocial interventions. ‘Psychosocial interventions’ is an umbrella term used to capture a diverse range of different treatment and support options, making any meaningful comparisons challenging. It also suggests a level of specialist knowledge or skills required to deliver in practice. These can be off-putting to practitioners working in primary or community care settings. The BRENDA model is a biopsychosocial approach which combines the medical management of alcohol dependency with a sequence of short structured discussions between the patient and practitioner. Its component parts are similar to many other frameworks such as FRAMES and FLAGS. This review examines the essence of a psychosocial approach and highlights three key elements, Motivation, Self-efficacy and Support which are common to the most effective interventions. It concludes that the ability to explore these elements in an empathetic, reflective conversation with their patient will assist general practitioners and other community-based health and social care workers in delivering an effective and appropriate level of support to people with alcohol use disorders.