Please ensure Javascript is enabled for purposes of website accessibility Brief intervention – Help With Drinking

Need immediate support?
Please call 8-1-1 for 24/7 general health information and advice. Indigenous people across Canada can also call the toll-free Hope for Wellness Helpline at 1-855-242-3310.

Brief intervention



Brief intervention (BI) should be offered to all patients (youth and adults) with high-risk alcohol use or diagnosed AUD.


BI supports behavioural change to reduce or stop alcohol consumption. BI typically uses the principles of motivational interviewing (MI), a counselling approach that helps patients enhance their motivation to change. The goal is to create a therapeutic alliance that is a partnership with the patient, rather than an expert/patient dynamic.


Providers are encouraged to complete an MI training to maximize the effectiveness of this intervention.


Tips to help you build partnership with a patient using active listening:


  • Ask open-ended questions.
  • Acknowledge and praise their efforts, thoughts and values.
  • Reflect back what you hear.
  • Summarize the key points of the discussion and ask if anything was missed.


For more details and examples, see Appendix 3 of the Guideline.

download guideline

The 5As model


The 5As model is a framework for motivational interviewing that has been adapted for use in primary care to support behaviour change. The 5 steps are:


Ask —> Advise —> Assess —> Assist —> Arrange


The “Ask” step consists of the screening and diagnosis process. The remaining steps are where the motivational dialogue and care planning occur.

Here is a step-by-step guide to an alcohol BI.



  • Initiate a conversation about the patient’s alcohol use.
  • Proceed with screening and diagnosis.


  • Clearly describe the screening result.
  • Discuss the implications on the patient’s health.
  • Connect the health risks to the laboratory investigations and medical findings in lay terms (e.g., anxiety, insomnia, liver function tests, gastroesophageal reflux disease, blood pressure), if relevant.
  • Discuss the patient’s health concerns and goals.
  • Provide personalized recommendations.


Sample questions:

  • “I think your drinking is putting your health at risk. What health goals are most important for you?”
  • “I strongly recommend that you cut down or stop drinking. What has worked for you in the past?”



Assess the patient’s motivation and interest in changing their drinking.

Sample questions:

  • “Are you interested in or considering making changes to your drinking?”
  • “What would you lose or gain by cutting back on your drinking?”
  • “On a scale of 1 to 10, how important is it to you to cut down on your drinking?”
    “How do you feel about my recommendation? Do you have any questions or concerns?”


If the patient expresses readiness to change:

  • Express your support and offer encouragement.
  • Affirm your confidence in the patient’s motivation and ability to change.
  • Collaboratively set goals that are meaningful to the patient. Goals do not have to be limited to reducing or stopping alcohol use, and can include safer alcohol consumption. Share this list of tips and strategies to cut down.
  • In line with the patient’s goals, provide a menu of options, including pharmacotherapy, psychosocial interventions, and recovery-oriented and community-based supports.
  • Agree on a specific plan and a change date or schedule.
  • Provide referrals to other health care services.
  • Offer educational material, such as the public summary of Canada’s Guidance on Alcohol and Health, and connect the patient to social supports and community resources near them or available online.

If the patient does not express readiness to change:

  • Restate your concern about the patient’s health.
  • Ask about any barriers to change the patient may be experiencing, and invite the patient to consider how these could be navigated.
    Encourage the patient to take time to reflect on the conversation.
  • Reaffirm your willingness to support when the patient is ready.
  • Provide referrals to other health care services.
  • Offer educational material and connect to social supports and community resources.
  • Follow-up. Repeat screening and brief intervention regularly.


  • Schedule follow-up visits.
  • At follow-up, document alcohol use and assess if the patient has been able to meet and sustain planned goals.

If the patient has met their planned goal:


  • Congratulate them, and reinforce and support continued change.
  • Coordinate care with referral partners if the patient has accessed additional support. With the patient’s consent, communicate with external or community agencies on the patient’s progress.
  • Assess and address any comorbid medical conditions or concurrent mental health symptoms or disorders (e.g., insomnia, depression, anxiety), noting that these may improve with reduction in alcohol use.
  • Encourage the patient to set new self-identified goals and schedule follow-up appointments.

If the patient has been unable to meet their planned intervention goal:


  • Acknowledge that change is difficult.
  • Relate drinking to problems a patient may be experiencing (e.g., health, psychological, social) as appropriate.
  • If the following measures are not already being taken, consider:
    • Referring patient to external or community-based resources (e.g., peer support groups).
    • Recommending the involvement of family (if appropriate and with the patient’s consent).
    • Offering pharmacotherapy, psychosocial interventions, or both to patients with AUD.
    • Re-assessing or adjusting current treatment plan.
  • Continue to assess and address any concurrent medical conditions or co-occurring mental health symptoms or disorders (e.g., insomnia, depression, anxiety), noting that these may improve with reduction in alcohol use.
    • Note: Pharmacological management of depression and anxiety is less effective while the patient continues to use alcohol.
  • Schedule follow-up appointments.

Brief intervention in action


In this video, you will see a clinician discussing alcohol use with a patient who has filled out the Alcohol Use Disorders Identification Test (AUDIT) questionnaire. It’s a good example of using motivational interviewing techniques (including asking permission), using open-ended questions and allowing the patient to guide the plan. Note that in this example, the clinician performs all of the 5As described above, but the patient is not ready to change, so the “Arrange” portion consists of scheduling a follow-up visit.