In this guest blog, we introduce David Brown, a Winnipeg-based consultant and a CanFASD Board member. David tells us about the integrated approach he and his colleague, Wayne Skinner, recommend for supporting individuals who are trying to reduce their alcohol intake. 

Introduction 

Many people want to rethink their relationships with alcohol and take steps toward change. This includes women who are pregnant or may be planning to have children. To reduce the incidences of FASD in our communities, it is important to provide them with resources and support. The same resources and support will go a long way toward reducing the wide range of alcohol-related harms. This includes life-threatening stroke and cancer. 

Motivational Interviewing 

Evidence suggests that the most important factor in efforts to help people make life changes is the quality of the helping relationship itself. This is the case whether the helper is a healthcare professional, a therapist or a community member. It is vital that helpers also are provided with effective resources and support. This will help them to engage in compassionate and empowering conversations with those they are trying to help. 

The form of conversation that strives toward being skilful compassionate dialogue is Motivational Interviewing (MI). The style of MI is compatible with various formal therapeutic approaches and helping situations. It is common now for practitioners and other helpers to have some introductory training on the nature of MI principles. However, the training too often leaves learners without enough tools for practice. 

Personal Guidebooks 

My colleague, Wayne Skinner, and I have spent much of our careers trying to improve resources for practitioners and other helpers. Wayne’s clinical work and his design of MI training have focused on preparing helpers to better engage in supportive personal change conversations. My own work with primary care clinics resulted in the development of MI-structured guidebooks that individuals could use to have change conversations with themselves when working with a helper was not viable or desired. 

Our collaborative work over the past few years has been geared toward integrating these two approaches: compassionate MI dialogue and self-help guidebooks. MI-based counselling alone can be very effective, emphasising careful listening and evocative questions. Similarly, guiding themselves through an MI-based guidebook can be quite helpful for some people. Our experience in a clinical setting suggests that using counselling and guidebooks together can enhance the benefits of both. 

Helper’s Manual 

MI-based helping conversations are skilful practices that helpers can strengthen through training and practice. The integration of those conversations with an individual’s use of their own guidebook requires a further level of skill-building. With that in mind, we have developed a Helper’s Manual that shows the helper how to engage the person in supportive dialogue as they use their guidebook over several weeks. 

The helper’s manual includes suggested language for MI-grounded questions and statements corresponding to each page in the patient’s or client’s guidebook. It also explains why particular questions or statements are recommended for each page in the guidebook.

Advantages 

There are multiple advantages to this integrated approach. In counselling, the person answering questions in the MI-based guidebook provides rich therapeutic material to engage with them. It also lends an often-helpful structure to the counselling process, with the person seeking change in a lead role. The integration helps the person actively pursue change goals between counselling sessions, even if these are weeks apart. It may also help sustain individuals on waiting lists for counselling in their readiness to change.  

On the guidebook side, the integration with compassionate dialogue ensures that the person is not left feeling they are working on change alone. Even while using the guidebook, the person can experience the helper walking alongside them on their healing journey. The person can use the guidebook on their own, with some advice from their helper, or work on the guidebook entirely as part of counselling sessions. This flexibility enables the helper to support each person as needed. 

Webinar 

To share this approach with practitioners and other helpers, we developed a webinar discussing MI compassionate dialogue, including its concrete applications and underlying principles. The webinar also introduces CCSA’s MI-based personal Guidebook and our own Helper’s Manual. The webinar then has us interacting with participants around the practical issues of accomplishing the integration described above in their work. 

We recently offered the webinar through the New Brunswick FASD Centre of Excellence. It was delivered over three 3-hour sessions to 50 or so participants who are involved in efforts to help people reduce or end their alcohol use. It was a great opportunity for us to learn from their front-line experiences. We look forward to offering the webinar to other groups across Canada. 

Future Directions  

Over the next few months we hope to create versions of the Personal Guidebook and Helper’s Manual designed specifically for women who are pregnant or trying to become pregnant. This includes modifying the self-screening section to be in line with best practices. We are also creating an interactive digital version of the Personal Guidebook that allows for greater ease of access and use. These Guidebook innovations will further strengthen the integrated approach described above. 

If you would like to get in touch with David with any questions, comments or suggestions you can reach him at: dbrown@pathwaysresearch.org.

David Brown (PhD) is a consultant serving agencies and jurisdictions across Canada in the areas of harmful substance use research, program evaluation, knowledge exchange, and prevention education. David has worked as a research scientist with both BC Mental Health and Addictions Services and with the Department of Family Medicine at the University of Wisconsin-Madison. David’s focus for the past decade has been on the challenges of early identification and intervention for risky drinking, particularly in primary care settings.