The brilliance of opportunistic interventions

For almost the last 8 years of my life, I've worked as a specialist nurse in the field of substance misuse (alcohol and other drugs).  However I've done this work in a relatively unusual setting (though one which is thankfully becoming less unusual as its potential is increasingly realised); that of the general hospital as opposed to in the community.

My work is extremely rewarding, I am passionate about the role and its effectiveness; so contrary to what a number of people may believe, the job - whilst undoubtedly challenging at times - is certainly not "depressing" or filled with a continual procession of people who "don't want to change" or who are "hopeless cases."  Sadly there are a small number of people who I see on a number of occasions but even then to regard people in the negative terms you often hear is at best unfair and at worst hopelessly inadequate; the way I see it is that people take differing lengths of time to place sufficient value on aspects of their lifestyle and as such take varying lengths of time to decide to make changes / make sufficient changes.

The main differences between my work and that of workers in community settings are firstly that the people I see have an active physical health problem that may or may not be related to their substance use; this health problem is so severe that hospitalisation is required.  Secondly and crucially they are not actively seeking support or advice at the time of their admission to hospital.  Indeed the first time they often become aware that support is available to them is when I arrive at their bed-side.

The majority of my interventions are therefore highly opportunistic; I am required to have a range of specialist skills in initial engagement in order to take advantage of what has rightly been coined "the teachable moment."  Over the years of doing this job I have come to realise that using this moment to its fullest potential can often be a crucial component of an individual's recovery; it can be the "light-bulb" moment when the person begins to truly see the negative consequences of their substance use and more importantly acknowledge that something needs to change.

Taking advantage of moments when people are the most receptive to behaviour change messages is key to our success as substance misuse workers or indeed anyone engaged in the area of promoting behaviour / lifestyle change.  Using these moments to foster belief, optimism and hope in an individual is paramount.

Having someone who believes in you and the changes that you can make is a powerful thing.

Having said that these moments can be fleeting and therefore it is vital that they are recognised and valued as soon as they occur and regarded highly; they can represent a significant turning point in a person's life.

The evidence base for the effectiveness of such interventions is now so strong (around 30 years worth) that their value cannot be disputed.  In spite of this health professionals generally receive little or no training in delivering brief advice; as such they frequently fall back upon out-dated and inaccurate stereotypes; a version of the world where people don't change because they either don't want to or are incapable of it.  The greater esteem in which such interventions are held, the better for people who would benefit from them.

In almost 8 years I've seen on too many occasions to count (I estimate that I've now seen around 5000 individuals), the value of talking to people about their lifestyles at times when they've not necessarily requested such advice or support but who are receptive to such messages because of their situation.  This of course doesn't have to be due to physical ill health, this concept can readily be applied to any number of settings.

What is key is using the 'teachable moment' to its fullest potential and empowering people with the belief that they can make positive changes to their lives.