Brief Intervention And Brief Therapies For Substance Abuse

Substance Abuse and Mental Health Services AdministrationCenter for Su stance A use TreatmentBrief Interventions ndBrief Ther pies forSubst nce Abuse34Treatment Improvement Protocol (TIP) Series

Brief Interventionsand BriefTherapiesFor SubstanceAbuseTreatment Improvement Protocol (TIP) Series34U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services Administration1 Choke Cherry RoadRockville, MD 20857

AcknowledgmentsThis publication was prepared under contractnumber 270-95-0013 for the Substance Abuseand Mental Health Services Administration(SAMHSA), U.S. Department of Health andHuman Services (HHS). Sandra Clunies, M.S.,I.C.A.D.C., served as the Contracting Officer’sRepresentative.Electronic Access and Printed CopiesThis publication may be ordered for free fromSAMHSA’s Publications Ordering Web page athttp://store.samhsa.gov. Or, please callSAMHSA at 1-877-SAMHSA-7 (1-877-726-4727)(English and Español). The document can bedownloaded from the KAP Web site athttp://kap.samhsa.gov.DisclaimerThe opinions expressed herein are the views ofthe consensus panel members and do notnecessarily reflect the official position ofSAMHSA or HHS. No official support of orendorsement by SAMHSA or HHS for theseopinions or for the instruments or resourcesdescribed are intended or should be inferred.The guidelines presented should not beconsidered substitutes for individualized clientcare and treatment decisions.Recommended CitationCenter for Substance Abuse Treatment. BriefInterventions and Brief Therapies for SubstanceAbuse. Treatment Improvement Protocol (TIP)Series, No. 34. HHS Publication No. (SMA) 123952. Rockville, MD: Substance Abuse andMental Health Services Administration, 1999.Public Domain NoticeAll materials appearing in this volume exceptthose taken directly from copyrighted sourcesare in the public domain and may bereproduced or copied without permission fromSAMHSA or the authors. Citation of the sourceis appreciated. However, this publication maynot be reproduced or distributed for a feewithout the specific, written authorization of theOffice of Communications, SAMHSA, HHS.iiOriginating OfficeQuality Improvement and WorkforceDevelopment Branch, Division of ServicesImprovement, Center for Substance AbuseTreatment, Substance Abuse and Mental HealthServices Administration, 1 Choke Cherry Road,Rockville, MD 20857.HHS Publication No. (SMA) 12-3952First Printed 1999Revised 2002, 2003, 2004, 2007, 2009, 2011, and2012

ContentsWhat Is a TIP?. viiEditorial Advisory Board. ixConsensus Panel . xiForeword. xiiiExecutive Summary and Recommendations . xvSummary and Recommendations. xviChapter 1—Introduction to Brief Interventions and Therapies .1An Overview of Brief Interventions .3An Overview of Brief Therapies . 7The Demand for Brief Interventions and Therapies.8Barriers to Increasing the Use of Brief Treatments .10Evaluating Brief Interventions and Therapies .11Chapter 2—Brief Interventions in Substance Abuse Treatment .13Stages-of-Change Model .14Goals of Brief Intervention.16Components of Brief Interventions .18Brief Intervention Workbooks .24Essential Knowledge and Skills for Brief Interventions .25Brief Interventions in Substance Abuse Treatment Programs .27Brief Interventions Outside Substance Abuse Treatment Settings.28Research Findings .30Chapter 3—Brief Therapy in Substance Abuse Treatment.37Research Findings .38When To Use Brief Therapy .39Approaches to Brief Therapy .41Components of Effective Brief Therapy .41Therapist Characteristics.49iii

ContentsChapter 4—Brief Cognitive–Behavioral Therapy.51Behavioral Theory .51Behavioral Therapy Techniques Based on Classical Conditioning Models .53Behavioral Therapy Techniques Based on Operant Learning Models .55Cognitive Theory .61Cognitive Therapy .63Cognitive–Behavioral Theory.68Cognitive–Behavioral Therapy .77Chapter 5—Brief Strategic/Interactional Therapies .87Solution-Focused Therapy for Substance Abuse .88Compatibility of Strategic/Interactional Therapies and 12-Step Programs .89When To Use Strategic/Interactional Therapies .90Case Study .92Strategic/Interactional Therapies .99Chapter 6—Brief Humanistic and Existential Therapies .105Using Humanistic and Existential Therapies .106The Humanistic Approach to Therapy .109The Existential Approach to Therapy .117Chapter 7—Brief Psychodynamic Therapy .121Background .121Introduction to Brief Psychodynamic Therapy.122Psychodynamic Psychotherapy for Substance Abuse .123Psychodynamic Concepts Useful in Substance Abuse Treatment .128Transference. 131Models of Brief Psychodynamic Therapy .135Other Research . 140Chapter 8—Brief Family Therapy.143Appropriateness of Brief Family Therapy . 144Definitions of “Family” . 145Theoretical Approaches . 147Using Brief Family Therapies . 152Followup . 154Cultural Issues . 154Chapter 9—Time-Limited Group Therapy .157Appropriateness of Group Therapy .157Group Therapy Approaches . 158Theories of Group Therapy .160Use of Psychodrama Techniques in a Group Setting . 164Therapeutic Factors . 166Using Time-Limited Group Therapy .168iv

ContentsAppendix A—Bibliography.173Appendix B—Information and Training Resources .209General Brief Therapy . 209Cognitive–Behavioral Therapy .209Strategic/Interactional Therapies .210Humanistic and Existential Therapies .211Psychodynamic Therapy. 213Family Therapy . 213Group Therapy . 214Appendix C—Glossary .215Appendix D—Health Promotion Workbook .221Part 1: Summary of Health Habits.221Part 2: Types of Drinkers in the U.S. Population . 222Part 3: Consequences of Heavy Drinking .223Part 4: Reasons To Quit or Cut Down on Your Drinking .224Part 5: Drinking Agreement .225Part 6: Handling Risky Situations .227Appendix E—Resource Panel .229Appendix F—Field 2-92-103-13-23-33-43-54-1Substance Abuse Severity and Level of Care .4Goal of Brief Interventions According to Setting.6The Stages of Change .15Sample Objectives .16American Society of Addiction Medicine (ASAM) Patient Placement Criteria.18FRAMES .19Scripts for Brief Intervention.20Screening for Brief Interventions for Alcoholism .22Client Feedback and Plan of Action.23Talking About Change at Different Stages .24Steps in Active Listening .26Professionals Outside of Substance Abuse Treatment Who Can AdministerBrief Interventions .28Criteria for Longer Term Treatment .39Selected Criteria for Providing Brief Therapy .40Approaches to Brief Therapy .42Characteristics of All Brief Therapies .44Sample Battery of Brief Assessment Instruments .45Classical Conditioning and Operant Learning .52v

ic Assumptions of Behavioral Theories of Substance Abuse and Its Treatment . 53Advantages of Behavioral Theories in Treating Substance Abuse Disorders .54Functional Analysis . 56Teaching Stress Management . 60Programmed Therapy and Writing Therapy.61The Relationship Among Factors Maintaining Behavior in Behavioral andCognitive Models . 62Fifteen Common Cognitive Errors .63Characteristic Thinking of People With Substance Abuse Disorders .64Common Irrational Beliefs About Alcohol and Drugs With More Rational Alternatives .65Thoughts, Feelings, and Behaviors .66Introducing Cognitive Therapy: A Sample Script . 67Common Elements of Brief Cognitive Behavioral Therapies.69Attributional Styles . 70Relapse Prevention Model Based on Self-Efficacy Theory .

Center for Substance buse Treatment . Brief Interventions and Brief Therapies for Substance buse . Treatment Improvement Protocol (TIP) Series . 34 . Brief Interventions and Brief Therapies. For Substance . Abuse. Treatment Improvement Protocol (TIP) Series . 34. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration . 1 Choke Cherry Road .