TIP 34: Brief Interventions and Brief Therapies for Substance Abuse

384 Pages·2009·3.09 MB·English

by  Alicia Fayne

TIP 34: Brief Interventions and Brief
Therapies for Substance Abuse: Treatment
Improvement Protocol (TIP) Series 34
A59192
Kristen Lawton Barry, Ph.D.
Consensus Panel Chair
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
Rockwall II, 5600 Fishers Lane
Rockville, MD 20857
DHHS Publication No. (SMA) 99-3353
Printed 1999
Link to the National Guideline Clearinghouse
Disclaimer
This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical
assistance program. All material appearing in this volume except that taken directly from
copyrighted sources is in the public domain and may be reproduced or copied without permission
from the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for
Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated.
This publication was written under contract number 270-95-0013 with The CDM Group, Inc.
(CDM). Sandra Clunies, M.S., I.C.A.D.C., served as the CSAT government project officer. Rose
M. Urban, L.C.S.W., J.D., C.C.A.S., served as the CDM TIPs project director. Other CDM TIPs
personnel included Raquel Ingraham, M.S., project manager; Jonathan Max Gilbert, M.A.,
managing editor; Janet G. Humphrey, M.A., editor/writer; Cara Smith, production editor; Erica
Flick, editorial assistant; Y-Lang Nguyen, former production editor; and Paul Seaman, former
editorial assistant. Special thanks go to consulting writers Scott M. Buchanan, M.S.Ed.; Dennis
M. Donovan, Ph.D.; Jeffrey M. Georgi, M.Div.; Delinda E. Mercer, Ph.D.; Larry Schor, Ph.D.; and
George E. Woody, M.D.
The opinions expressed herein are the views of the Consensus Panel members and do not reflect
the official position of CSAT, SAMHSA, or the U.S. Department of Health and Human Services
(DHHS). No official support or endorsement of CSAT, SAMHSA, or DHHS for these opinions or for
particular instruments or software that may be described in this document is intended or should
be inferred. The guidelines proffered in this document should not be considered as substitutes for
individualized client care and treatment decisions.
What Is a TIP?
Treatment Improvement Protocols (TIPs) are best practice guidelines for the treatment of
substance abuse disorders, provided as a service of the Substance Abuse and Mental Health
Services Administration's Center for Substance Abuse Treatment (CSAT). CSAT's Office of
Evaluation, Scientific Analysis and Synthesis draws on the experience and knowledge of clinical,
research, and administrative experts to produce the TIPs, which are distributed to a growing
number of facilities and individuals across the country. The audience for the TIPs is expanding
beyond public and private substance abuse treatment facilities as alcoholism and other
substance abuse disorders are increasingly recognized as major problems.
The TIPs Editorial Advisory Board, a distinguished group of substance abuse experts and
professionals in such related fields as primary care, mental health, and social services, works
with the State Alcohol and Other Drug Abuse Directors to generate topics for the TIPs based on
the field's current needs for information and guidance.
After selecting a topic, CSAT invites staff from pertinent Federal agencies and national
organizations to a Resource Panel that recommends specific areas of focus as well as resources
that should be considered in developing the content of the TIP. Then recommendations are
communicated to a Consensus Panel composed of non-Federal experts on the topic who have
been nominated by their peers. This Panel participates in a series of discussions; the information
and recommendations on which it reaches consensus form the foundation of the TIP. The
members of each Consensus Panel represent substance abuse treatment programs, hospitals,
community health centers, counseling programs, criminal justice and child welfare agencies, and
private practitioners. A Panel Chair (or Co-Chairs) ensures that the guidelines mirror the results
of the group's collaboration.
A large and diverse group of experts closely reviews the draft document. Once the changes
recommended by these field reviewers have been incorporated, the TIP is prepared for
publication, in print and online. The TIPs can be accessed via the Internet on the National Library
of Medicine's home page at the URL: http://text.nlm.nih.gov. The move to electronic media also
means that the TIPs can be updated more easily so they continue to provide the field with state-
of-the-art information.
Although each TIP strives to include an evidence base for the practices it recommends, CSAT
recognizes that the field of substance abuse treatment is evolving and that research frequently
lags behind the innovations pioneered in the field. A major goal of each TIP is to convey "front
line" information quickly but responsibly. For this reason, recommendations proffered in the TIP
are attributed to either Panelists' clinical experience or the literature. If there is research to
support a particular approach, citations are provided.
This TIP, Brief Interventions and Brief Therapies for Substance Abuse, is intended primarily for
counselors and therapists working in the substance abuse treatment field, but parts of it will be
of value to other audiences, including health care workers, social services providers, clergy,
teachers, and criminal justice personnel. In fact, those portions of this TIP dealing with brief
interventions will be of use to any professional service provider who may need to make an
intervention to help persons with substance abuse disorders alter their use patterns or seek
treatment. However, brief therapy should only be practiced by those who are properly qualified,
educated, and licensed.
The first chapter of this TIP presents an overview of brief interventions and brief therapies,
describing their basic characteristics and the reasons for increased interest in them. Chapter 2
describes the goals and components of brief interventions, and Chapter 3 discusses some of the
basic elements of all brief therapies. Chapters 4 through 9 each highlight a different type of brief
therapy, describing the theory behind it as well as some of the techniques developed from that
theory that can be used to treat clients with substance abuse disorders. Separate chapters are
presented describing cognitive-behavioral therapy, strategic/interactional therapies, humanistic
and existential therapies, psychodynamic therapies, family therapy, and group therapy.
Appendixes are also included that provide resources for further information and training, a
glossary of terms used in the TIP, and a sample workbook for use in brief interventions.
The goal of this TIP is to make readers aware of the research, results, and promise of brief
interventions and brief therapies in the hope that they will be used more widely in clinical
practice and treatment programs across the United States.
Other TIPs may be ordered by contacting SAMHSA's National Clearinghouse for Alcohol and Drug
Information (NCADI), [phone] or [phone]; TDD (for hearing impaired), (800)
487-4889.
Contents
Editorial Advisory Board
Consensus Panel
Foreword
Executive Summary and Recommendations
Chapter 1—Introduction to Brief Interventions and Therapies
Chapter 2—Brief Interventions in Substance Abuse Treatment
Chapter 3—Brief Therapy in Substance Abuse Treatment
Chapter 4—Brief Cognitive-Behavioral Therapy
Chapter 5—Brief Strategic/Interactional Therapies
Chapter 6 --Brief Humanistic and Existential Therapies
Chapter 7—Brief Psychodynamic Therapy
Chapter 8—Brief Family Therapy
Chapter 9—Time-Limited Group Therapy
Appendices
Editorial Advisory Board
Karen Allen, Ph.D., R.N., C.A.R.N.
Professor and Chair
Department of Nursing
Andrews University
Berrien Springs, Michigan
Richard L. Brown, M.D., M.P.H.
Associate Professor
Department of Family Medicine
University of Wisconsin School of Medicine
Madison, Wisconsin
Dorynne Czechowicz, M.D.
Associate Director
Medical/Professional Affairs
Treatment Research Branch
Division of Clinical and Services Research
National Institute on Drug Abuse
Rockville, Maryland
Linda S. Foley, M.A.
Former Director
Project for Addiction Counselor Training
National Association of State Alcohol and Drug Abuse Directors
Washington, D.C.
Wayde A. Glover, M.I.S., N.C.A.C. II
Director
Commonwealth Addictions Consultants and Trainers
Richmond, Virginia
Pedro J. Greer, M.D.
Assistant Dean for Homeless Education
University of Miami School of Medicine
Miami, Florida
Thomas W. Hester, M.D.
Former State Director
Substance Abuse Services
Division of Mental Health, Mental Retardation and Substance Abuse
Georgia Department of Human Resources
Atlanta, Georgia
James G. (Gil) Hill, Ph.D.
Director
Office of Substance Abuse
American Psychological Association
Washington, D.C.
Douglas B. Kamerow, M.D., M.P.H.
Director
Office of the Forum for Quality and Effectiveness in Health Care
Agency for Health Care Policy and Research
Rockville, Maryland
Stephen W. Long
Director
Office of Policy Analysis
National Institute on Alcohol Abuse and Alcoholism
Rockville, Maryland
Richard A. Rawson, Ph.D.
Executive Director
Matrix Center and Matrix Institute on Addiction
Deputy Director, UCLA Addiction Medicine Services
Los Angeles, California
Ellen A. Renz, Ph.D.
Former Vice President of Clinical Systems
MEDCO Behavioral Care Corporation
Kamuela, Hawaii
Richard K. Ries, M.D.
Director and Associate Professor
Outpatient Mental Health Services and Dual Disorder Programs
Harborview Medical Center
Seattle, Washington
Sidney H. Schnoll, M.D., Ph.D.
Chairman
Division of Substance Abuse Medicine
Medical College of Virginia
Richmond, Virginia
Consensus Panel
Chair
Kristen Lawton Barry, Ph.D.
Associate Research Scientist
Alcohol Research Center
University of Michigan
Ann Arbor, Michigan
Workgroup Leaders
Christopher W. Dunn, Ph.D., M.A.C., C.D.C.
Psychiatry and Behavioral Science
University of Washington
Seattle, Washington
Jerry P. Flanzer, D.S.W., L.C.S.W., C.A.C.
Director
Recovery and Family Treatment, Inc.
Alexandria, Virginia
Stephen Gedo, Ph.D.
Clinical Psychologist
Gaffney, South Carolina
Eugene Herrington, Ph.D.
Associate Professor
Department of Counseling and Psychological Services
Clark Atlanta University
Atlanta, Georgia
Fredrick Rotgers, Psy.D.
Director
Program for Addictions Consultation and Treatment
Center of Alcohol Studies
Rutgers University
New Brunswick, New Jersey
Terry Soo-Hoo, Ph.D.
Clinic Director/Assistant Professor
Counseling Psychology Department
University of San Francisco
San Francisco, California
Panelists
Janice S. Bennett, M.S., C.S.A.C.
Owner/Consultant
Pacific Consulting and Training Services of Hawaii
Honolulu, Hawaii
Robert L. Chapman, M.S.S.W., C.A.D.O.A.C., C.R.P.S.
Cumberland Heights
Nashville, Tennessee
John W. Herdman, Ph.D., C.A.D.A.C.
Psychologist
The Encouragement Place
Lincoln, Nebraska
Fanny G. Nicholson, C.C.S.W., A.C.S.W., N.C.A.C.I., C.S.A.E.
Alcohol and Drug Specialist
Oconaluftee Job Corps
Cherokee, North Carolina
Mary Alice Orito, C.S.W., C.A.S.A.C., N.C.A.C.I.
Evaluation Supervisor
Stuyvesant Square Outpatient Services for Chemical Dependency
New York, New York
Jerome J. Platt, Ph.D.
Professor of Psychiatry and Public Health
Director, Institute for Addictive Disorders
Hahnemann School of Medicine
Allegheny University of the Health Sciences
Philadelphia, Pennsylvania
Marilyn Sawyer Sommers, Ph.D., R.N.
Professor
College of Nursing
University of Cincinnati
Cincinnati, Ohio
José Luis Soria, M.A., L.C.D.C., I.C.A.D.C., C.C.G.C., C.A.D.A.C.
Clinical Deputy Director
Aliviane NO-AD, Inc.
El Paso, Texas
Ava H. Stanley, M.D.
Somerset, New Jersey
Robert S. Stephens, Ph.D.
Associate Professor
Department of Psychology
Virginia Polytechnic Institute and State University
Blacksburg, Virginia
Foreword
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*
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The Treatment Improvement Protocol (TIP) series fulfills SAMHSA/CSAT's mission to improve
treatment of substance abuse by providing best practices guidance to clinicians, program
administrators, and payors. TIPs are the result of careful consideration of all relevant clinical and
health services research findings, demonstration experience, and implementation requirements.
A panel of non-Federal clinical researchers, clinicians, program administrators, and client
advocates debates and discusses its particular areas of expertise until it reaches consensus on
best practices. This panel's work is then reviewed and critiqued by field reviewers.
The talent, dedication, and hard work that TIPs panelists and reviewers bring to this highly
participatory process have bridged the gap between the promise of research and the needs of
practicing clinicians and administrators. We are grateful to all who have joined with us to
contribute to advances in the substance abuse treatment field.
Nelba Chavez, Ph.D.
Administrator
Substance Abuse and Mental Health Services Administration

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM
Director
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration