Brief Interventions and Brief Therapies for Substance Abuse. Treatment Improvement Protocol (TIP ...

259 Pages·2012·3.38 MB·English

DOCUMENT RESUME
ED 443 041
CG 030 101
TITLE
Brief Interventions and Brief Therapies for Substance Abuse.
Treatment Improvement Protocol (TIP) Series 34.
INSTITUTION
CDM Group, Inc.; Substance Abuse and Mental Health Services
Administration (DHHS/PHS), Rockville, MD. Center for
Substance Abuse Treatment.
REPORT NO
SMA-99-3353
PUB DATE
1999-00-00
NOTE
258p.; For other documents in the TIP Series, see CG 030
099-103 and CG 030 130-134.
CONTRACT
270-95-0013
AVAILABLE FROM
National Clearinghouse for Alcohol and Drug Information,
P.O. Box 2345, Rockville, MD 20847-2345. Tel: [phone]
(Toll Free).
PUB TYPE
Guides
Non-Classroom (055)
Information Analyses (070)
-- Tests/Questionnaires (160)
EDRS PRICE
MF01/PC11 Plus Postage.
DESCRIPTORS
At Risk Persons; *Behavior Modification; Cognitive
Restructuring; Counseling Effectiveness; Counselor Training;
*Drug Rehabilitation; Group Therapy; *Intervention; Mental
Health; *Outcomes of Treatment; *Substance Abuse
IDENTIFIERS
Humanistic Psychology; *Solution Focused Brief Therapy
ABSTRACT
This TIP, on the best practice guidelines for treatment of
substance use disorders, was compiled from an increasing body of research
literature that documents the effectiveness of brief interventions and
therapies in both the mental health and substance abuse treatment fields.
It
links research to practice by providing counselors with up-to-date
information on the usefulness of these treatment forms for selected
subpopulations of people with substance abuse disorders or for those at risk.
The manual states that brief interventions and therapies
are less costly, yet
effective, in substance abuse treatment. Brief interventions have been found
to be effective for a range of problems; they can greatly improve substance
abuse treatment by making it available to a greater number of people and by
tailoring the level of treatment to the level of client need. This TIP
includes sections on brief interventions and therapy in substance abuse
treatment, along with sections on brief therapies in the fields of
cognitive-behavioral, strategic/interactional, humanistic and existential,
psychodynamic, family, and group counseling. Appendixes include
"Bibliography," "Information and Training Resources,"
" Glossary," "Health
Promotion Workbook," "Resource Panel," and "Field Reviewers." (Contains
43
figures and approximately 450 resources.)
(JDM)
Reproductions supplied by EDRS are the best that can be made
from the original document.
Substance Abuse and Mental Health Services Administration
US. DEPARTMENT
AND
OF
HUMAN SERVICES
Public Health Service
Center for Substance Abuse Treatment
Substance Abuse and
Mental Health Services
Administration
Brief
Interventions
And
rief Therapies
For Substance
Abuse
Treatment Improvement Protocol (TIP) Series
34
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U.S. DEPARTMENT OF EDUCATION
Mice of Educational Research and Improvement
EDUCATIONAL RESOURCES INFORMATION
CENTER (ERIC)
This document has been reproduced
as
received from the person or organization
originating it.
Minor changes have been made to
improve reproduction quality.
BEST COPY AVAILABLE
Points of view or opinions stated in this
document do not necessarily represent
official OERI position or policy.
Screening and Brief Interventions
for Alcoholism
Screen
At each visit, ask about alcohol use
How many drinks per week?
Maximum drinks per occasion in past
0
month?
CA
CIJ
Use CAGE questions to probe for alcohol
problems
Have you ever tried to Cut down on your
(-4
drinking?
sZt
Do you get Annoyed when people talk
about your drinking?
et:
Do you feel Guilty about your drinking?
cn
Have you ever had an Eye-opener? (A drink
first thing in the morning)
Screen is positive if
4'4
Consumption is greater than 14 drinks per
4.1
week or greater than 4 drinks per occasion
cu
(men)
Consumption is greater than 7 drinks per
M re)
week or greater than 3 drinks per occasion
(women)
E-4
CAGE score is greater than 1
Then assess for
°
Medical problems: e.g., blackouts, depression,
4.6
hypertension, trauma, abdominal pain, liver
dysfunction, sexual problems, sleep disor-
o
ders
;4..
Laboratory: elevated gamma-glutamyl
transpeptidase or other liver function tests;
elevated mean corpuscular volume; posi-
tive blood alcohol concentrations
Behavioral problems: work, family, school,
Et
accidents
E-4
Alcohol dependence: a score of 3 or higher on
(./)
CAGE or one or more of the following:
compulsion to drink, impaired control,
withdrawal symptoms, increased tolerance,
relief drinking
a
Client Feedback and Plan of Action
Give specific feedback to the patient,
then advisein a firm but empathic
w
cn
manner
=
4
et
If diagnosed as at risk
to
co
0
Advise patient of risk
rsi
di'
Advise abstinence/moderation
=
Set consumption goals
cf)
id
Schedule followup to discuss progress
0
..1-,
Ch
4)
...
t:16
es
PROGRESS
w
or
E.4
,..lo
ctr
'i"."..
DOES NOT SUCCEED
SUCCEEDS
I:2
C
fti
C/3
=
0
.11
CONTINUE FOLLOWUP
.6a.
or
oh,
I1
If diagnosed as substance dependent
.4.4
2
id
Advise patient of objective evidence
02
4
Advise on plan of action
en
Assess acute risk of intoxication/with-
O.,
drawal
E-
Medical/psychiatric comorbidities
8
Agree on plan of action
,...1
2
0
Plan of action
i..
Or
4.
Involve family: refer for family treatment and
CU".
self-help (e.g., Al-Anon, etc.) (must have
E
or
patient permission and involvement)
0
Abstinence should be stressed
z..
=
Urge patient to attend self-help meetings
Zg-
d...
(Alcoholics Anonymous, Narcotics
=
o.)
Anonymous, SMART Recovery, etc.)
t
Consider referral to addiction medicine
cs.),_
specialist, and/or possible pharmaco-
F+
.-4
therapy with disulfiram (Antabuse) or
(l)
U
Naltrexone (Re Via)
Reprinted with permission from the American
Society of Addiction Medicine
4
Brief
Interventions
And Brief
Therapies for
Substance
Abuse
Treatment Improvement Protocol (TIP) Series
34
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
5
former production editor; and Paul Seaman,
This publication is part of the Substance Abuse
former editorial assistant. Special thanks go to
Prevention and Treatment Block Grant technical
consulting writers Scott M. Buchanan, M.S.Ed.;
assistance program. All material appearing in
Dennis M. Donovan, Ph.D.; Jeffrey M. Georgi,
this volume except that taken directly from
M.Div.; Delinda E. Mercer, Ph.D.; Larry Schor,
copyrighted sources is in the public domain and
Ph.D.; and George E. Woody, M.D.
may be reproduced or copied without
permission from the Substance Abuse and
The opinions expressed herein are the views of
Mental Health Services Administration's
the Consensus Panel members and do not reflect
(SAMHSA) Center for Substance Abuse
the official position of CSAT, SAMHSA, or the
Treatment (CSAT) or the authors. Citation of
U.S. Department of Health and Human Services
the source is appreciated.
(DHHS). No official support or endorsement of
CSAT, SAMHSA, or DHHS for these opinions or
This publication was written under contract
for particular instruments or software that may
number
with The CDM Group, Inc.
270-95-0013
be described in this document is intended or
(CDM). Sandra Clunies, M.S., I.C.A.D.C., served
should be inferred. The guidelines proffered in
as the CSAT government project officer. Rose
this document should not be considered as
M. Urban, L.C.S.W., J.D., C.C.A.S., served as the
substitutes for individualized client care and
CDM TIPs project director. Other CDM TIPs
treatment decisions.
personnel included Raquel Ingraham, M.S.,
project manager; Jonathan Max Gilbert, M.A.,
DHHS Publication No. (SMA)
99-3353
managing editor; Janet G. Humphrey, M.A.,
Printed
1999
editor/writer; Cara Smith, production editor;
Erica Flick, editorial assistant; Y-Lang Nguyen,
6
ii
Contents
What Is a TIP?
vii
Editorial Advisory Board
ix
Consensus Panel
xi
Foreword
xiii
Executive Summary and Recommendations
xv
Summary and Recommendations
xvi
Chapter 1 Introduction to Brief Interventions and Therapies
1
An Overview of Brief Interventions
3
An Overview of Brief Therapies
7
The Demand for Brief Interventions and Therapies
8
Barriers to Increasing the Use of Brief Treatments
10
Evaluating Brief Interventions and Therapies
11
Chapter 2Brief Interventions in Substance Abuse Treatment
13
Stages-of-Change Model
14
Goals of Brief Intervention
16
Components of Brief Interventions
18
Brief Intervention Workbooks
24
Essential Knowledge and Skills for Brief Interventions
25
Brief Interventions in Substance Abuse Treatment Programs
27
Brief Interventions Outside Substance Abuse Treatment Settings
28
Research Findings
30
Chapter 3Brief Therapy in Substance Abuse Treatment
37
Research Findings
38
When To Use Brief Therapy
39
Approaches to Brief Therapy
41
Components of Effective Brief Therapy
41
Therapist Characteristics
49
iii
Contents
Chapter 4Brief Cognitive-Behavioral Therapy
51
51
Behavioral Theory
53
Behavioral Therapy Techniques Based on Classical Conditioning Models
55
Behavioral Therapy Techniques Based on Operant Learning Models
61
Cognitive Theory
63
Cognitive Therapy
68
Cognitive-Behavioral Theory
77
Cognitive-Behavioral Therapy
87
Chapter 5Brief Strategic/Interactional Therapies
88
Solution-Focused Therapy for Substance Abuse
Compatibility of Strategic/Interactional Therapies and 12-Step Programs
89
90
When To Use Strategic/Interactional Therapies
92
Case Study
99
Strategic/Interactional Therapies
Chapter 6Brief Humanistic and Existential Therapies
105
106
Using Humanistic and Existential Therapies
109
The Humanistic Approach to Therapy
117
The Existential Approach to Therapy
Chapter 7Brief Psychodynamic Therapy
121
121
Background
122
Introduction to Brief Psychodynamic Therapy
123
Psychodynamic Psychotherapy for Substance Abuse
128
Psychodynamic Concepts Useful in Substance Abuse Treatment
131
Transference
135
Models of Brief Psychodynamic Therapy
140
Other Research
143
Chapter 8Brief Family Therapy
144
Appropriateness of Brief Family Therapy
145
Definitions of "Family"
147
Theoretical Approaches
152
Using Brief Family Therapies
154
Follow up
154
Cultural Issues
Chapter 9Time-Limited Group Therapy
157
157
Appropriateness of Group Therapy
158
Group Therapy Approaches
160
Theories of Group Therapy
164
Use of Psychodrama Techniques in a Group Setting
166
Therapeutic Factors
168
Using Time-Limited Group Therapy
iv
Contents
Appendix ABibliography
173
Appendix BInformation and Training Resources
209
General Brief Therapy
209
CognitiveBehavioral Therapy
209
Strategic/Interactional Therapies
210
Humanistic and Existential Therapies
211
Psychodynamic Therapy
213
Family Therapy
213
Group Therapy
214
Appendix CGlossary
215
Appendix DHealth Promotion Workbook
221
Part 1: Summary of Health Habits
221
Part 2: Types of Drinkers in the U.S. Population
222
Part 3: Consequences of Heavy Drinking
223
Part 4: Reasons To Quit or Cut Down on Your Drinking
224
Part 5: Drinking Agreement
225
Part 6: Handling Risky Situations
-227
Appendix EResource Panel
229
Appendix FField Reviewers
231
Figures
Substance Abuse Severity and Level of Care
4
1-1
Goal of Brief Interventions According to Setting
1-2
6
The Stages of Change
2-1
15
Sample Objectives
2-2
16
American Society of Addiction Medicine (ASAM) Patient Placement Criteria
2-3
18
2-4 FRAMES
19
Scripts for Brief Intervention
2-5
20
Screening for Brief Interventions for Alcoholism
2-6
22
Client Feedback and Plan of Action
2-7
23
Talking About Change at Different Stages
2-8
24
Steps in Active Listening
2-9
26
2-10 Professionals Outside of Substance Abuse Treatment Who Can Administer
Brief Interventions
28
Criteria for Longer Term Treatment
39
3-1
Selected Criteria for Providing Brief Therapy
3-2
40
Approaches to Brief Therapy
3-3
42
Characteristics of All Brief Therapies
44
3-4
Sample Battery of Brief Assessment Instruments
3-5
45
Classical Conditioning and Operant Learning
52
4-1
Contents
Basic Assumptions of Behavioral Theories of Substance Abuse and Its Treatment
53
4-2
Advantages of Behavioral Theories in Treating Substance Abuse Disorders
54
4-3
Functional Analysis
56
4-4
Teaching Stress Management
60
4-5
4-6 Programmed Therapy and Writing Therapy
61
4-7 The Relationship Among Factors Maintaining Behavior in Behavioral and
Cognitive Models
62
Fifteen Common Cognitive Errors
63
4-8
Characteristic Thinking of People With Substance Abuse Disorders
64
4-9
4-10 Common Irrational Beliefs About Alcohol and Drugs With More Rational Alternatives
65
4-11 Thoughts, Feelings, and Behaviors
66
4-12 Introducing Cognitive Therapy: A Sample Script
67
4-13 Common Elements of Brief CognitiveBehavioral Therapies
69
4-14 Attributional Styles
70
4-15 Relapse Prevention Model Based on Self-Efficacy Theory
73
4-16 Taxonomy of High-Risk Situations Based on Marlatt's Original
Categorization System
75
4-17 A CognitiveBehavioral Model of the Relapse Process
76
4-18 Essential and Unique Elements of CognitiveBehavioral Interventions
78
4-19 Intrapersonal and Interpersonal Skills Training Elements
80
4-20 Assertiveness Training
80
4-21 Types of Clients for Whom Outpatient CBT Is Generally Not Appropriate
85
Deliberate and Random Exceptions to Substance Abuse Behaviors
89
5-1
Strategic/Interactional Therapy in Practice: A Case Study
93
5-2
6-1 A Case Study
111
Defense Mechanisms
132
7-1
Brief Psychodynamic Therapy
136
7-2
1.0
vi