Brief Intervention for Adolescent Alcohol and Drug Use Manual Ken Winters, Ph.D., Andria Botzet, M.A., Tamara Fahnhorst M.P.H., & Willa Leitten, M.A. Center for Adolescent Substance Abuse Research University of Minnesota, 2006 1 Table of Contents I. User Information and Development of Brief Intervention…….. 3 II. Adolescent Therapy Session One………………………………… 19 III. Adolescent Therapy Session Two………………………………… 43 IV. Parent or Guardian Therapy Session……………………………... 53 V. References…………………………………………………………….. 70 VI. Appendix A (Substance-Specific Information)…………………… 73 VII. Appendix B (Supplemental Resources)…………………………… 151 VII. Appendix C (Copy-ready Worksheets) …………………………… 198 All materials in this manual, with the exception of resources included in the appendices, are not reproducible without permission from the author. 2 SECTION I USER INFORMATION & DEVELOPMENT OF BRIEF INTERVENTION 3 Brief Cognitive-Behavioral Intervention Overview # of BCBI Module Sessions Primary Treatment Objectives Rational-Emotive 1 1. Identify activating events for drug use Curriculum a. attending a party where most adolescents use alcohol b. using alcohol or drugs to cope with negative emotions 2. Examine irrational beliefs underlying pros and cons to activating events a. all adolescents use drugs (false perception) b. fun parties always involve drugs (false perception) 3. Develop list of alternate beliefs that promote abstinence a. many adolescents have fun at parties without using drugs b. activities can be rewarding without having alcohol/drug involvement Problem Solving 1 1. Discuss rationale for problem-solving skill development Curriculum 2. Define problem-solving components 3. Apply problem-solving process to develop risk reduction coping skills to: a. identify high-risk situations b. resist peer pressure and handle negative emotions c. generate healthy alternatives to using drugs or alcohol 4. Apply problem-solving process to develop positive coping skills for: a. effective communication b. prosocial peer and family relationships c. academic success Parent Training 1 1. Discuss rationale for BCBI for child 2. Develop skills to encourage effective parenting behaviors a. disciplining attitudes and behaviors b. house rules c. rewards and enforcement 3. Develop skills for supporting parenting behaviors a. family solidarity b. emotional closeness c. providing developmentally appropriate advice 4. Apply parenting skills to home situations 5. Examine personal attitudes and behaviors regarding alcohol and other drug use 4 BRIEF INTERVENTION OVERVIEW The Brief Intervention approach addressed in this manual is based on five premises regarding adolescent substance abuse. First, the gap between treatment need and treatment availability appears to be significantly increasing among adolescents, particularly those who present with mild or moderate substance use behaviors. Low-end severe cases are estimated to represent about 30% of adolescents who present for a drug abuse evaluation in the Twin Cities (Winters, 1999). Second, this gap in service access is in part the result of tightening treatment eligibility criteria by cost-conscious third-party payers. Similarly, lower cost treatment options for less-severe adolescent drug abusers are potentially attractive to cost-conscious manage care systems. Fourth, with some exceptions, brief and relatively inexpensive interventions (i.e. 3 - 4 sessions) have been shown to be as effective as stand-alone therapies for adult substance abusers (see Bien et al., 1993; Center for Substance Abuse Treatment, 2000), and early pilot work with young adults are promising. Fifth, brief interventions are developmentally fitting given that (i) many drug-abusing youth are not “career” drug abusers and thus not amenable to disease-oriented treatment approaches, and (ii) developmentally, young people are likely to be more receptive to self-guided behavior change strategies, a cornerstone of brief interventions (Miller & Sanchez, 1994). This manual describes a 3-session (each session lasting approximately one hour) individual therapy model for use with teenagers (12-19 years old) who are suspected of experiencing mild or moderate problems associated with alcohol or other drug use. Sessions 1 and 2 involve individual counseling with the adolescent; Session 3 involves an individual counseling session with the parent or guardian of the teenager. It is recommended that the three sessions be scheduled such that there is a 10-day interval between Sessions 1 and 2, and a 10-day interval between Sessions 2 and 3. USERS OF BRIEF INTERVENTION This brief intervention is designed for trained professionals, including teachers, school counselors, social workers, psychologists and other youth-serving professionals who are working with drug-abusing teenagers. The techniques presented in this manual are kept simple and concise so that teachers, school counselors, social workers, and other professionals can take advantage of these methods. It is important that the person initiating the intervention be familiar with basic counseling skills, the theories and practices involved, and a basic understanding of the etiology, course and treatment of adolescent alcohol and other drug addiction. This includes knowledge of cognitive- behavioral therapy, motivational interviewing, and the stages of change model. Preferably, users of brief intervention have a certified degree in addiction counseling or a license in a related field of behavioral science. 5 Knowledge about the various drugs and their effects is crucial to implementing this type of intervention. The therapist must pay attention to the physical symptoms and emotional behavioral effects of substance use and abuse. Clarification may be needed to help the adolescents recognize their possible misconceptions about using drugs and their effects. Drug education materials and resources are provided in the appendix of this manual. CLIENTS FOR WHOM BRIEF INTERVENTION IS INTENDED The brief intervention model has been developed for application with teenagers that display the early stages of drug use problems (see Figure 1). That is, the intervention is intended for teenagers who are exhibiting mild or moderate problems associated with alcohol or other drug use. Such early-stage users often meet formal criteria for a substance abuse disorder and show harmful or hazardous consequences of their drug use. For example, the youth may be experiencing problems at school resulting from drug use or is getting into arguments with his or her parents and friends as a result of drug use. Assessments are used prior to the intervention to screen for individuals who would be better suited for other more extensive or specific treatment methods. The U.S. Department of Health and Human Services has provided some criteria for determining the appropriateness of a brief intervention (Center for Substance Abuse Treatment, 1999). The criteria below can assist with identifying participants who are not appropriate for a brief intervention: • Previous treatment failure • Serious drug dependency • Severe psychoses • Hazardous intoxication • Significant withdrawal symptoms This brief intervention will focus on drug abusing adolescents (ages 12- to 19- years old) whose substance use ranges from mild to moderate levels. It is not intended for individuals who are in crisis, or those who require hospitalization for medical or psychiatric circumstances. 6 Figure 1 Severity of Drug Problems None Mild Moderate Severe Specialized Treatment Brief Intervention Primary Prevention Continuum of Response * Adapted from Broadening the Base of Alcohol Treatment, Institute of Medicine, 1990 Figure 1(above) represents a model for exploring how a continuum of care can be applied across a variety of drug use problems. The range of drug use problems is indicated on the top; responses to these problems are illustrated on the bottom. In general, specialized treatments, such as intensive outpatient and residential treatment, are appropriate referrals for youth with severe drug use problems, such as a substance dependence disorder, whereas brief interventions are viewed as an appropriate response for mild-to- moderate users, that is, youth with an substance abuse disorder. POTENTIAL SETTING Schools Brief intervention is appropriate for inclusion in school-based chemical health programs that wish to add more services to supplement extant prevention and education programs. The procedures are a suitable response for students with a mild or moderate drug abuse problem. In a recent study by D’Amico and Fromme (2000), a group of high school students were given a school-based brief intervention in comparison to a group who received the traditional Drug Abuse Resistance Education (DARE) curriculum. Students who had participated in the brief intervention had considerably larger reductions in the frequency of alcohol consumption and drug use versus those who participated in only the DARE program (D’Amico & Fromme, 2000). Juvenile Justice Alcohol and drug abuse is a common factor among adolescent offenders and yet treatment for these problems is not widely available. Thus, a brief intervention, with its focus on reducing resistance to change and increasing participant engagement, can be a valuable 7 tool in this setting. Research has indicated that participants in brief intervention programs have reduced overall criminal behaviors (Hubbard, Craddock, Flynn, Anderson, & Ethridge, 1997). Mental Health Several adolescent studies indicate a strong co-association between psychiatric