Substance Abuse and Mental Health Services Administration Center for Su stance A use Treatment Brief Interventions nd Brief Ther pies for Subst nce Abuse 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 Rockville, MD 20857 Acknowledgments Electronic Access and Printed Copies This publication was prepared under contract This publication may be ordered for free from number 270-95-0013 for the Substance Abuse SAMHSA’s Publications Ordering Web page at and Mental Health Services Administration http://store.samhsa.gov. Or, please call (SAMHSA), U.S. Department of Health and SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) Human Services (HHS). Sandra Clunies, M.S., (English and Espaol). The document can be I.C.A.D.C., served as the Contracting Officer’s downloaded from the KAP Web site at Representative. http://kap.samhsa.gov. Disclaimer Recommended Citation The opinions expressed herein are the views of Center for Substance Abuse Treatment. Brief the consensus panel members and do not Interventions and Brief Therapies for Substance necessarily reflect the official position of Abuse. Treatment Improvement Protocol (TIP) SAMHSA or HHS. No official support of or Series, No. 34. HHS Publication No. (SMA) 12- endorsement by SAMHSA or HHS for these 3952. Rockville, MD: Substance Abuse and opinions or for the instruments or resources Mental Health Services Administration, 1999. described are intended or should be inferred. The guidelines presented should not be Originating Office considered substitutes for individualized client Quality Improvement and Workforce care and treatment decisions. Development Branch, Division of Services Improvement, Center for Substance Abuse Public Domain Notice Treatment, Substance Abuse and Mental Health All materials appearing in this volume except Services Administration, 1 Choke Cherry Road, those taken directly from copyrighted sources Rockville, MD 20857. are in the public domain and may be reproduced or copied without permission from HHS Publication No. (SMA) 12-3952 SAMHSA or the authors. Citation of the source First Printed 1999 is appreciated. However, this publication may Revised 2002, 2003, 2004, 2007, 2009, 2011, and not be reproduced or distributed for a fee 2012 without the specific, written authorization of the Office of Communications, SAMHSA, HHS. 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 2—Brief 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 3—Brief 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 4—Brief Cognitive–Behavioral Therapy..............................................................................................51 Behavioral Theory ............................................................................................................................................... 51 Behavioral Therapy Techniques Based on Classical Conditioning Models ................................................53 Behavioral Therapy Techniques Based on Operant Learning Models ........................................................55 Cognitive Theory ................................................................................................................................................ 61 Cognitive Therapy .............................................................................................................................................. 63 Cognitive–Behavioral Theory ............................................................................................................................68 Cognitive–Behavioral Therapy .........................................................................................................................77 Chapter 5—Brief Strategic/Interactional Therapies ..........................................................................................87 Solution-Focused Therapy for Substance Abuse ............................................................................................ 88 Compatibility of Strategic/Interactional Therapies and 12-Step Programs ...............................................89 When To Use Strategic/Interactional Therapies ............................................................................................90 Case Study ........................................................................................................................................................... 92 Strategic/Interactional Therapies .....................................................................................................................99 Chapter 6—Brief Humanistic and Existential Therapies ...............................................................................105 Using Humanistic and Existential Therapies ................................................................................................106 The Humanistic Approach to Therapy ..........................................................................................................109 The Existential Approach to Therapy ............................................................................................................117 Chapter 7—Brief Psychodynamic Therapy .......................................................................................................121 Background ........................................................................................................................................................ 121 Introduction