Title : KK-tip34 9-04-01ph.qxd (Page 1) Description : Keywords : Author : ----------------------------------------------- KAP KEYS Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse CSAT’s Knowledge Application Program KAP Keys For Clinicians Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment www.samhsa.gov ----------------------------------------------- KAP KEYS Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse These KAP Keys were developed to accompany the Treatment Improvement Protocol (TIP) Series published by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration. These KAP Keys are based entirely on TIP 34 and are designed to meet the needs of the busy clinician for concise, easily accessed "how-to" infor mation. For more information on the topics in these KAP Keys, readers are referred to TIP 34. Introduction TIP 25, Substance Abuse Treatment and Domestic Violence (1997) BKD139 TIP 26, Substance Abuse Among Older Adults (1998) BKD250 TIP 29, Substance Use Disorder Treatment for People with Physical and Cognitive Disabilities (1998) BKD288 TIP 32, Treatment of Adolescents With Substance Use Disorders (1999) BKD307 TIP 35, Enhancing Motivation for Change in Substance Abuse Treatment (1999) BKD342 Other Treatment Improvement Protocols (TIPs) that are relevant to these KAP Keys: ----------------------------------------------- The Stages of Change 1 KAP KEYS Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse Precontemplation: The user is not considering change, is aware of few negative consequences, and is unlikely to take action soon. Contemplation: The user is aware of some pros and cons of substance abuse but feels ambivalent about change. This user has not yet decided to commit to change. Preparation: This stage begins once the user has decided to change and begins to plan steps toward recovery. Action: The user tries new behaviors, but these are not yet sta ble. This stage involves the first active steps toward change. Maintenance: The user establishes new behaviors on a long- term basis. Source: Adapted from Prochaska and DiClemente 1984. ----------------------------------------------- Sample Battery of Brief Assessment Instruments 2 KAP KEYS Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse Assessment Domain Quantity/Frequency of Use Sample Instrument Timeline Follow Back Technique Assessment Domain Severity of Dependence Sample Instrument • Short Alcohol Dependence Data (SADD) • Severity of Dependence Scales (SDS) Assessment Domain Consequences of Use Sample Instrument • Michigan Alcoholism Screening Test (MAST) • Drug Abuse Screening Test (DAST) • Substance Abuse Subtle Screening Inventory (SASSI) • DRINK Assessment Domain Readiness to Change Sample Instrument • Commitment to Change Algorithm • SOCRATES Assessment Domain Problem Areas Sample Instrument • Problem Checklist (from Comprehensive Drinker Profile) • Problem-Oriented Screening Instrument for Teenagers (POSIT) • Adolescent Assessment/Referral System (AARS) Continued on Back ----------------------------------------------- KAP KEYS Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse Assessment Domain Treatment Placement Sample Instrument Addiction Severity Index (ASI) Assessment Domain Goal choice and commitment Sample Instrument Intentions Questionnaire Sources: Allen and Columbus 1995; Miller 1991 ----------------------------------------------- Fifteen Common Cognitive Errors 3 1. Filtering: Taking negative details and magnifying them, while filtering out all positive aspects of a situation 2. Polarized thinking: Thinking of things as black or white, good or bad, perfect or failure, with no middle ground 3. Overgeneralization: Jumping to a general conclusion based on a single incident or piece of evidence. Expecting some thing bad to happen over and over again if one bad thing occurs 4. Mind reading: Thinking that you know, without any external proof, what people are feeling and why they act the way they do; believing you can tell how others feel about you 5. Catastrophizing: Expecting disaster; hearing about a prob lem and then automatically considering the possible nega tive consequences (e.g. "What if it happens to me?") 6. Personalization: Thinking that everything people do or say is some kind of reaction to you; comparing yourself to others, trying to determine who's smarter or better looking 7. Control fallacy: Feeling externally controlled (helpless or a victim of fate) or feeling internally controlled (responsible for the pain and happiness of everyone around) 8. Fallacy of fairness: Feeling resentful because you think you know what is fair, even though others do not agree 9. Blaming: Holding other people responsible for your pain or blaming yourself for every problem 10. Shoulds: Having a list of ironclad rules about how you and other people "should" act; becoming angry at those who break the rules and feeling guilty if you violate them 11. Emotional reasoning: Believing that what you feel must be true, automatically (e.g., if you feel stupid, you must be stupid) Continued on Back KAP KEYS Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse ----------------------------------------------- KAP KEYS Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse 12. Fallacy of change: Expecting that other people will change to suit you if you pressure them enough; having to change people because your hopes for happiness depend on them 13. Global labeling: Generalizing one or two qualities into a negative global judgment 14. Being right: Proving that your opinions and actions are cor rect on a continual basis; thinking that being wrong is unthinkable; going to any lengths to prove you are correct 15. Heaven's reward fallacy: Expecting all sacrifice and self- denial to pay off, and feeling disappointed and even bitter when the reward does not come Source: Beck 1976 ----------------------------------------------- Selected Criteria for Providing Brief Therapy 4 • Dual diagnosis issues such as a coexisting psychiatric disor der or developmental disability • The range and severity of presenting problems • The duration of abuse • Availability of familial and community supports • The level of client motivation (brief therapy may require more work on the part of the client but a less extensive time com mitment) • The clarity of the client's short- and long-term goals (brief therapy will require more clearly defined goals) • The client's belief in the value of brief therapy ("buy in") • Large number of clients needing treatment The following criteria are derived from clinical experience: • Less severe substance abuse, as measured by an instru ment like the Addiction Severity Index (ASI) • Level of past trauma affecting the client's substance abuse • Insufficient resources available for more prolonged therapy • Limited amount of time available for treatment (e.g., 7-day average length of stay in county-jail-level correctional facili ties; 30- to 45-day limitation in Job Corps program) • Presence of coexisting medical or mental diagnoses • Large numbers of clients needing treatment leading to wait ing lists for specialized treatment KAP KEYS Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse ----------------------------------------------- Characteristics of All Brief Therapies 5 • They are either problem focused or solution focused; they target the symptom and not what is behind it. • They clearly define goals related to a specific change or behavior. • They should be understandable to both client and clinician. • They should produce immediate results. • They can be easily influenced by the personality and the counseling style of the therapist. • The therapeutic style is highly active, empathic, and some times directive. • Responsibility for change is placed clearly on the client. • Early in the process, the focus is to help the client have expe riences that enhance self-efficacy and confidence that change is possible. • Termination is discussed from the beginning. • Outcomes are measurable. KAP KEYS Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse ----------------------------------------------- Professionals Outside of Substance Abuse Treatment Who Can Administer Brief Interventions 6 KAP KEYS Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse • Primary care physicians • Substance abuse treatment providers • Emergency department staff members • Nurses • Social workers • Health educators •Lawyers • Mental health workers • Teachers • EAP counselors • Crisis hotline workers, student counselors • Clergy ----------------------------------------------- Criteria for Longer Term Treatment The following criteria can help identify clients who could benefit from longer term treatment: • Failure of previous shorter treatment • Multiple concurrent problems • Severe substance abuse (i.e., dependence) • Acute psychoses • Acute intoxication • Acute withdrawal • Cognitive inability to focus • Long-term history of relapse • Many unsuccessful treatment episodes • Low level of social support • Serious consequences related to relapse 7 KAP KEYS Based on TIP 34 Brief Interventions and Brief Therapies for Substance Abuse ----------------------------------------------- Ordering Information TIP 34 Brief Interventions and Brief Therapies for Substance Abuse Easy Ways to Obtain Free Copies of All TIPs Products 1. Call SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI) at 800-729-6686, TDD (hearing impaired) 800-487-4889. 3. Visit CSAT's Website at www.csat.samhsa.gov Do not reproduce or distribute this publication for a fee with out specific, written authorization from the Office of Communications, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. DHHS Publication No. (SMA) 01-3601 Printed 2001