Brief Interventions in Substance Abuse Treatment Flashcards

Brief Interventions in Substance Abuse Treatment

• Used by various professionals and settings: alcohol and drug counselors, social workers, psychologists, physicians, nurses, social service agencies, hospital emergency departments, court-ordered educational groups, and vocational rehabilitation programs.

• Effective for primary care providers addressing substance abuse issues of clients unable or unwilling to access specialty care.

• Examples: Asking clients to try non-use, encouraging attendance at self-help groups (AA or NA), and engaging in brief, structured efforts to help pregnant clients stop using.

• Research-proven procedures for individuals with at-risk use and less severe abuse behaviors.

• Can be successful in specialist treatment settings when performed by alcohol and drug counselors.

• Approaches range from unstructured counseling and feedback to formal structured therapy.

• Defined as time-limited, structured, and directed toward a specific goal; following a specific plan with timelines for adopting specific behaviors.

• Client characteristics are not strong predictors of response to brief intervention; may be applicable across cultures and backgrounds.

Stages-of-Change Model

• Developed by Prochaska and DiClemente.

• Helps clinicians tailor brief interventions to clients' needs.

• Model consists of five stages:

  • Pre-contemplation: User not considering change.

    • Example: Functional alcohol-dependent individual with no legal or health problems.

    • Treatment Needs: Information linking problems with substance abuse.

  • Contemplation: User aware of pros and cons but ambivalent about change.

    • Example: Individual cited for driving while intoxicated who vows not to drive when drinking but makes no commitment to stop drinking.

    • Treatment Needs: Explore feelings of ambivalence and conflicts between substance abuse and personal values.

  • Preparation: User decides to change and plans steps toward recovery.

    • Example: Individual who decides to stop abusing substances.

    • Treatment Needs: Work on strengthening commitment by providing treatment options.

  • Action: User tries new behaviors.

    • Example: Individual who attends meetings.

    • Treatment Needs: Help with executing action plan to maintain sobriety.

  • Maintenance: User establishes new behaviors on a long-term basis.

    • Example: Individual attends counseling regularly, is actively involved in AA or NA, has a sponsor, and has made new sober friends.

    • Treatment Needs: Help with relapse prevention.

• Stages are useful in predicting those most likely to quit smoking and in targeting specific interventions.

• Motivational support should be appropriate to client's stage of change. Otherwise, treatment resistance or noncompliance could result.

• Pre-contemplation: Raise awareness.

• Contemplation: Help choose positive change.

• Preparation: Help identify change strategies.

• Action: Help carry out change strategies.

• Clinician needs to:

  • Assess client's stage of readiness.

  • Plan a corresponding strategy.

  • Implement strategy without distraction.

Goals of Brief Intervention

• Basic goal: Reduce the risk of harm from continued substance use.

• Specific goal: Determined by consumption pattern, consequences, and setting.

• Focusing on intermediate goals allows for more immediate successes.

• In specialized treatment, intermediate goals might include quitting one substance or decreasing frequency of use.

• Setting goals for clients is particularly useful in centers that specialize in substance abuse treatment.

• The key to a successful brief intervention is to extract a single, measurable behavioral change from the broad process of recovery.

• Sample Objectives:

  • Learning to schedule and prioritize time.

  • Expanding a sober support system.

  • Socializing with recovering people or learning to have fun without substance abuse.

  • Beginning skills exploration or training if unemployed.

  • Giving up resentments or choosing to forgive others and self.

  • Attending an AA or NA meeting.

  • Staying in the "here and now."

• Goals based on consumption level:

  • Abstainer: prevention education

  • Light/Moderate User: education about low-risk use and potential problems of increased use. For example, no more than 14 drinks per week or 4 per occasion for men and no more than 7 drinks per week or 3 per occasion for women.

  • At-Risk User: Level of use, encourage moderation or abstinence, and educate about consequences of risky behavior and the risks associated with increased use.

  • Abuser: Prevent any increase in the use of substances, to facilitate introspection about the consequences of risky behaviour.

  • Substance-dependent User: Users to consider treatment, to contemplate abstinence, or to return to treatment after a relapse.

ASAM Criteria

• Brief interventions are aimed at the nondependent user, at level 0.5 or possibly level I.

• Individuals at level II may be appropriate for a brief intervention if relapse potential and recovery environment are major problems for those with relatively minor physiological and psychological substance problems and high motivation to change.

• ASAM delineates the following levels of service:

  • Level 0.5-early intervention

  • Level I - outpatient services

  • Level II - intensive outpatient/partial hospitalisation services

  • Level III - residential inpatient services

  • Level IV - medically-managed intensive inpatient services

Components of Brief Interventions

• Clients make changes for different reasons.

• Tailored to different populations with options to augment interventions and treatments.

• Not a substitute for specialized care for clients with a high level of dependency.

• Used to engage clients in specific aspects of treatment programs.

• Help potential clients move toward seeking treatment.

FRAMES

• Six elements critical to a brief intervention:

  • Feedback: given to the individual about personal risk or impairment.

  • Responsibility: for change is placed on the participant.

  • Advice: to change is given by the provider.

  • Menu: of alternative self-help or treatment options is offered to the participant.

  • Empathic: style is used in counselling.

  • Self-efficacy: or optimistic empowerment is engendered in the participant.

Five Basic Steps

• Five basic steps that incorporate FRAMES:

  1. Introducing the issue in the context of the client's health

  2. Screening, evaluating, and assessing

  3. Providing feedback

  4. Talking about change and setting goals

  5. Summarizing and reaching closure

• Providers may not have to use all five components in every session.

• Vital part: monitoring to determine the patient is progressing after the initial intervention has been completed.

Detailed descriptions of the five basic steps for script brief interventions

• Introducing the Issue: build rapport, define purpose, gain permission, help client understand. State the target topic clearly and stress confidentiality; be non-judgmental and avoid labels.

• Screening, Evaluating, and Assessing: Process:structured or non-structured interview and questionnaires determined by the setting, time, and available resources. Watch for defensiveness or other resistance, and avoid pushing too hard.

• Providing Feedback:interactive dialog for discussing the assessment findings, given in small amounts. Ask active listening, Be aware of cultural, language, and literacy issues and be non-judgmental.

• Talking about Change and Setting Goals, assess the client's readiness to change. Offer change options that match client's readiness for change. Be realistic: Recommend the ideal change, but accept less if the client is resistant.

• Summarising and Reaching Closure Includes a summary of the discussion and a review of the agreed-upon changes. If no agreement was reached, review the positive action the client took during the session.

Brief Intervention Workbooks

• Provide opportunities to discuss cues, reasons for using, and reasons for cutting down or quitting.

• Usually provides a substance abuse agreement and diary cards for self-reporting.

• Steps often include:

  • Identification of future goals

  • Customized feedback on screening questions

  • Discussion of where the client's substance abuse patterns fit into the population norms for his age group

  • Identification of the pros and cons of substance abuse

  • Consequences of continued substance use

  • Reasons to cut down or quit using

  • Sensible use limits and strategies for cutting down or quitting

  • A substance abuse agreement

  • Coping with risky situations

  • Summary of the session

Essential Knowledge and Skills for Brief Interventions

• Skills that produce good outcomes:

  • Overall attitude of understanding and acceptance

  • Counseling skills such as active listening and helping clients explore and resolve ambivalence

  • A focus on intermediate goals

  • Working knowledge of the stages-of-change model

Counseling Skills

• Active listening: accurately restate the content, feeling, and meaning of the client's statements.

  • Steps in Active Listening

    1. Listen to what the client says.

    2. Form a reflective statement. To reflect your understanding, repeat in your own words what the client said.

    3. Test the accuracy of your reflective statement. Watch, listen, and/or ask the client to verify the accuracy of the content, feeling, and/or meaning of the statement.

    4. Skilled active listeners perform these three steps automatically, naturally, smoothly, and quickly. Active listening saves time by reducing or preventing resistance, focusing the client, focusing the clinician, encouraging self-disclosure, and helping the client remember what was said during the intervention.

• Exploring and resolving ambivalence: Hallmark of contemplation stage is to increase awareness ofambivalence by identify the benefits and costs with an understanding and supporting relationship can inspire the client.

Brief Interventions in Substance Abuse Treatment Programs

• Can be effectively integrated into more comprehensive treatment plans.

• Used to address specific targeted client behaviors and issues in the treatment process.

• Can be used before, during, and after substance abuse treatment through training and resources.

• The Consensus Panel recommends that agencies consider allocating counselor training time and resources to these modalities.

• Important for substance abuse treatment personnel to collaborate with other medical personnel. that include both brief interventions and more intensive care to help keep the client focused on treatment and recovery

• Potential benefits include:

  • Reduce no-show rates for the start of treatment

  • Reduce dropout rates after the first session of treatment

  • Increase treatment engagement after intake assessment

  • Increase compliance for doing homework

  • Increase group participation

  • Address noncompliance with treatment rules

  • Reduce aggression and violence

  • Reduce isolation from other clients

  • Reduce no-show rates for continuing care

  • Increase mutual-help group attendance

  • Obtain a sponsor, if involved with a 12-Step program

  • Increase compliance with psychotropic medication therapies

  • Increase compliance with outpatient mental health referrals

  • Serve as interim intervention for clients on treatment program waiting lists

Brief Interventions outside Substance Abuse Treatment Settings

• Commonly administered in opportunistic settings in many setting to help people change their substance abuse patterns.

• Level of substance use is detected through screening instruments, medical tests, observation, or simply asking about consumption patterns.

• Goal: Raise the recipient's awareness of the association between the expressed problem and substance abuse and to recommend change, either by natural, client-directed means or by seeking additional substance abuse treatment.

• Treatment providers who work in settings other than substance abuse treatment must be flexible during interventions. For example, those in the United States there are four times as many risky drinkers as dependent drinkers.

• For a health client a medical record for treatment of a substance abuse disorder, those medical records are strictly protected by Federal law and may not be put in the client's chart.

• For older adults, Intervention strategies should be non-confrontational and supportive due to increased shame and guilt.

Research Findings

• Reviews of Brief Intervention Studies Have merit, especially for carefully selected clients and can be applied successfully in several settings for different purposes to improve clients' acceptance of referrals for additional specialist.

• Trials of brief interventions for excessive drinkers identified in health care settings showed significant reductions in alcohol consumption levels.

• strong research evidence supports the use of brief interventions for heavy or excessive, nondependent drinkers, particularly those identified in general medical practice settings and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

• Many studies that focus on alcohol,rely on self-report data to determine outcomes.

• Most randomized had improvements in drinking outcomes for the experimental group compared to the control group.

• Trials included women finding that they were more likely than men to decrease their drinking based on brief targeted advice.

• trials, computerised real-time tailored booklets for at-risk drinkers, and the use of Interactive Voice Recognition (IVR) for interventions and follow-up.

• NIAAA studies focused on the effectiveness of motivating alcohol-dependent patients to enter specialised alcohol treatment but in small studies the protocol had a positive personal responsibility to stop drinking. brief but there where less severe alcohol problems did best in the brief intervention group.

• Some portion of the most severe alcoholic population will reduce or discontinue their drinking without formal intervention (IOM, 1990). Project MATCH comparing 1-hour session of motivational enhancement therapy, 12 sessions of 12-Step facilitation, and 12 sessions of cognitive-behavioural coping skills therapy.

• The motivational subjects had significantly fewer opiate-related problems than the others.

• evaluating study recommendations. The clinical trials in this manual on the use of brief interventions have been specific regarding the targeted population tested and the level of generalisability possible.

• validity of measuring alcohol and other use by self-report is routinely questioned; however, reviewers of relevant literature have concluded that these data are generally valid and reliable (Midanik, 1982; Sobell and Sobell, 1990)

• in opportunistic settings, new trials with special populations (e.g., older adults, injured patients in emergency departments, pregnant women) are now being proposed and conducted.

• few studies have tested the implementation of brief intervention strategies in community-based medical and treatment settings is needed to determine whether brief interventions can be useful for clients with dual diagnoses or whether they always require more intensive treatments because of the complexity of their illnesses.

• In sum, the Consensus Panel believes it is critical for policymakers and providers of managed care to understand that brief interventions should never be thought of as the only