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Brief Intervention: Brief Intervention: An Approach for An Approach for

Substance Abusing Substance Abusing AdolescentsAdolescents

A CARS Training ProgramA CARS Training ProgramPrepared by Joël L. Phillips and Prepared by Joël L. Phillips and

Pam Smithstan, MFTPam Smithstan, MFT

Based on the Work ofBased on the Work ofKen Winters, Ph.D.Ken Winters, Ph.D.

Ira SachnoffIra SachnoffKevin R. GoginKevin R. Gogin

May 6, 2009

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What is Brief Intervention?What is Brief Intervention?

Are experiencing few problems with their drug Are experiencing few problems with their drug useuseHave low levels of dependenceHave low levels of dependenceHave a short history of drug useHave a short history of drug useHave stable backgroundsHave stable backgroundsAre unsure or ambivalent about changing their Are unsure or ambivalent about changing their drug usedrug use

It is a counseling type intervention consisting of 2 – 4 sessions for individuals who:

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Purpose of Brief InterventionPurpose of Brief Intervention

Provide a forum for a young person to talk about Provide a forum for a young person to talk about their drug usetheir drug useGive accurate information about their drug of Give accurate information about their drug of choicechoiceSupport the person in identifying drug use Support the person in identifying drug use related issues that impact their health, lifestyle related issues that impact their health, lifestyle and relationshipsand relationshipsEmpower the person to set goals and make Empower the person to set goals and make informed choices relating to their drug useinformed choices relating to their drug useAssist the person in accessing other servicesAssist the person in accessing other services

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Why Brief Intervention?Why Brief Intervention?

Need for prevention services specifically Need for prevention services specifically targeting youth with problems associated with targeting youth with problems associated with their drug use (“indicated” population in the IOM their drug use (“indicated” population in the IOM prevention model).prevention model).The gap between treatment need and treatment The gap between treatment need and treatment availability is significantly increasing for availability is significantly increasing for adolescents.adolescents.Tightening of treatment eligibility criteria.Tightening of treatment eligibility criteria.Brief Interventions (Brief Interventions (e.g.e.g. 3 – 4 sessions) have 3 – 4 sessions) have recently been shown to be as effective as stand recently been shown to be as effective as stand alone therapies.alone therapies.

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Why Brief Intervention?Why Brief Intervention?

Lower cost treatment options for less-Lower cost treatment options for less-severe adolescent AOD users.severe adolescent AOD users.Brief Interventions make developmental Brief Interventions make developmental sense given that many drug-using youth sense given that many drug-using youth are not “career” drug abusers.are not “career” drug abusers.Developmentally, young people are likely Developmentally, young people are likely to be receptive to self-guided behavior to be receptive to self-guided behavior change strategies, a cornerstone of brief change strategies, a cornerstone of brief interventions (Miller & Sanchez, 1993).interventions (Miller & Sanchez, 1993).

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Spectrum of Adolescent AOD UseSpectrum of Adolescent AOD Use

NoneMild Moderate

SubstantialSevere

Primary Prevention

Brief Intervention

Specialized Treatment

(Use recent California data: Nearly ¼ of 11th graders binge drink 1 or more times each month. Many who binge also have problems with their social/school life. Brief Intervention may be the most appropriate intervention for these youths.)

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Process of AddictionProcess of AddictionExper. Exper. UseUse

Reg. Reg. UseUse

1st Neg. 1st Neg. Consq.Consq.

AbuseAbuse AddictionAddiction

FUNFUN FUN + PROBLEMSFUN + PROBLEMS PROBLEMSPROBLEMS

Window for Brief Intervention Approach

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Best Practices in Brief InterventionBest Practices in Brief Intervention

Specific information on Specific information on consequencesconsequences to the to the individual use of drugs.individual use of drugs.Information on harm reduction strategies relating Information on harm reduction strategies relating to:to:– OverdoseOverdose– Frequency and intensity of useFrequency and intensity of use– Utilizing safe alternativesUtilizing safe alternatives– Changing the means of administration of a substanceChanging the means of administration of a substance

Referrals for additional servicesReferrals for additional services

It is recommended that brief intervention at a minimum includes the provision of:

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Brief Intervention:Training Modules

Pre Session:

Ground RulesOral History of Substance UseAssessment Tool

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Session One Building the Relationship:

Ground RulesConfidentiality Feedback from any AssessmentsWorksheet #1, Pros and ConsWorksheet #2, What If?Worksheet #3, What Triggers Me?Worksheet #4, How Ready am I to Change?Worksheet #5, Social Support Worksheet Worksheet #6. Establishing Goals

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Session Two: Enhancing Session Two: Enhancing Motivation to ChangeMotivation to Change

Worksheet #6, How Ready Am I to Change?

Worksheet #7, Emergency PlanningWorksheet #8, How Ready am I to Change?Worksheet #9, Setting New Goals

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Session Four: Optional Session Four: Optional Parent/Guardian Parent/Guardian

SessionSession

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Skills Required to be an Skills Required to be an Effective B.I. WorkerEffective B.I. Worker

Reflective ListeningReflective Listening

Supportive, Empathetic StyleSupportive, Empathetic Style

Complimentary vs. PunitiveComplimentary vs. Punitive

Adjust to ResistanceAdjust to Resistance

Create Cognitive DissonanceCreate Cognitive Dissonance

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Ground Rules for the Ground Rules for the Brief InterventionBrief Intervention

If the adolescent agrees to attend the If the adolescent agrees to attend the sessions – all sessions are mandatory.sessions – all sessions are mandatory.

Adolescent is requested to participate Adolescent is requested to participate fully.fully.

Adolescent is requested to make a Adolescent is requested to make a commitment to coming to the sessions commitment to coming to the sessions clean: not under the influence of any clean: not under the influence of any substances.substances.

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Theoretical Pillars for Theoretical Pillars for Brief InterventionBrief Intervention

Theory on Stages of Change (Proshka Theory on Stages of Change (Proshka and Di Clemente)and Di Clemente)

Cognitive Behavioral Therapy (CBT)Cognitive Behavioral Therapy (CBT)

Motivational Interviewing (Miller and Motivational Interviewing (Miller and Rollnick)Rollnick)

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Why are these Important?Why are these Important?

One explains the stages individuals must One explains the stages individuals must go through to change their behaviors go through to change their behaviors (Stages of Change).(Stages of Change).

One provides a plan for individuals to One provides a plan for individuals to change their behavior (CBT).change their behavior (CBT).

One provides guidance on how to work One provides guidance on how to work with an individual needing to change their with an individual needing to change their behavior (MI).behavior (MI).

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Stages of Change ModelStages of Change Model

Pre-Pre-contemplationcontemplation

Don’t plan to Don’t plan to changechange ““What problem?”What problem?”

ContemplationContemplation Considering Considering changechange

““Should I Should I change?”change?”

PreparationPreparation Taking first stepsTaking first steps ““Can I change?”Can I change?”

ActionAction Changing Changing behaviorsbehaviors

““How do I How do I change?”change?”

MaintenanceMaintenance Sustaining Sustaining changechange ““Is it worth it?”Is it worth it?”

Prochaska & D. Clemente, J. Consult and Clinical Psychology, 1983

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MI Recognizes…MI Recognizes…

• • Recognize that a current behavior is a Recognize that a current behavior is a concern or a problem.concern or a problem.

• • Believe that they will be better off if they Believe that they will be better off if they change.change.

• • Believe that they are able to change.Believe that they are able to change.• • Know how and what they need to change.Know how and what they need to change.

In this way, MI builds on stages of change theory and CBT principles.

For an individual to change, they need to:

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Role of the Worker in Role of the Worker in Motivational InterviewingMotivational Interviewing

Explore positive and negative Explore positive and negative consequences of drug use and be consequences of drug use and be directive in helping the client examine and directive in helping the client examine and resolve ambivalent feelings.resolve ambivalent feelings.Provide opportunity to explore the client’s Provide opportunity to explore the client’s specific concernsspecific concernsUse reflective listening and summaries to Use reflective listening and summaries to understand and communicate understand and communicate understandingunderstanding

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Role of the Worker in Role of the Worker in Motivational Interviewing Motivational Interviewing (Cont.)(Cont.)

Elicit self-motivational statementsElicit self-motivational statements

Help the client decide whether to changeHelp the client decide whether to change

Understand the relationship is more like a Understand the relationship is more like a partnership or companionship rather than partnership or companionship rather than expert/recipient rolesexpert/recipient roles

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Four Key Principles of Four Key Principles of Motivational Interviewing*Motivational Interviewing*

• • Express EmpathyExpress Empathy – acceptance facilitates – acceptance facilitates change.change.

• • Develop DiscrepancyDevelop Discrepancy – consequences that – consequences that conflict with important goals will favor change.conflict with important goals will favor change.

• • Roll with Resistance and Avoid Roll with Resistance and Avoid ArgumentationArgumentation – use this to look for solutions – use this to look for solutions with the clientwith the client

• • Support Self ResponsibilitySupport Self Responsibility – the client is – the client is responsible for choosing and carrying out responsible for choosing and carrying out change.change.

* (Miller and Rollnick)* (Miller and Rollnick)

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SummarySummaryStages of Change Model, CBT, MIStages of Change Model, CBT, MI

Provides a framework to describe how people changeProvides a framework to describe how people change

Provides an effective, innovative method to help people Provides an effective, innovative method to help people with problem behaviors change their behavior, and can with problem behaviors change their behavior, and can lead to improvement in a client’s health outcomelead to improvement in a client’s health outcome

Identifies client’s own fears and difficulties and helps to Identifies client’s own fears and difficulties and helps to resolve the issuesresolve the issues

These are the cornerstones for the Brief Intervention Approach presented in the workbook modules.