Title : QGcover tip34 9-04-01gvp.qxd (Page 2)
 Description : 
 Keywords : 
 Author : 

-----------------------------------------------
Quick Guide
For Clinicians

Based on TIP 34
Brief Interventions and Brief
Therapies for Substance
Abuse

-----------------------------------------------
Contents
Why a Quick Guide?  . . . . . . . . . . . . . . . . . . . 2
What is a TIP?  . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction  . . . . . . . . . . . . . . . . . . . . . . . . . 4
Brief Interventions  . . . . . . . . . . . . . . . . . . . . 5
Brief Therapies . . . . . . . . . . . . . . . . . . . . . . 13
Brief CognitiveBehavioral Therapy . . . . . . 20
Brief Strategic/Interactional Therapies  . . . 24
Brief Humanistic and 
Existential Therapies  . . . . . . . . . . . . . . . . . 26
Brief Psychodynamic Therapy . . . . . . . . . . 28
Brief Family Therapy  . . . . . . . . . . . . . . . . . 30
Time-Limited Group Therapy  . . . . . . . . . . . 35
Glossary   . . . . . . . . . . . . . . . . . . . . . . . . . . .36

-----------------------------------------------
Quick Guide
For Clinicians

This Quick Guide is based almost entirely on information con
tained in TIP 34, published in 1999 and based on information
updated through May 1998. No additional research has been
conducted to update this topic since publication of the original
TIP.
Based on TIP 34
Brief Interventions and Brief
Therapies for Substance
Abuse

-----------------------------------------------
2
Brief Interventions and Brief Therapies for Substance Abuse

WHY A QUICK GUIDE?

This Quick Guide was developed to accompany
Brief Interventions and Brief Therapies in
Substance Abuse, Number 34 in the Treatment
Improvement Protocol (TIP) Series published by
the Center for Substance Abuse Treatment (CSAT),
Substance Abuse and Mental Health Services
Administration. This Quick Guide is based entirely
on TIP 34 and is designed to meet the needs of
the busy clinician for concise, easily accessed
"how-to" information.

The Guide is divided into 10 sections to help read
ers quickly locate relevant material.

Terms related to these treatment methods are list
ed on page 38 in the Glossary. These terms are
included to enable clinicians to talk knowledge
ably with their clients and clients' medical
providers.

For more information on the topics in this Quick
Guide, readers are referred to TIP 34.

-----------------------------------------------
What  Is a TIP? 3

WHAT IS A TIP?

The TIP series has been in production since 1991.
This series provides the substance abuse treat
ment and related fields with consensus-based,
field-reviewed guidelines on substance abuse
treatment topics of vital current interest.

TIP 34, Brief Interventions and Brief Therapies for
Substance Abuse

 Addresses concerns of a broad range of readers
including clinicians, social workers, medical per
sonnel, mental health workers, program admin
istrators, and policymakers
 Includes extensive research
 Lists numerous resources for further informa
tion
 Is a comprehensive reference for clinicians on
applying these methods in substance abuse
treatment
See the inside back cover for information on how
to order TIPs and other related products.

-----------------------------------------------
4
Brief Interventions and Brief Therapies for Substance Abuse

INTRODUCTION

The use of brief intervention and brief therapy
techniques has become an increasingly important
part of the continuum of care in the treatment of
substance abuse problems. They provide the
opportunity for clinicians to increase positive out
comes by using these modalities independently as
stand-alone interventions or treatments and as
additions to other forms of substance abuse and
mental health treatment.

Used for a variety of substance abuse problems
from at-risk use to dependence, brief interven
tions can help clients reduce or stop abuse, act as
a first step in the treatment process to determine
if clients can stop or reduce on their own, and act
as a method to change specific behaviors before
or during treatment. 

For more detailed information, see TIP 34, 
p. 1.

-----------------------------------------------
Brief Interventions 5

BRIEF INTERVENTIONS

Brief interventions are those practices that aim to
investigate a potential problem and motivate an
individual to begin to do something about his sub
stance abuse, either by natural, client-directed
means or by seeking additional treatment.

The basic goal of any intervention is to lower the
likelihood of damage that could result from contin
ued use of substances. The specific goal for each
individual client is determined by his use and by
the setting in which the brief intervention is deliv
ered.

Professionals who can administer brief interven
tions

 Primary care physicians
 Substance abuse treatment providers
 Substance abuse clinicians
 Emergency department staff members
 Nurses
 Social workers
 Health educators
Lawyers
 Mental health workers

-----------------------------------------------
6
Brief Interventions and Brief Therapies for Substance Abuse

 Teachers
 Employee assistance program counselors
 Crisis hotline workers, student counselors

 Clergy
Treatment Needs During the Stages of
Change
 Precontemplation. The client needs information
linking his problems with his substance abuse.
A brief intervention might be to educate him
about the negative consequences of substance
abuse.
 Contemplation. The client should explore feel
ings of ambivalence and the conflicts between
her substance abuse and personal values. The
Objectives to Address with Brief Interventions
 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 unem
ployed
 Attending an AA or NA meeting
 Giving up resentments or choosing to forgive
others and self
 Staying in the "here and now"

-----------------------------------------------
Brief Interventions 7

brief intervention might seek to increase the
client's awareness of the consequences of con
tinued abuse and the benefits of decreasing or
stopping use.
 Preparation. The client needs work on strength
ening commitment. A brief intervention might
give the client a list of options for treatment,
then help the client plan how to go about seek
ing the treatment.
 Action. The client requires help executing an
action plan and may have to work on skills to
maintain sobriety. The clinician should acknowl
edge the client's feelings and experiences as a
normal part of recovery.
 Maintenance. The client needs help with
relapse prevention. A brief intervention could
reassure, evaluate present actions, and rede
fine long-term sobriety plans.
It is important to extract one measurable change
in the client's behavior, such as

 Attending an AA or NA meeting
 Expanding his sober support system
 Socializing with recovering people

-----------------------------------------------
8
Brief Interventions and Brief Therapies for Substance Abuse

FRAMES
A brief intervention consists of five basic steps
that incorporate FRAMES and remain consistent
regardless of the number of sessions or the length
of the intervention:
 Feedback is given to the individual about per
sonal risk or impairment.
 Responsibility for change is placed on the partic
ipant.
 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 counseling.
 Self-efficacy or optimistic empowerment is
engendered in the participant.

A brief intervention consists of five basic steps
that incorporate FRAMES:

 Introducing the issue in the context of client
health
 Screening, evaluating, and assessing
 Providing feedback
 Talking about change and setting goals
 Summarizing and reaching closure

-----------------------------------------------
Brief Interventions 9

Screening, Evaluating, and Assessing
This is a process of gaining information on the tar
geted problem; it varies in length from a single
question to several hours of assessment on the
targeted topic of change. Additional information
about and examples of screening and assessment
instruments can be found in the TIP.

Attitude of Understanding and Acceptance
Clinicians must assure their clients that they will
listen carefully and make every effort to under
stand the client's point of view during a brief inter
vention. Active listening saves time by reducing or
preventing resistance, focusing on the client,
focusing the clinician, encouraging self-disclosure,
and helping the client remember what was said
during the intervention. Skilled active listeners
perform these three steps automatically, naturally,
smoothly, and quickly:

 Listen to what the client says.
 Form a reflective statement. To reflect your
understanding, repeat in your own words what
the client said.
 Test the accuracy of your reflective statement.
Watch, listen, and/or ask the client to verify the
accuracy of the content, feeling, and/or mean
ing of the statement.

-----------------------------------------------
10
Brief Interventions and Brief Therapies for Substance Abuse

Brief Interventions in Substance Abuse
Treatment Programs
Brief interventions can be used before, during,
and after substance abuse treatment. The follow
ing is a list of the potential benefits of using brief
interventions in substance abuse treatment set
tings:

 Reduce no-show rates for the start of treatment,
no-show rates for continuing care, and dropout
rates after the first session of treatment
 Increase treatment engagement after intake
assessment 
 Increase compliance for doing homework
 Increase group participation and mutual-help
group attendance
 Address noncompliance with treatment rules
 Reduce aggression, violence, and isolation from
other clients
 Obtain a sponsor, if involved with a 12-Step pro
gram
 Increase compliance with psychotropic medica
tion therapies and outpatient mental health
referrals
 Serve as interim intervention for clients on treat
ment program waiting lists

-----------------------------------------------
Brief Interventions 11

Brief Interventions Outside Substance Abuse
Treatment Settings
Brief interventions are commonly administered in
nonsubstance abuse treatment settings, often
referred to as opportunistic settings, where clients
are not seeking help for a substance abuse disor
der but have come to receive medical treatment,
to meet with an Employee Assistance Program
counselor, or to respond to a court summons. 

Treatment providers who work in settings other
than substance abuse treatment must be flexible
when assessing, planning, and carrying out brief
interventions. When delivering a brief intervention
in any treatment setting, the provider should be
mindful of room conditions and interruptions
because client confidentiality is of utmost impor
tance.

Essential Knowledge and Skills
The following are four essential skills for providing
effective brief interventions:

 An overall attitude of understanding and accept
ance
 Counseling skills such as active listening and
helping clients explore and resolve ambivalence
 A focus on intermediate goals

-----------------------------------------------
12
Brief Interventions and Brief Therapies for Substance Abuse

A working knowledge of the stages-of-change
through which a client moves when thinking
about, beginning, and trying to maintain new
behavior

For more detailed information, see TIP 34, 
pp. xvixvii, pp. 1529.

-----------------------------------------------
Brief Therapies 13

BRIEF THERAPIES

The following is a list of characteristics pertaining
to all brief therapies:

 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 counseling style of the therapist.
 They rely on rapid establishment of a strong
working relationship between client and thera
pist.
 The therapeutic style is highly active, empathic,
and sometimes directive.
 Responsibility for change is placed clearly on
the client.
 The client is helped to have experiences that
enhance self-efficacy and confidence that
change is possible.
 Termination is discussed from the beginning.

-----------------------------------------------
14
Brief Interventions and Brief Therapies for Substance Abuse

 Outcomes are measurable.
Determining when to use a particular type of brief
therapy is an important consideration for coun
selors and therapists. Client needs and the suit
ability of brief therapy must be evaluated on a
case-by-case basis. The following are some criteria
for considering the appropriateness of brief
therapy:

 Dual diagnosis issues
 The range and severity of presenting problems
 The duration of substance dependence
 Availability of familial and community supports
 The level and type of influence from peers, fami
ly, and community
 Previous treatment or attempts at recovery
 The level of client motivation
 The clarity of the client's short- and long-term
goals
 The client's belief in the value of brief therapy
 The numbers of clients needing treatment 

-----------------------------------------------
Brief Therapies 15

Criteria for LongerTerm Treatment
 Failure of previous shorter treatment
 Multiple concurrent problems
 Severe substance abuse
 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

Screening and Assessment
Screening identifies the need for more in-depth
assessment and is not a substitute for an assess
ment. The assessment should determine whether
the client's substance abuse problem is suitable
for a brief therapy approach. Therapists should
gather as much information as possible about a
client before the first counseling session. Refer to
TIP 34, pp. 4146 for more information on
screening and assessment issues. 

-----------------------------------------------
16

Core Assessment Areas
Before proceeding with brief therapy for substance
abuse disorders, a number of areas should be
assessed:
 Current use patterns
 History of substance abuse
 Consequences of substance abuse
 Information about major medical problems and
health status
 Information about education and employment
 Support mechanisms
 Client strengths and situational advantages
 Previous treatment
 Family history of substance abuse disorders and
psychological disorders

The Opening Session
In the first session, the main goals for the thera
pist are to gain a broad understanding of the
client's presenting problems, begin to establish
rapport and an effective working relationship, and
implement an initial intervention. During the first
session, the clinician must accomplish certain crit
ical tasks including

 Producing rapid engagement
 Identifying, focusing, and prioritizing problems
Brief Interventions and Brief Therapies for Substance Abuse

-----------------------------------------------
Brief Therapies 17

 Working with the client to develop possible solu
tions to substance abuse problems and a treat
ment plan that requires the client's active par
ticipation
 Negotiating the route toward change with the
client
 Eliciting client concerns about problems and
solutions
 Understanding client expectations
 Explaining the structural framework of brief
therapy, including the process and its limits
 Making referrals for critical needs that have
been identified but cannot be met within the
treatment setting
Maintenance Strategies
Maintenance strategies must be built into the
treatment design from the beginning. A practition
er of brief therapy must continue to provide sup
port, feedback, and assistance in setting realistic
goals. Also, the therapist should help the client
identify relapse triggers and situations that could
endanger continued sobriety.

Strategies to help maintain the progress made
during brief therapy include the following:

 Educating the client about the chronic, relaps
ing nature of substance abuse disorders

-----------------------------------------------
18
Brief Interventions and Brief Therapies for Substance Abuse

 Developing a list of circumstances that might
provide reasons for the client to return to treat
ment and plans to address them
 Reviewing problems that emerged but were not
addressed in treatment and helping the client
develop a plan for addressing them in the future
 Developing strategies for identifying and coping
with high-risk situations or the reemergence of
substance abuse behaviors
 Teaching the client how to capitalize on person
al strengths
 Emphasizing client self-sufficiency
 Developing a plan for future support, including
mutual help groups, family support, and com
munity support
Ending Treatment
Termination of therapy should always be planned
in advance. In many types of brief therapy, the
end of therapy will be an explicit focus of discus
sion in which the therapist should

 Leave the client on good terms, with an
enhanced sense of hope for continued change
and maintenance of changes already accom
plished
 Leave the door open for possible future ses
sions dealing with the client's other problems

-----------------------------------------------
Brief Therapies 19

 Elicit commitment for the client to try to follow
through on what has been learned or achieved
 Review what positive outcomes the client can
expect
 Review possible pitfalls the client may
encounter
 Review the early indicators of relapse
For more detailed information, see TIP 34, p. xvii, 
pp. 3948.

-----------------------------------------------
20
Brief Interventions and Brief Therapies for Substance Abuse

BRIEF COGNITIVEBEHAVIORAL 
THERAPY (CBT)

The cognitivebehavioral model assumes that
substance abusers are deficient in coping skills,
choose not to use those they have, or are inhibit
ed from doing so. Cognitivebehavioral theory is
generally effective because it helps clients recog
nize the situations in which they are likely to use
substances, find ways of avoiding those situa
tions, and cope more effectively with the variety of
situations, feelings, and behaviors related to their
substance abuse. To achieve these therapeutic
goals, CBT incorporates three core elements:

 Functional analysisThis analysis attempts to
identify the antecedents and consequences of
substance abuse behavior, which serve as 
triggering and maintaining factors.
 Coping skills trainingA major component in
CBT is the development of appropriate coping
skills.
 Relapse preventionThese approaches rely
heavily on functional analyses, identification of
high risk relapse situations, and coping skills
training, but also incorporate additional 
features.

-----------------------------------------------
Brief Cognitive-Behavioral Therapy 21

Initial Session for Behavioral Techniques
The initial session in brief behavioral therapy
involves an exploration of the
 Reasons the client is seeking treatment
 Extent to which this motivation for treatment is
intrinsic, rather than influenced by external
sources
 Areas of concern that the client and significant
others may have about his substance abuse
 Situations in which she drinks or uses 
excessively
 Consequences she experiences
When Not to Use Brief CognitiveBehavioral
Therapy
CBT is generally not appropriate for certain
clients, namely, those

 Who have psychotic or bipolar disorders and are
not stabilized on medication
 Who have no stable living arrangements
 Who are not medically stable (as assessed by a
pretreatment physical examination)

Initial Session for Cognitive Techniques
Cognitive therapy works under the assumption
that a client can be educated to approach his

-----------------------------------------------
22
Brief Interventions and Brief Therapies for Substance Abuse

problems rationally. There are three major steps in
this process:

 The therapist establishes a rapport by listening
carefully to the client, using questions and
reflective listening to try to understand how the
client thinks about his life circumstances and
how those thoughts relate to problematic feel
ings and behavior. Thus, the client educates the
therapist about himself and his problems.
 The therapist educates the client about the cog
nitive model of therapy and determines if he is
satisfied with the model.
 The therapist asks the client to describe a
recent event that has triggered some recent
negative feelings, as a way of illustrating the
cognitive therapy process.
Sample Script to Introduce Cognitive Therapy 
"I want to spend a few minutes telling you about
my approach. It seems that how we feel and how
we act in certain situations depend on how we
think. In working with you, my goal is to under
stand how you see thingsthe important things in
your life that relate to substance abuse. I want to
help you look at those things objectively and hon
estly.

"Maybe, you are viewing everything correctly. But
often, people get into automatic ways of thinking

-----------------------------------------------
Brief Cognitive-Behavioral Therapy 23

about themselves and their circumstances. They
don't examine the facts carefully.

"So, let's explore some possibilities and find out
how you think about things. How does that sound
to you?"

For more detailed information, see TIP 34, p. xxii, 
pp. 5967.

-----------------------------------------------
24
Brief Interventions and Brief Therapies for Substance Abuse

BRIEF STRATEGIC/INTERACTIONAL
THERAPIES

In brief strategic/interactional therapies, the focus
is on the individual's strengths rather than on
pathology, the relationship to the therapist is
essential, and interventions are based on client
self-determination with the community serving as
a resource rather than an obstacle.

No matter which type of strategic/interactional
therapy is used, this approach can help to

 Define the situations that contribute to sub
stance abuse in terms meaningful to the client
 Identify steps needed to control or end sub
stance use
 Heal the family system so it can better support
change
 Maintain behaviors that will help control sub
stance use
 Respond to situations in which the client has
returned to substance use after a period of
abstinence
Strategic/interactional therapies normally require
6 to 10 sessions, with 6 considered typical.
Sessions are usually weekly, with no more than
two per week.

-----------------------------------------------
Brief Strategic/Interactional Therapies 25

Initial Session of Brief Strategic/Interactional
Therapies
The first question that a therapist using a strate
gic/interactional approach should ask is, 
"Why are you here?" 
The first session should be spent trying to under
stand the client's problem.

Once the therapist has encouraged a person with
a substance abuse disorder to take further steps
toward change, the subsequent sessions will
focus on identifying and supporting additional
steps in the same direction. As the end of the
therapeutic process nears, the therapist can fol
low these suggestions to help the client prepare
for the future:

 Prepare the client to maintain positive change
through difficult times.
 Identify what the potential next stressors and
challenges will be.
 Devote some time to preparing the client for
changes to the environment.
 Ask the client to look into the future at the end
of the treatment period and tell the therapist
where he intends to be at a certain time.
For more detailed information, see TIP 34, 
pp. 87101.

-----------------------------------------------
26

Initial Session for Brief Humanistic and 
Existential Therapies

The opening session is extremely important in
brief therapy for building an alliance, developing
therapeutic rapport, and creating a climate of
mutual respect.
 Start to develop the alliance.
 Emphasize the client's freedom of choice and
potential for meaningful change.
 Articulate expectations and goals of therapy
(how goals are to be reached).
Brief Interventions and Brief Therapies for Substance Abuse

BRIEF HUMANISTIC AND EXISTENTIAL
THERAPIES

Humanistic and existential therapies are united by
an emphasis on understanding human experience
and a focus on the client rather than the symp
tom. Psychological problems are viewed as the
result of inhibited ability to make authentic, mean
ingful, and self-directed choices about how to live.

Humanistic and existential approaches can be
used at all stages of recovery in creating a foun
dation of respect for clients and mutual accept
ance of the significance of their experiences.
Some therapeutic moments lend themselves
more readily to one or more specific approaches:

-----------------------------------------------
Brief Humanistic and Existential Therapies 27

 Client-centered therapy can be used immediate
ly to establish rapport and to clarify issues
throughout the session.
 Existential therapy may be used most effectively
when a client has access to emotional experi
ences or when obstacles must be overcome to
facilitate a client's entry into or continuation of
recovery.
 Narrative therapy can be used to help the client
conceptualize treatment as an opportunity to
assume authorship and begin a "new chapter"
in life.
 Gestalt approaches can be used throughout
therapy to facilitate a genuine encounter with
the therapist and the client's own experience.
 Transpersonal therapy can enhance spiritual
development by focusing on the intangible
aspects of human experience and awareness of
unrealized spiritual capacity.
For more detailed information, see TIP 34, 
pp. 105108.

-----------------------------------------------
28
Brief Interventions and Brief Therapies for Substance Abuse

BRIEF PSYCHODYNAMIC THERAPY

A psychodynamic approach enables the client to
examine unresolved conflicts and symptoms that
arise from past dysfunctional relationships and
manifest themselves in the need and/or desire to
abuse substances. Psychodynamic therapy is gen
erally thought more suitable for the following types
of clients:

 Those who have coexisting psychopathology
with their substance abuse disorder
 Those who do not need or who have completed
inpatient hospitalization or detoxification
 Those whose recovery is stable
 Those who do not have organic brain damage or
other limitations due to their mental capacity
In the treatment of substance abuse disorders,
defenses are seen as a means of resisting
changechanges that inevitably involve eliminat
ing or at least reducing drug use. The following
strategies are recommended for avoiding ineffec
tive adversarial interactions around the client's
use of defenses:

 Working with the client's perceptions of reality
rather than arguing
 Asking questions

-----------------------------------------------
Brief Psychodynamic Therapy 29

 Sidestepping rather than confronting defenses
 Demonstrating the denial defense while inter
acting with the client to show her how it works
The Therapeutic Alliance
Of all the brief psychotherapies, psychodynamic
approaches place the most emphasis on the ther
apeutic relationship and provide the most explicit
and comprehensive explanations of how to use
this relationship effectively.

For more detailed information, see TIP 34, p. xxiv, 
pp. 128131.

-----------------------------------------------
30
Brief Interventions and Brief Therapies for Substance Abuse

BRIEF FAMILY THERAPY

For many individuals with substance abuse disor
ders, interactions with their family of origin, as
well as their current family, set the patterns and
dynamics for their problems with substances.
Furthermore, family member interactions with the
substance abuser can either perpetuate and
aggravate the problem or substantially assist in
resolving it.

Family therapy offers an opportunity to

 Focus on the expectation of change within the
family
 Test new patterns of behavior
 Teach how a family system works and how the
family supports symptoms and maintains need
ed roles
 Elicit the strengths of every family member
 Explore the meaning of substance abuse within
the family

-----------------------------------------------
Brief Family Therapy 31

Opening Session for Brief Family Therapy
 The therapist seeks to clarify the nature of the
problem and to identify the family's goals with
open-ended questions such as "What is your
goal in coming here?"
 The therapist educates the family in what is
needed to participate effectively in the therapeu
tic process and to understand key biosocial
issues related to substance abuse.
 The therapist provides feedback to the family on
what was said, demonstrating whose goals are
similar or different.
 The therapist can then move on to prioritizing
directions for change or, if the direction is suffi
ciently clear, start work. 

Family therapy is particularly appropriate when
the client exhibits signs that his substance abuse
is strongly influenced by family members' behav
iors or communications with them. Short-term
therapy is an option that could be used in the fol
lowing circumstances:

 When resolving a specific problem in the family
and working toward a solution
 When the therapeutic goals do not require in-
depth, multigenerational family history, but
rather a focus on present interactions

-----------------------------------------------
32
Brief Interventions and Brief Therapies for Substance Abuse

 When the family as a whole can benefit from
teaching and communication to better under
stand some aspect of the substance abuse 
disorder
Family therapy can involve a network beyond the
immediate family, may involve only one family
member in treatment or a few members of the
family system, or may even include several fami
lies at once. Multiple family therapy offers an
opportunity to deal with concerns for families in
which substance abuse has been a problem:

 Inadequate internal family development
 Family systems and role imbalance
 Selected socialization variances within the 
family
 Dysfunctional, ineffective family behaviors that
maintain the problem
For more detailed information, see TIP 34, p. xxiv, 
pp. 145153.

-----------------------------------------------
Time-Limited Group Therapy 33

TIME-LIMITED GROUP THERAPY

Group psychotherapy is one of the most common
modalities for treatment of substance abuse dis
orders. Groups can be extremely beneficial to indi
viduals with substance abuse problems and can

 Help reduce denial, process ambivalence, and
facilitate acceptance of alcohol abuse
 Increase motivation for sobriety and other
changes
 Treat the emotional conditions that often
accompany drinking
 Increase the capacity to recognize, anticipate,
and cope with situations that may precipitate
drinking behavior
 Meet the intense needs of alcohol-dependent
clients for social acceptance and support
Assessment and Preparation
Client preparation is particularly important in any
time-limited group experience. In terms of exclu
sionary issues, persons with severe disorders or
those who cannot accept support may need to be
given more individual time before a group experi
ence. It is particularly effective for group members
as they are being assessed and prepared for
group to either watch or participate in a practice
group as a trial experience.

-----------------------------------------------
34
Brief Interventions and Brief Therapies for Substance Abuse

Initial Session for Time-Limited 
Group Therapy
 New group members introduce themselves at
the opening session, responding to a simple
request such as "Tell us what led you here." In
the context of substance abuse treatment, the
therapist should therefore initially discuss with
group members how substance abuse issues
will be addressed so as to ensure that focus is
maintained.
 The "locus of control" for the group is clarified.
Clients explore whether they believe they have
the ability to choose effective actions or if they
think of themselves as helpless victims of cir
cumstance.
 Goals for the group are clarified.
 The therapist seeks to establish a safe, warm,
supportive environment. There may be a need
to establish rules to increase safety.
 The therapist helps group members establish
connections with each other, pointing out com
mon concerns and problems.
Duration of Therapy and Frequency 
of Sessions
The preferred timeline for time-limited group ther
apy is not more than two sessions per week
(except in the residential settings), with as few as
six sessions in all, or as many as 12, depending

-----------------------------------------------
Time-Limited Group Therapy 35

on the purpose and goals of the group. The group
needs time to define its identity, develop cohe
sion, and become a safe environment in which
there is enough trust for participants to reveal
themselves.

For more detailed information, see TIP 34, 
pp. 158169.

-----------------------------------------------
36
Brief Interventions and Brief Therapies for Substance Abuse

GLOSSARY
Attribution(s): An individual's explanation of why
an event occurred.

Authenticity: In existential therapy, this concept
refers to the conscious feelings, perceptions, and
thoughts that one expresses and communicates
honestly.

Classical conditioning: According to this theory,
an originally neutral stimulus becomes a condi
tioned stimulus when paired with an uncondi
tioned stimulus or with a conditioned stimulus.

Cognitive restructuring: The general term applied
to the process of changing the client's thought
patterns.

Contact: A term used in Gestalt therapy that
refers to meeting oneself and what is other than
oneself.

Contingency management: This approach
attempts to change those environmental contin
gencies that may influence substance abuse
behavior. The goal is to increase behaviors that
are incompatible with use. 

Core conflictual relationship theme (CCRT):
Used in Supportive-Expressive (SE) Therapy, this 

-----------------------------------------------
Glossary 37

concept refers to the way in which the client inter
acts with others and with herself.

Core response from others (RO): A term used in
SE therapy to explain one way in which the core
conflictual relationship theme is unconsciously
developed.

Core response of the self (RS): A term used in SE
therapy that helps to develop an individual's core
conflictual relationship theme.

Counterconditioning: A method that uses classi
cal conditioning principles to make behaviors pre
viously associated with positive outcomes less
appealing by more closely associating them with
negative consequences.

Countertransference: The phenomenon in which
the therapist transfers his emotional needs and
feelings onto his client.

Covert sensitization: A technique used in counter-
conditioning therapy that pairs negative conse
quences with substance-related cues through
visual imagery.

Cue exposure: This principle of classic condition
ing holds that if a behavior occurs repeatedly
across time but is not reinforced, the strength of
both the cue for the behavior and the behavior

-----------------------------------------------
38
Brief Interventions and Brief Therapies for Substance Abuse

itself will diminish, and the behavior will eventually
vanish.

Defense mechanisms: The measures taken by an
individual's ego to relieve excessive anxiety.

Deliberate exception: A situation in which a client
has intentionally maintained a period of sobriety
or reduced use for any reason.

Directive approach: This form of group therapy
offers structured goals and therapist-directed
interventions to enable individuals to change in
desired ways.

Effect expectancies: A set of cognitive expectan
cies that the client develops concerning anticipat
ed effects on her feelings and behavior as drink
ing and drug use are reinforced by the positive
effects of the substance being taken.

Family sculpting: A technique used in family ther
apy. The therapist "sculpts" family members in typ
ical roles and presents significant situations relat
ed to substance abuse patterns.

Functional analysis: A process used in behavioral
and cognitivebehavioral therapy that probes the
situations surrounding the client's substance
abuse.

-----------------------------------------------
Glossary 39

Insight: A particular kind of self-realization or self-
knowledge, usually regarding the connections of
experiences and conflicts in the past with present
perceptions and behavior, and the recognition of
feelings or motivations that have been repressed. 

Miracle question: A solution-focused interviewing
strategy in which the therapist asks the client the
question, "If a miracle happened and your condi
tion were suddenly not a problem for you how
would your life be different?"

Operant learning: Refers to the process by which
behaviors that are reinforced increase in 
frequency. 

Process-sensitive approach: The process-sensi
tive group approach examines the unconscious
processes of the group as a whole, using these
energies to help individuals see themselves more
clearly and therefore open up the opportunity for
change.

Psychodrama: A method of psychotherapy in
which clients act out their personal problems by
spontaneously enacting specific roles in dramatic
performances performed before fellow clients.

Random exception: An occasion upon which a
client reduces substance use or abstains because

-----------------------------------------------
40
Brief Interventions and Brief Therapies for Substance Abuse

of circumstances that are apparently beyond his
control.

Selfobject: A term used in self psychology that
refers to something or someone else that is expe
rienced and used as if it were part of one's own
self.

Therapeutic alliance: The development of a posi
tive relationship between the therapist and client.

Transference: The process, basic to all psychody
namic therapies, of the client's transference of
salient characteristics of unresolved conflicted
relationships with significant others onto the 
therapist.

Transpersonal awakening: The process of awak
ening from a lesser to a greater identity in
transpersonal psychotherapy.

For more detailed information, see TIP 34,
Appendix C.
For information on resources for brief interven
tions and brief therapies, refer to TIP 34, 
pp. 209214.

-----------------------------------------------
Ordering Information
TIP 34 Brief Interventions and Brief
Therapies for Substance Abuse

TIP 34-Related Products
KAP Keys for Clinicians
based on TIP 34

Do not reproduce or distribute this publication for a fee without spe
cific, written authorization from the Office of Communications,
Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services.

Easy Ways to Obtain Free Copies 
of All TIP Products
1. Call SAMHSA's National Clearinghouse for Alcohol
and Drug Information (NCADI) at 800-729-6686, 
TDD (hearing impaired) 800-487-4889
2. Visit CSAT's Website at www.csat.samhsa.gov

-----------------------------------------------
Other Treatment Improvement
Protocols (TIPs) that are relevant to
this Quick Guide:

See the inside back cover for ordering information for all
TIPs and related products.

DHHS Publication No. (SMA) 01-3600
Printed 2001
TIP 25, Substance Abuse Treatment and
Domestic Violence (1995) 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
TIP32, Treatment of Adolescents With Substance
Use Disorders (1999) BKD307
TIP35, Enhancing Motivation for Change in
Substance Abuse Treatment (1999) BKD342