SAMHSA's 

Knowledge Application Program 

KAP KEYS Based on TIP 34 

Brief Interventions and Brief Therapies for 

Substance Abuse 

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 

Introduction 

These KAP Keys were developed to accompany the Treatment 

Improvement Protocol (TIP) Series published by the 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" information. 

For more information on the topics in these KAP Keys, readers 

are referred to TIP 34. 

Other Treatment Improvement Protocols (TIPs) 

that are relevant to these KAP Keys: 

TIP 25, Substance Abuse Treatment and Domestic Violence 

(1997) SMA 08-4076 

TIP 26, Substance Abuse Among Older Adults 

(1998) SMA 08-3918 

TIP 29, Substance Use Disorder Treatment for People with 

Physical and Cognitive Disabilities (1998) SMA 08-4078 

TIP 32, Treatment of Adolescents With Substance Use 

Disorders (1999) SMA 08-4080 

TIP 35, Enhancing Motivation for Change in Substance Abuse 

Treatment (1999) SMA 08-4212 
1 

KAP KEYS Based on TIP 34 

Brief Interventions and Brief Therapies for Substance Abuse 

The Stages of Change 

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 stable. This stage involves the first active steps toward change. 

Maintenance: The user establishes new behaviors on a longterm basis. 

Source: Adapted from Prochaska and DiClemente 1984. 

Sample Battery of Brief Assessment 

Instruments 

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 
KAP KEYS Based on TIP 34 

Brief Interventions and Brief Therapies for Substance Abuse 

2

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) 

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 
KAP KEYS Based on TIP 34 

Brief Interventions and Brief Therapies for Substance Abuse 

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 

something 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 problem and then automatically considering the possible negative 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) 

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 
KAP KEYS Based on TIP 34 

Brief Interventions and Brief Therapies for Substance Abuse 

4 

13. Global labeling: Generalizing one or two qualities into a 

negative global judgment 

14. Being right: Proving that your opinions and actions are correct 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 selfdenial to pay off, and feeling disappointed and even bitter 

when the reward does not come 

Source: Beck 1976 

Selected Criteria for Providing Brief Therapy 

• Dual diagnosis issues such as a coexisting psychiatric disorder 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 commitment) 

• 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 instrument 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 facilities; 30- to 45-day limitation in Job Corps program) 

• Presence of coexisting medical or mental diagnoses 

• Large numbers of clients needing treatment leading to waiting lists for specialized treatment 
KAP KEYS Based on TIP 34 

Brief Interventions and Brief Therapies for Substance Abuse 

Characteristics of All Brief 5 

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 the 

counseling style of the therapist. 

• The therapeutic style is highly active, empathic, and sometimes directive. 

• Responsibility for change is placed clearly on the client. 

• Early in the process, the focus is to help the client have experiences that enhance self-efficacy and confidence that 

change is possible. 

• Termination is discussed from the beginning. 

• Outcomes are measurable. 
6

Professionals Outside of Substance 

AbuseTreatment Who Can Administer 

Brief Interventions 

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 7 

Treatment 

KAP KEYS Based on TIP 34 

Brief Interventions and Brief Therapies for Substance Abuse 

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 
X5AMlls:A
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