Interventions for Addiction

Comprehensive Addictive Behaviors and Disorders, Volume 3

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• Publisher: Academic Press
• Year: 2013
• Print ISBN: 9780123983381
• eBook ISBN: 9780123983633
• Topic: Psychology
• Subtopic: Pharmacology
• Index: Psychology

Interventions for Addiction examines a wide range of responses to addictive behaviors, including psychosocial treatments, pharmacological treatments, provision of health care to addicted individuals, prevention, and public policy issues. Its focus is on the practical application of information covered in the two previous volumes of the series, Comprehensive Addictive Behaviors and Disorders. Readers will find information on treatments beyond commonly used methods, including Internet-based and faith-based therapies, and criminal justice interventions. The volume features extensive coverage of pharmacotherapies for each of the major drugs of abuse—including disulfiram, buprenorphine, naltrexone, and others—as well as for behavioral addictions. In considering public policy, the book examines legislative efforts, price controls, and limits on advertising, as well as World Health Organization (WHO) efforts. Interventions for Addiction is one of three volumes comprising the 2,500-page series, Comprehensive Addictive Behaviors and Disorders. This series provides the most complete collection of current knowledge on addictive behaviors and disorders to date. In short, it is the definitive reference work on addictions. - Includes descriptions of both psychosocial and pharmacological treatments. - Addresses health services research on attempts to increase the use of evidence-based treatments in routine clinical practice. - Covers attempts to slow the progress of addictions through prevention programs and changes in public policy.

Section 1

Treatment

Chapter 1 Brief Feedback-Focused Interventions

Chapter 2 Motivational Enhancement Approaches

Chapter 3 Cognitive Behavioral Therapies

Chapter 4 Cue Exposure Treatments for Substance Use Disorders

Chapter 5 Contingency Management

Chapter 6 Community Reinforcement Approaches

Chapter 7 Behavioral Couples Therapy for Alcoholism

Chapter 8 Network Support Treatment for Alcohol Dependence

Chapter 9 Multisystemic Therapy for Adolescent Substance Use

Chapter 10 Multidimensional Family Therapy for Adolescent Substance Abuse

Chapter 11 Brief Strategic Family Therapy for Adolescent Drug Abuse

Chapter 12 Functional Family Therapy for Adolescent Substance Use Disorders

Chapter 13 Individual and Group Counseling for Substance Use Disorders

Chapter 14 Self-Help Groups

Chapter 15 Twelve-Step Facilitation Therapy

Chapter 16 Faith-Based Substance Abuse Programs

Chapter 17 Behavioral Treatments for Smoking

Chapter 18 Behavioral Treatments for Adolescents with Substance Use Disorders

Chapter 19 Gender-Specific Treatments for Substance Use Disorders

Chapter 20 PTSD and Substance Abuse Treatment

Chapter 21 Criminal Justice Interventions

Chapter 22 Driving While Impaired (Treatments)

Chapter 23 Mindfulness

Chapter 24 Psychological Treatments for Pathological Gambling

Chapter 25 HIV/AIDS and Substance Abuse

Chapter 26 Treatment-as-Usual for Substance Abuse in Community Settings

Chapter 27 Disparities in Health Services for the Treatment of Substance Use Disorders

Chapter 28 A Decade of Research on Recovery Management Checkups

Chapter 29 Technology-Delivered Treatments for Substance Use Disorders

Chapter 30 Screening and Interventions in Medical Settings Including Brief Feedback-Focused Interventions

Chapter 31 Screening and Assessment of Comorbidity

Chapter 32 Diagnostic Dilemmas in Comorbidity

Chapter 33 Treatment for Co-occurring Substance Abuse and Mental Health Disorders

Chapter 34 Implications of Comorbidity for Clinical Practice

Chapter 1

Brief Feedback-Focused Interventions

Brian Borsari^∗,$, Nadine R. Mastroleo^$, ^∗Mental Health and Behavioral Sciences Service, Providence, RI, USA, ^$Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA

Outline

Definition

The Development of Brief Feedback-Focused Interventions

Role in Overall Treatment

Goals of BFIs

Proposed Active Ingredients of BFIs

FRAMES

MI

Readiness to Change

Assessment Reactivity

Behaviors Addressed by BFIs

Smoking

Gambling

Sexual Risk

Other Behaviors

Feedback Content

Occurrence of Target Behavior

Personal Problems Associated with Target Behavior

Norms

Alcohol-Related Expectancies

Strategies to Reduce Risk

Other Feedback

Modalities

Individual

Group

Mailed

Internet

Peer-Based Intervention Approaches

Populations

Adolescents

College Students

Noncollege Adults

Summary

Definition

Opinions vary regarding what exactly constitutes a brief intervention – many terms and definitions have been developed over the years, such as brief advice, feedback interventions, feedback evaluations, brief intervention, and minimal intervention. For the purpose of this entry, a brief feedback-focused intervention (BFI) will be defined as an interaction addressing an addictive behavior lasting typically from 15 min to an hour in duration. The number of sessions can range from one to six, with the potential for follow-up contacts used to monitor the individual’s progress. BFIs have been used therapeutically with a wide range of problem behaviors (e.g. alcohol and other drug use), with a typical goal of identifying a real or possible problem and motivating the individual to take steps to change the behavior. These BFIs are delivered by trained interventionists, who provide the recipient personalized information regarding his or her substance use. The source of this feedback is typically an assessment of the behavior of interest. The complexity of this assessment varies as some assess only basic information (e.g. quantity and frequency of drinking), while others may also include problems and beliefs the individual may have related to their addictive behavior. Other BFIs may include laboratory analysis of blood or urine to evaluate the individual’s health (e.g. liver damage).

BFIs can be confused with minimal interventions due to their shared emphasis on limited contact with the individual. Minimal interventions are defined as consisting of one contact with the individual, resulting in a therapeutic effect, which can be as short as 5 min. These treatments are usually based on self-help principles, and in some minimal interventions there is no face-to-face contact with a therapist: bibliotherapy (the use of books or written materials to address a behavioral or emotional problem) is an example. Minimal interventions have also been called “simple” or “brief” advice because it prescribes a certain change, yet does not specify a specific way to achieve this objective. In contrast, BFIs provide specific information regarding the behavior of interest as well as recommendations and strategies for change.

The Development of Brief Feedback-Focused Interventions

Over the past 30 years, BFIs have emerged as a promising option for reducing addictive behaviors. For example, such interventions have been used in the treatment of heroin addiction, helping individuals quit smoking, promoting cardiovascular health. Brief interventions have been used extensively in the treatment of alcohol abuse, with clients ranging from adolescent to elderly.

Since 1980, the World Health Organization (WHO) has been developing and implementing BFIs for individuals experiencing problems with alcohol. These efforts began with the recognition that there was not an efficient way to identify individuals who were experiencing a problem with alcohol. Therefore, Phase I of the WHO Collaborative Project in Identification and Treatment of Persons with Harmful Alcohol Consumption began in 1982, and led to the development of the Alcohol Use Disorders Identification Test (AUDIT). The AUDIT was developed to identify individuals who could benefit from a BFI in primary care settings. Phase II consisted of implementing a randomized clinical trial implementing screening and BFI in primary health care settings, and Phase III focused on identifying the barriers to the widespread adoption of the BFI by general practitioners. Phase IV, currently underway, is to develop and implement strategies that would successfully implement the BFI in primary care settings in 13 countries around the world.

The Drinker’s Check-Up (DCU) represents one of the first applications of administering BFIs in the general population. Advertisements were placed in newspapers and on a college campus that described the check-up as follows: “The check-up is not part of any treatment program, and it is not intended for alcoholics. Rather, it is an informal health service. Participants will not be labeled or diagnosed, and consultation is completely confidential. Objective personal feedback of results will be provided. It is up to the participant to determine what, if anything, to do about the feedback received.” Individuals who responded to the advertisements were given the DCU, which consisted of a 2-h assessment followed by a 1-h feedback session. The assessment component consisted of measures that evaluated the quantity and frequency of alcohol consumption, blood tests designed to detect alcohol-related liver damage, and neuropsychological tests that were sensitive to drinking-related impairment. At a later date, the results of these tests were then provided to the individual in an empathetic, nonjudgmental way. Then, the participant was asked to discuss his or her feelings about the assessment results. Finally, the interviewer discussed possible change options with the participant.

The feedback interview in the DCU was done in the style known as motivational interviewing (MI). Such an interview approach is defined as a counseling style that is both client centered and directive and seeks to explore and resolve the client’s ambivalence about engaging in a particular behavior. This exploration and resolution of ambivalence is done by the individual and not the interviewer, fostering a greater awareness of his or her problems with alcohol and the need to change. The interviewer’s role is to listen and provide the necessary information and advice regarding the changes the client feels is needed. Above all, the interviewer takes care to avoid confrontation, a style that has been observed to result in client resistance and even increase in drinking.

Role in Overall Treatment

In the context of the continuum of prevention developed by the Institute of Medicine in 2004, BFIs are typically used as a selective and indicated prevention strategy. Selective prevention targets individuals who are at risk for developing the problem behavior (e.g. substance use). Indicated prevention efforts are appropriate for those who are already experiencing harm from the target behavior (e.g. individuals who are experiencing alcohol-related problems). In contrast, universal prevention efforts are provided to the entire population, and tend to be more didactic in nature and may not include the personalized feedback provided in BFIs. Furthermore, BFIs are not intended as a stand-alone treatment for individuals exhibiting alcohol dependence. Although these individuals may significantly change their alcohol use following a BFI, often the desired outcome is engagement in more intensive treatment.

Goals of BFIs

The nature of the outcome goal may play a role in the success of brief interventions. Recent BFIs, such as those conducted with college students, tend not to present abstinence as the only acceptable option. Rather, they reflect an approach more oriented toward raising the awareness of students about their drinking habits and the potential risks associated with it. This approach, identified as harm reduction, has become the focus of the majority of BFIs regardless of the target population (adults, college students, adolescents). This flexibility has been spurred by research indicating that a mandatory goal of abstinence may not be very productive for several reasons. First, the majority of individuals may not view themselves as problem drinkers, and may view abstinence as too drastic a response to their drinking, where instead, moderation of their drinking may be more appealing. Second, the limited contact the interventionist has with the BFI recipient may make it more productive to view abstinence as an ideal outcome but not as a necessary result of brief interventions. Third, long-term follow-ups of traditional alcohol treatment programs indicate that a goal of abstinence following an intervention may not be realistic. Research with adult drinkers indicates that about a third of the participants remained abstinent after 1 year; 4 years after treatment, less than 10% have remained abstinent.

For these reasons, many BFIs often adopt a harm reduction approach. Any movement of an individual on this continuum that reduces the amount of alcohol one consumes (and concordantly reduces the risk of negative consequences as a result of their drinking) is seen as a desirable result. This approach has been used with a number of addictive behaviors ranging from alcohol and drug use to gambling and has influenced several college drinking reduction efforts. An intervention approach that pro...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Preface
• Editors: Biographies
• List of Contributors
• Section 1: Treatment
• Section 2: Medications to Treat Addictions
• Section 3: Applying Addiction Science to Clinical Practice
• Section 4: Public Policy
• Section 5: Alcohol and Drug Prevention, Adolescents and College Students, Gambling
• Index