Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.

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The primary audience for this TIP is administrators of outpatient substance abuse treatment programs. A few words about this audience are in order. Whereas TIP 8 addressed intensive outpatient treatment, the current TIP drops the word "intensive" from its title because the consensus panel hopes that this TIP will find an audience beyond administrators of IOT programs. Most of the concepts and guidelines included in this TIP apply to the administration of all substance abuse outpatient treatment (OT) programs. On those rare occasions when information applies only to IOT programs, the authors have been sure to make this clear. Although the term "administrator" is used most often to describe the audience for this book, the terms "executive" and "director" appear as well and are used interchangeably with administrator. These overlapping terms emphasize the varied roles and responsibilities that administrators assume.

Many health problems that healthcare practitioners encounter derive from or are complicated by alcohol use disorders (AUD). Four approved medications that treat AUD make treatment in primary care a viable adjunct or alternative to specialty care, with many potential advantages. Screening for and providing brief interventions to treat AUD in general medical settings promote healthy life choices and increase the likelihood of recovery, especially for patients who have not yet progressed to chronic alcohol dependence, those with comorbid medical disorders being treated in these settings, and those who otherwise would not seek or receive treatment for their AUD. This report provides a resource to assist the health-care provider in this effort. Illus.

Part 1 of this Protocol is for substance abuse counselors and consists of two chapters. Chap. 1 presents the ¿what¿ and ¿why¿ of working with clients with substance use disorders who have depressive symptoms. Chap. 2 presents the ¿how to¿ of working with clients with depressive symptoms. Part 2 is an implementation guide for program administrators and consists of two chapters. Chap. 1 lays out the rationale for the approach taken in Chap. 2 and will help you understand the processes of organizational change and the factors that can facilitate or impede such change. Chap. 2 provides detailed info. on how to achieve high-quality implementation of the recommendations in Part 1 of this report. Illustrations.