Module 4

Work to due by Wednesday:

This activity will help you achieve two module outcomes, namely the ability to analyze the relationships between stages of change and addiction treatment and relate appropriate treatment interventions to the identified stage of change of an individual.

As always, the first question in this discussion is opinion-based, so jump right into the discussion immediately. For subsequent questions, please meaningfully integrate your readings, including the text, articles, and Module Notes, into your posts.  Engage in the discussions early, since time goes by so quickly.

Things to Think About
What causes us to want to make changes in our lives? How would this compare to an individual addicted to a substance in terms of wanting to make changes in his/her behavior? What forces within us support change in behavior? Are there external driving forces as well?

This week, we have an opportunity to explore our beliefs about motivation and change and to examine how motivation impacts outcomes in substance abuse treatment.

First, in your opinion:

1. When we think of change, we often think of the carrot and the stick analogy. Some changes come from anticipation of something positive after making the change, while other changes may come from fear of unpleasant outcomes. What kinds of things – internal and external – motivate people to make changes in their lives?  Think about what motivates you to change. Do you think that change is more often motivated by the carrot or the stick perspective? How so?

Now applying this weeks materials in conversation:

2. We have explored in our opinion question what moves people toward change.  Now, lets look at the substance abuse field. How has the field traditionally tried to motivate people to change their behavior? What societal factors have led providers toward the current perspectives toward change?

3. Now, lets focus on the six stages of change. How does the Stage of Change model motivate people toward change? As you engage in conversation around this question, be sure to consider each of the stages of change, as well as the cyclical ways in which people move through these stages. As people move through the stages, how might this impact treatment recommendations? Please share concrete examples from Nics story (required) and from other professional/personal experiences as appropriate.

Note: We will be discussing each question together as a group, one at a time. As you create your posts, remember that the goal is an informed, dynamic conversation. Be creative in your headings and responsive to others who have posted before you. As you create responses to others, create new and descriptive titles to your post. Dont simply put “re:” or type in a person’s name that is already clear from the thread. Instead, if you type a full sentence or long enough phrase that the point of your post will be clear. This tip for using the subject line effectively will make navigating all discussion threads easy and meaningful. There is no right or wrong response, but you should demonstrate an ability to relate the module materials to the discussion questions in an articulate, well-reasoned manner.

Video Require:

https://youtu.be/ziH33JqCGAU

https://www.dailymotion.com/video/x305lnr?GK_FACEBOOK_OG_HTML5=1

Reading Material:

Sheff, N. (2008). Tweak: Growing up on methamphetamines, New York, NY: Athenum Books, p. 1 108. 

https://www.ncbi.nlm.nih.gov/books/NBK64947/pdf/Bookshelf_NBK64947.pdf

https://www.ncbi.nlm.nih.gov/books/NBK64208/

Building Motivation:
Often, individuals who are substance abusers are not really motivated to change their behavior.  They see many benefits to their current use and fear giving up these benefits.  Motivational interviewing allows for a person-centered approach to helping make behavior changes while dealing with the ambivalence that individuals often have surrounding making these changes.

Ultimately, the substance abuser must be responsible for making the changes necessary in his /her life.  Motivational Interviewing, often referred to simply as MI, provides a variety of techniques that can be used to assist the individual to deal with ambivalence on a conscious level and make choices about continued use.

With some models of treatment, individuals are considered motivated if they agree to participate in a program, are compliant with the program, and accept the label assigned to them, e.g. alcoholic or addict.  They are considered unmotivated if they do not accept a diagnosis and refuse to participate in a program.

Given that motivation is the key to change, it is important for us to look at this concept carefully. Motivation is multi-dimensional it is influenced from within and from outside the individual.  There are internal desires and perceptions of risk/benefit that influence an individual, as well as external pressures.

Everyones motivation fluctuates and changes over time, based on both the environment and internal conflicts.  Social interactions with family and friends influence motivation.  If an individual is in treatment, the clinical style of the provider may heavily influence ones motivation.

Motivational Interviewing:
The techniques of motivational interviewing are designed to assist an individual to examine current use patterns and to move past ambivalence to allow him or her to participate more effectively in treatment.  It can be an effective tool to engage individuals in treatment, improve treatment outcomes, and encourage a more timely return to treatment if substance abuse recurs.

Health/addictions professionals employing motivational interviewing will engage in the following techniques:

expressing empathy
developing discrepency
avoiding argumentation
rolling with resistance
supporting self-efficacy
Stages of Change
The Stages of Change model was developed by Prochaska and DiClemente to organize and conceptualize ones motivation to make substance abuse changes. This model may be familiar to you from other courses, as it is frequently used in the health professions for many types of interventions. There is a vast and ever-growing evidence base that supports the effectiveness of the Stages of Change model in supporting behavioral change.

The model includes six stages of change. Lets look at these stages in connection to substance use/abuse.

Precontemplation In this stage, the individual is not aware of a problem, nor is he or she thinking of making any changes in the substance use.
Contemplation During this phase, the individual has begun to identify pros and cons of making a change, but has not committed oneself to addressing it.
Preparation The individual has decided to make a change in his/her substance abuse and is beginning to make plans to address the change.
Action This is the stage of change in which new actions are tried.  The individual may be learning alternative behaviors and practicing these behaviors to cease or decrease the substance use.
Maintenance It is at this phase that an individual has incorporated new behaviors into the daily routine and is exhibiting them on a long-term basis.
Recurrence This is the relapse stage in which an individual may need help to quickly resume the change process.
Please see below for a graphic depiction of the Stages of Change Model. Plain text transcript

Prochaska and DiClementes Stages of Change

The change process is not linear, but is cyclical in nature.  Recovery is a lifelong journey. People typically move back and forth between stages and sometimes linger in a particular stage for a period of time.  Recurrence is a normal event.  Many people cycle through the stages of change several times before achieving abstinence.

Stages of Treatment
It is important to match the stage of change that the individual is in with the stage of treatment. Without awareness and willingness to change, many treatment stages are less likely to be successful. Treatment is generally broken into early, mid, and late stage. Lets take a closer look at each stage.

Early Stage:
In early stage treatment, the focus is on engaging the individual and beginning to help him see the role that substance abuse has played in his life and current functioning. Making the connection that substance abuse is linked to current problems assists in motivating the individual to make a change. For example, a woman whose growing dependence on alcohol may find herself at risk for losing her children, her job, and her apartment. As Margot makes this connection, and it is reinforced by others in her life, she may well become increasingly motivated to change for the sake of her children.

Mid Stage:
In mid stage, the treatment is aimed at helping the individual to enter the world of recovery and to take advantage of the resources available. Helping an individual see how far they have come, helping them see the small gains that are being made is essential to staying on course. Margot may take action on her motivation to change by entering outpatient rehabilitation and beginning to attend evening group treatment and Alcoholics Anonymous meetings. She is now receiving support from other single mothers who have struggled with substance abuse and nearly lost their children.

Late Stage:
In the late stage of treatment, the focus is on maintaining the positive gains of the treatment process. In addition, a focus is on identifying possible triggers and temptations that may cause relapse. Carrying this example through to late stage treatment, Margot may join a relapse prevention group at the outpatient rehabilitation center and continue her attendance at 12-step meetings with the support of a sponsor. She may develop a list of relapse triggers and warning signs. She will ideally also have a list of supports whom she can reach out to as needed to prevent relapse, or to re-engage with treatment should relapse occur.

As we enter this weeks discussion, lets consider this question: What causes people to want to change? Some of these motivators are universally held by all human beings, while some may be felt more acutely, or perhaps less acutely, by someone with an addiction. In this weeks discussion, we will look at the extrinsic and intrinsic forces driving motivation and change, and how these are experienced by persons with an addiction and those close to them.

As always, please join the opinion-based question in our discussion right away, and then complete this weeks learning materials. Once you have read and viewed this weeks materials, rejoin us in the discussion to apply what we are learning.