Stages of Change and StageWise

(1) precontemplation

(characterized by defensiveness about substance use),

(5) maintenance

(when the person consolidates gains and works to prevent relapse),

(3) preparation

(when the person intends to make a change in the near future or has unsuccessfully taken action in the past year),

(2) contemplation

(when the person is aware that a problem exists but is ambivalent about making a change or has anxiety about what change will mean),

(4) Action

(when the person takes action to change his or her behavior or environment to overcome a problem behavior, such as becoming abstinent or cutting down on drug use),

(6) relapse

(which may occur repeatedly and is considered a normal, inevitable part of the behavior change process)

More on Engagement

May be a long-term process Precontemplation = Engagement stage ● Develop working alliance with client built on trust ● (Do not attend to substance misuse) ● Outreach ● Concrete practical assistance—how to do laundry, clean apartment ● Crisis intervention ● Build wider arena of social networks ● Stabilize psychiatric symptoms ● Be available at local diner, on the sidewalk—meet them where they are ● Non-verbal stress management—yoga, etc. ● Involuntary hospitalization if needed ● Non-abstinence based supportive housing for homeless

Trans-theoretical model

The idea that we change in stages, not all at once

StageWise Treatment—Prochuska and DiClemente stage based interventions

Two assumptions: 1) people with CODs are capable of making decision and taking actions that will help them achieve their goals, 2) abstinence is not an initial goal for many clients and that motivation to work on substance abuse probs develop gradually under months and years within therapy.

More on Active Treatment

When a client is motivated to work on substance use reduction or abstinence as a goal. This stage occurs when a client is engaged in treatment and has reduced or abstained from substance abuse for 1 to 6 years. ● Goal: manage substance use cravings and mental illness symptoms. ● CBT is recommended to help clients identify thoughts, behaviors, etc, that lead to substance abuse. ● "How do your feelings of victimization lead you to want to use cocaine?" ● - ABC chart (antecedent, behavior, consequences) and journal ● Mindfulness training ● Assertiveness training ● Managing mood probs ● DBT

Active Treatment

client begins to see how addiction is affecting his/her life and is trying to stop; here you can develop treatment plans and begin to initiate consistent treatment strategies

Relapse Prevention

client has been abstinent or has no negative consequences from use for at least 6 months; work focuses on maintenance and long-term change

Persuasion

client is not motivated to change, but they do come in regularly; can focus on stabilizing psychiatric symptoms and offering practical guidance

Engagement

little regular contact; focus on helping the person see what their addiction is doing to their life

More on Relapse Prevention

● Continuation of learning those skills and practicing sobriety. ● Defined formally when client is engaged in treatment and has abstained from substance use for 6 months or more. ● Dual focus on both mental health and substance abuse. ● Goals: avoid addiction, reduce impact of relapse from both issues, return to work, improve social relationships, etc. ● Social skills training group—support group that provides ongoing relapse prevention and non-judgment relapse care. ● Recovery is NOT LINEAR

More on Persuasion

● Has now established regular contact with integrated treatment specialist, but still using at full force, or slightly reduced. ● Most challenging stage for professionals—butt up against internal desire to be in control of their recovery and wellness—can't view an addict as being a problem to be fixed ● Affirm with clients that THEY have the right to live their own life and our job is to help them find their own goals and reach them. ● Persuasion is NOT: to persuade the client to DO anything to quit drugs, take psych meds, etc. ● Persuasion IS: open up opps for the client to think about their own life goals and whether their issues prevent them from achieving them. Motivational Interviewing