Motivation is a strong predictor of addiction treatment outcomes (Miller & Moyers, 2015). Motivation can fluctuate over different stages of the SOC and varies in intensity. It can decrease when the client feels doubt or ambivalence about change and increase when reasons for change and specific goals become clear. In this sense, motivation can be an ambivalent state or a resolute commitment to act—or not to act.
Key strategies in this stage include eliciting the client’s perception of the problem, exploring the events that led chapter 1 a new look at motivation enhancing motivation for change in substance use disorder treatment ncbi bookshelf to entering treatment, and identifying the client’s style of Precontemplation. Mental health service providers, such as psychologists, licensed clinical social workers, and psychiatric/mental health nurses. By the 1920s, compassionate treatment of opioid addiction was available in medical clinics. At the same time, equally passionate support for the temperance movement, with its focus on drunkenness as a moral failing and abstinence as the only cure, was gaining momentum. Offer simple suggestions that match the client’s level of understanding and readiness, the urgency of the situation, and his or her culture. In some cultures, a directive approach is required to convey the importance of advice or situations; in others, a directive style is considered rude and intrusive.
Many adults in the United States resolve an alcohol or drug use problem without assistance (Kelly et al., 2017). This is called “natural recovery.” Recovery from SUDs can happen with limited treatment or participation in mutual-aid support groups such as Alcoholics Anonymous and Narcotics Anonymous. As many as 45 percent of participants in the National Prevalence Survey resolved their substance use problems through participation in mutual-aid support programs (Kelly et al., 2017).
Feedback should address cultural differences and norms related to substance misuse. For example, a review of the research on adaptations of BI found that providing feedback specifically related to cultural and social aspects of drinking to Latino clients reduced drinking among these clients to a greater degree than standard feedback (Manuel et al., 2015; Satre et al., 2015). Confrontation of psychological defenses and substance misuse behaviors is an effective counseling approach. Historically, the idea that resistance and denial are characteristic of addiction led to the use of confrontation as a way to aggressively break down these defenses (White & Miller, 2007).
Integration helps address health disparities, reduces healthcare costs, and improves general health outcomes. The separation of SUD treatment from mainstream healthcare services has created obstacles to successful treatment and care coordination. 8.5 million adults ages 18 and older (3.4 percent of all adults) had both a mental disorder and at least one past-year SUD. The need for a broader base of treatment and prevention components to serve all segments of the population that have minimal to severe use and misuse patterns. Ask for clarification if the client makes a specific request, rather than give advice immediately. When you provide feedback, show the client his or her score on any screening or assessment instrument and explain what the score means.
Exhibit 2.1 is a sample feedback handout to share with a client after completing the Alcohol Use Disorders Identification Test (AUDIT). Ask whether the client had any difficulties with answering questions or filling out forms. Preparation, in which people have identified a change goal and are forming a plan to change. Secondary audiences include prevention specialists, educators, and policymakers for SUD treatment and related services. 11.4 million people ages 12 and older misused opioids (defined as prescription pain reliever misuse or heroin use) in the past year. 18.2 million people who needed SUD treatment did not receive specialty treatment.
This TIP shows how SUD treatment counselors can influence positive behavior change by developing a therapeutic relationship that respects and builds on the client’s autonomy. Through motivational enhancement, counselors become partners in the client’s change process. In the past, addiction treatment consisted of detoxification, inpatient rehabilitation, long-term rehabilitation in residential settings, and aftercare. When care was standardized, most programs had not only a routine protocol of services but also a fixed length of stay. Twenty-eight days was considered the proper length of time for successful inpatient (usually hospital-based) care in the popular Minnesota model of SUD treatment.
During the Maintenance stage, the client has achieved the initial change goals and is working toward maintaining those changes. In the Preparation stage, the client is committed and planning to make a change but is unsure of what to do next. In the Action stage, the client is actively taking steps to change but has not reached stable recovery.
In Maintenance develop new skills to maintain recovery and a lifestyle without substance misuse. If misuse resumes, help the client recover as fast as possible; support reentering the change cycle. People considering major changes in their lives, such as adopting an alcohol- or drug-free lifestyle, go through different change processes. Your job as a counselor is to match your treatment focus and counseling strategies with these processes throughout the SOC.
According to 2017 data from the National Survey on Drug Use and Health (SAMHSA, 2018), 46.6 million adults ages 18 and older (19 percent of all U.S. adults) had any mental illness during the previous year, including 11.2 million (4.5 percent of all adults) with serious mental illness (SMI). Of this 46.6 million, 18 percent also had an SUD versus only 5 percent of adults without any mental illness in the past year. Of the 11.2 million adults with an SMI in the previous year, almost 28 percent also had a co-occurring SUD. Understand not just how a client’s cultural values encourage change, but how they may present barriers to change. Some clients identify strongly with cultural or religious traditions and work hard to gain respect from elders or group leaders. Some cultures support involvement of family members in counseling; others find this disrespectful.
Giving clients choices for treatment goals and types of available service increases their motivation to participate in treatment. MI is effective when blended with other counseling approaches including group counseling, the motivational interviewing assessment, CBT, and recovery management checkups. Technology adaptations, including motivational counseling and brief interventions over the phone or via text messaging, are effective, cost effective, and adaptable to different client populations. Providing personalized feedback on assessment results and involving significant others in counseling sessions are key strategies for raising concern and moving the client toward contemplating change. Resistance is a characteristic of “unmotivated” clients in addiction treatment (Connors et al., 2013). Viewing resistance—along with rationalization and denial—as characteristic of addiction and making efforts to weaken these defenses actually strengthens them.
Recovery from SUDs is seen as a multidimensional process along a continuum (Office of the Surgeon General, 2016) that differs among people and changes over time within the individual. Motivational strategies can be effectively applied to a person throughout the addiction process. The crucial variable is not the severity of the substance use pattern but the client’s readiness for change. As the addiction treatment field has matured, it has tried to integrate conflicting theories and approaches and to incorporate research indings into a comprehensive model. The following sections address recent changes in addiction treatment with important implications for applying motivational methods.
Prochaska and DiClemente (1984) theorized that the change process is a journey through stages in which people typically think about behavior change, initiate behavior change, and maintain new behaviors. This model emerged from an examination of 18 psychological and behavioral theories about how change occurs, including components that compose a biopsychosocial framework for understanding addiction. In this sense, the model is “transtheoretical” (Prochaska & DiClemente, 1984).
A client in the Precontemplation stage is unconcerned about substance use or is not considering change. People go through stages in the SOC approach; this concept is known as the TTM of change. 8.5 million adults ages 18 and older (3.4 percent of all adults) had both a mental disorder and at least 1 past-year SUD. This is an open-access report distributed under the terms of the Creative Commons Public Domain License. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission.