The counselor’s focus in Precontemplation is to establish a strong counseling alliance and raise the client’s doubts and concerns about substance use. The four processes in MI (i.e., engaging, focusing, evoking, and planning) provide an overarching framework for employing the core skills in conversations with a client. Reflective listening is fundamental to person-centered counseling in general and MI in particular and is essential for expressing empathy.
TIP 35: Enhancing Motivation For Change in Substance Abuse
In this approach, motivation is viewed as a dynamic and changeable state rather than a static trait. This TIP shows how clinicians can influence this change process by developing a therapeutic relationship, one that respects and builds on the client’s autonomy and, at the same time, makes the treatment counselor a participant in the change process. The TIP also describes different motivational interventions that can be used at all stages of change, from precontemplation and preparation to action and maintenance. The goal of this TIP is to make readers aware of the research, results, and promise of motivational interventions in the hope that they will be used more widely in clinical practice and treatment programs across the United States. It emphasizes creating a coping plan to reduce the risk of recurrence in high-risk situations, identifying new behaviors that reinforce change, and establishing relapse prevention strategies. In this treatment approach, motivation for change is seen as a dynamic state that you can help the client enhance.
Advice
In other cases, clients might need a break from the intensity of treatment to focus on specific aspect of recovery. If you push clients at a faster pace than they are ready to take, the treatment alliance may break down. Others need time to resolve their ambivalence about current substance use before making a change. Knowing where a client has been and is now in the SOC helps you facilitate the change process at the right pace.
Counselors have come to recognize not only that SUDs vary in intensity but also that most involve more than one substance. Some evidence shows that motivational counseling approaches (including individual and group MI and brief interventions) demonstrate positive outcomes for clients who misuse alcohol and other substances (Klimas et al., 2014). Motivational counseling approaches with this client population should involve engaging clients and prioritizing their change goals. Chapter 2 examines science-informed elements of motivational approaches that are effective in treating substance use disorders (SUDs).
Counselor Focus in the SOC
Another leftover from earlier psychological perspectives on addiction is that people with SUDs have strong psychological defenses, such as denial and rationalization, which lead to challenging behaviors like evasiveness, manipulation, and resistance (Connors, DiClemente, Velasquez, & Donovan, 2013). The clinical and research literature does not support the belief that people with SUDs have more or stronger defenses than other clients (Connors et al., 2013). This view of motivation as static led to blaming clients for tension or discord in therapeutic relationships.
This chapter provides an overview of the spirit of MI, the principles of chapter 1 a new look at motivation enhancing motivation for change in substance use disorder treatment ncbi bookshelf person-centered counseling, the core counseling skills of MI (i.e. asking open questions, affirming, reflective listening, and summarizing), and the four processes of MI (i.e., engaging, focusing, evoking, and planning). The chapter discusses the components that counselors use to help clients resolve ambivalence and move toward positive substance use behavior change. This type of feedback usually compares a client’s scores or ratings on standard screening or assessment instruments with normative data from a general population or treatment groups.
- There are several BI models, but FRAMES is the dominant BI method for substance misuse (Mattoo et al., 2018).
- In response to an impending divorce, for example, one individual may begin to drink heavily whereas another may reduce or stop using alcohol.
- This process is usually called decisional balancing and is further described in Chapter 5.
Brief Motivational Interventions
Individuals naturally explore the pros and cons of any major life choice, such as changing jobs or getting married. In SUD recovery, the client weighs the pros and cons of changing versus not changing substance use behaviors. You assist this process by asking the client to articulate the positive and negative aspects of using substances. This process is usually called decisional balancing and is further described in Chapter 5. Counselors can support clients’ movement toward positive changes in their substance use by identifying and enhancing motivation that already exists.
- When clients make independent decisions, they are likely to be more committed to them.
- You cannot give clients motivation, but you can help them identify their reasons and need for change and facilitate planning for change.
- The development of the modern SUD treatment system dates only from the late 1950s.
- It also explores ways in which ongoing training, supervision, and coaching are essential to successful workforce development and integration.
- Key strategies in this stage include eliciting the client’s perception of the problem, exploring the events that led to entering treatment, and identifying the client’s style of Precontemplation.
Focus on client strengths
Motivational enhancement has evolved, and various myths about clients and what constitutes effective counseling have been dispelled. The notion of the addictive personality has lost credence, and a confrontational style has been discarded or significantly modified. Other factors in contemporary counseling practices have encouraged the development and implementation of motivational interventions, which are client centered and focus on client strengths. Counseling relationships are more likely to rely on empathy rather than authority and involve the client in all aspects of the treatment process. Motivation is accessible and can be enhanced at many points in the change process.
It also addresses the shift away from abstinence-only addiction treatment perspectives toward client-centered approaches that enhance motivation and reduce risk. This chapter is an overview of motivational counseling approaches, including screening, brief intervention, and referral to treatment (SBIRT). It describes elements of effective motivational counseling approaches, including FRAMES (Feedback, Responsibility, Advice, Menu of options, Empathy, and Self-efficacy), decisional balancing, discrepancy development, flexible pacing, and maintenance of contact with clients. It addresses special applications of motivational counseling with clients from diverse cultures and with clients who have co-occurring substance use and mental disorders (CODs).
A growing body of evidence indicates that early and brief interventions demonstrate positive treatment outcomes in a wide variety of settings including specialty SUD treatment programs, primary care offices, and emergency departments. Brief interventions emphasize reducing the health-related risk of a person’s substance use and decreasing consumption as an important treatment outcome. How can you help clients enhance their motivation to engage in substance use disorder (SUD) treatment and initiate recovery? This Treatment Improvement Protocol (TIP) will answer these and other important questions. Using the TTM of behavioral change as a foundation, Chapter 1 lays the groundwork for answering such questions. It offers an overview of the nature of motivation and its link to changing substance use behaviors.
Chapter 8—Integrating Motivational Approaches in SUD Treatment Settings
It emphasizes decisional balancing and exploring clients’ self-efficacy as important to moving clients toward preparing to change substance use behaviors. Summarizing change talk and exploring the client’s understanding of change prepare clients to take action. In developing a new understanding of motivation, substantial addiction research has focused on the determinants and mechanisms of change. By understanding better how people change without professional assistance, researchers and counselors have become better able to develop and apply interventions to facilitate changes in clients’ substance use behaviors.
Motivation is a critical element of behavior change (Flannery, 2017) that predicts client abstinence and reductions in substance use (DiClemente et al., 2017). You cannot give clients motivation, but you can help them identify their reasons and need for change and facilitate planning for change. Successful SUD treatment approaches acknowledge motivation as a multidimensional, fluid state during which people make difficult changes to health-risk behaviors, like substance misuse. Presenting and discussing assessment results can enhance client motivation to change health-risk behaviors.
Research and clinical literature have explored how to help clients sustain behavior change in ongoing recovery. Such recovery support helps prevent or lessen the social, mental, and health problems that result from a recurrence of substance use or a relapse to previous levels of substance misuse. The field has expanded the definition of positive treatment outcomes to include intermediate goals of risk reduction. Risk-reduction interventions include medication-assisted treatment for AUD and OUD and reduction in substance use as an intermediate step toward abstinence for clients who are not ready or willing to commit to full abstinence. Risk-reduction strategies can be an important goal in early treatment and have demonstrated effectiveness in reducing substance-use-related consequences (Office of the Surgeon General, 2016). This chapter discusses strategies counselors can use to help clients raise doubt and concern about their substance use and move toward contemplating the possibility of change.
Historically, a diagnosis or disease defined the client and became a dehumanizing attribute of the individual. Person-first language (e.g., a person with an SUD) is the new standard; it reduces stigma, helps clients disentangle addiction from identity, and eliminates the judgmental tone left over from the moral model of addiction (SAMHSA, Center for the Application of Prevention Technologies, 2017). If the initial intervention does not result in substantial improvement, the provider can make a referral for specialized SUD treatment. A BI also can explore the pros and cons of entering treatment and present a menu of options for treatment, as well as facilitate contact with the treatment system. There are several BI models, but FRAMES is the dominant BI method for substance misuse (Mattoo et al., 2018). Explore with the client the benefits and drawbacks of change (Janis & Mann, 1977).
In Action, the counselor focuses on supporting client action steps and helping the client evaluate what is working and not working in the change plan. To reinforce movement toward change, the counselor reinforces the client’s understanding of the change process, reintroduces personalized feedback, explores client self-efficacy, and summarizes client change talk. Counselors should adopt the principles of cultural responsiveness and adapt motivational interventions to those principles when treating clients from diverse backgrounds. Each stage in the SOC approach has predominant experiential and behavioral catalysts for client change on which counselors should focus. It is multidimensional, dynamic, and fluctuating; can be enhanced; and is influenced by the counselor’s style. Behavior change is a process that occurs over time; it is not an outcome of any one treatment episode (Miller et al., 2011).
