Although some people experience a specific moment in which their desire to change suddenly crystalises, for most people this is a gradual process. As such, it is common for clients’ commitment to taking action to fluctuate over time [758]. MI is a method of facilitating the natural growth of commitment. The AOD worker will consolidate all issues raised by the client and help them build their commitment to change while also planning a concrete action plan. Ambivalence will still possibly be present, and if encountered, continue the use of the strategies and micro skills outlined above. It can be useful to encourage the client to confront the idea and process of change. For example:
- ‘Where do we go from here?’
- ‘What does everything we’ve discussed mean for your AOD use?’
- ‘How would your life be different if…?’
- ‘What can you think of that might go wrong with your plans?
Although abstinence is one possible goal, some people may not be ready to stop completely and may opt for reduced or controlled use. In MI, the client has the ultimate responsibility for change and total freedom of choice to determine their goal for treatment. The AOD worker’s role is to assist the client to determine treatment goals and guide the realisation of those goals. Goals may often change during the course of treatment, and an initial goal of cutting down may become a goal of abstinence as the client’s confidence increases.
In clients with co-occurring mental health conditions, abstinence is favoured [131, 1921] as mental health symptoms may be exacerbated by AOD use. In particular, those with more severe mental disorders (or cognitive impairment) may have adverse experiences even with low levels of substance use [795]. Those taking medications for mental health conditions (e.g., antipsychotics, antidepressants) may also find that they become intoxicated even with low levels of AOD use due to the interaction between substances. Although abstinence is favoured, many people with co-occurring conditions prefer a goal of moderation, and that goal should be respected. It is possible to accept a client’s decision to use and provide harm reduction information without condoning use.
Explore any fears or obstacles that are identified in the change process and assist the client with problem solving for each of these. Explore any concerns with the management of withdrawal symptoms (e.g., irritability, insomnia, mood disturbances, lethargy, and cravings to use) if this is raised. Education and support are essential components of getting through withdrawal.
Finally, when the client begins behaviour change, try manipulating the environment to exaggerate positive outcomes (e.g., involve family, increase social interaction, use encouragers and compliments), particularly in clients with co-occurring mental health conditions in order to strengthen resolve [1920].