Readiness for change

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It may be helpful to ascertain how motivated the client is to change his/her current AOD use. This involves an exploration of the client’s perception of the positive and negative aspects of continued AOD use. Prochaska and DiClemente [292] suggest that clients fall into one of six stages of change. Table 19 summarises these stages and outlines some useful interventions to use at each stage of change. The choice of treatment type can be informed in part by the client’s readiness to change; for example, harm reduction may be an appropriate treatment for someone in the pre-contemplation stage, whereas goal setting or relapse prevention may be more suitable for someone in later stages (e.g., preparation or action stages) [276].

The stages of change model is also relevant in assessing motivation to receive treatment for comorbid mental health conditions. Just because a person has presented for treatment for his/her AOD use, does not necessarily mean that he/she has the same readiness to receive mental health treatment. For example, just because the client is willing to consider reducing AOD use, this does not automatically mean that he/she is also ready to deal with the trauma-related symptoms they experience due to abuse suffered as a child. Appendix G provides a useful matrix for assessing motivation for both AOD and mental health treatment.

Although we include the stages of change model, it is important to note that this model has been subject to some criticism. Some researchers and clinicians have questioned the divide between stages, the distinction between stages, and the focus on conscious decision making (rather than the involvement of other factors, such as unconscious motivations) [293-295].

Table 19: Readiness for change

Stage Description Interventions
Pre-contemplation Client shows no interest in behaviour change.
  • Aim to raise doubt about perceptions.
  • Link behaviour with consequences.
  • Reduce harm.
  • Highlight negative consequences.
  • Build confidence and hope.
Contemplation Change is being considered, with negative concerns rising in awareness but ambivalence remains.
  • Motivational interviewing can assist in resolving ambivalence.
  • Elicit reasons for change and risks of not changing.
Preparation or determination Client is committing to and preparing for change.
  • Goal setting, match to needs. Identify risks for relapse.
  • Build self-efficacy.
  • Discuss treatment options.
Action Active behavioural change occurs.
  • Support self-efficacy.
  • Assist with coping and education.
  • Reinforce positive behaviour.
  • Avoid exposure to AOD use environment.
Maintenance Changes are consolidated and maintained.
  • Reinforce positives and assist with lapses.
  • Self-help groups.
  • Provide relapse prevention techniques.
  • Emphasise client alertness. Work towards longer-term goals.
Relapse Not so much a stage in itself, but rather any slip or lapse into any of the previous stages.
  • Avoid demoralisation.
  • Remain positive.
  • Normalise the process of lapsing.
  • Help the client to learn from mistakes.

Adapted from Clancy and Terry [296].