Substance Use & Addiction: How to Help Someone Make A Change In Their Own Life

    Motivation for a given action — for instance, stopping smoking pot — is different at different stages of one’s life, and may change over time. Because of this, if we are trying to motivate someone to make a change, we need to start by understanding a person’s stage of “readiness” for that change. This means adopting different helping strategies depending on where they are. In order to do that, we need a model of change to guide us, which we already have!

    James Prochaska and Carlo DiClemente’s “stages of change” model was developed to help describe how people change. With this model, we can describe the person’s readiness as being in one of five stages:

    1. Pre-contemplation (not even thinking about the issue as an “issue”)
    2. Contemplation (just starting to think something might be off)
    3. Preparation (starting to think through actual changes and how to accomplish them)
    4. Action (taking action and changing)
    5. Maintenance (the work of maintaining and consolidating the changes made for the longer haul)

    In a motivational treatment approach, we are taking these stages of readiness into account. How? By first understanding, acknowledging and accepting the person’s level of readiness (a huge deal for most people), and then tailoring our collaborative goals to fit in with this level of readiness.

    For example, compare:

    1. A 20-year-old college student suspended for intoxication,who thinks the administration is “way overreacting,” versus
    2. a 20-year-old who just finished rehab after a seven-month run of heavy cocaine use, who is incredibly grateful to still be alive.

    We can think that the first person should feel more wary of alcohol and the possibility of alcohol poisoning, but he’s not. Jumping in with him to work on skills for “saying ‘no’ to drinking with his buddies” is not what he wants to do, perhaps not something he can even conceive of doing. As a result, this would be an ineffective way to approach him. We may believe that that is what he “should” be learning; however,because he is in a different “stage of change,” there is little point in having that discussion, as he is not ready to learn and use those skills. In fact, insisting on teaching him those skills could easily result in him shutting down and leaving, with no change or movement having been accomplished at all!

    His 20-year-old counterpart from rehab? He’s ready to eat up those skills and be safer for it. We would like to make the first 20 year-old-safer, but force-feeding is not the answer. And this is what we mean by readiness. 20-year-old #1 is in the pre-contemplation or contemplation stage — if we’re lucky and not too pushy; 20-year-old #2 is in the action stage, and wants those skills.

    So do we cut #1 loose? Of course not, and with a motivational treatment approach, we can start where he is and develop a tailored plan. It might be a one-time consultation where we validate how hard it is to be suspended and away from school, and try to help him understand what led to that evening of intoxication past a certain point. We could also help him think through what matters to him (not being suspended, parental upset, how to prevent that again, how to talk to girls without being so drunk), and examine the “pros and cons” of drinking with him to understand if he perceives any downside at all to drinking (“don’t like being hungover, don’t like missing class, don’t like being sloppy in front of girls.”) We could also help him start to think through some ways to achieve the “pros” of drinking without overdoing it. Multiple paths forward could come from this, but the point is this: in a motivational approach, you start with their level and type of motivation, not yours, and let the paths forward make sense to them.

    This is an enormously powerful tool in helping people move forward at all, which would be the goal. This understanding also ties directly in with our point from above: our actions as treatment professionals — and yours as family members — have a direct impact on your loved one’s motivation; when we can start with them, they are more likely to come along.

    When we are thinking about how to help someone make change, it is best to take a motivational approach and think about where they are in the process of change. If you can meet someone where they are, and provide them the support that they want or need in that moment, it can help move them along through the stages of change.


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