Recovery begins with change. Somewhere in their life, a person in recovery has decided their habits aren’t working anymore and they need to make a change. This decision is a fundamental component of addiction recovery. Still, wanting to change is much different than actually changing – and many addicts require a lot of extra support to get to the point where they can make active changes.
What’s more, patients sometimes come to recovery through a court mandate or a parent’s ultimatum. How can a provider motivate a teen or adolescent who doesn’t even think they need to change? Understanding the process of behavioral changes is critical to inspiring motivation in these types of patients.
Stages of Change
The “Stages of Change” model was first introduced in the 1970s. It attempted to explain the process of change in humans as occurring in stages and not all at once. So two researchers – James Prochaska, Ph.D. and Carlo DiClimente, Ph.D. – set out to define these stages. They tested and refined the model until it became the most widely-used and accepted model in addiction treatment.
The model describes the six stages of change as follows:
- Pre-Contemplation: The person is aware they have an addiction and are aware of its harmful effects. Still, they have little motivation for changing as they view using as more beneficial than sobriety.
- Contemplation: The person is aware of the adverse effects that using is causing them. They see sobriety as the most effective option – however, they may lack confidence in their change.
- Preparation: The person acknowledges responsibility for change in their behavior. They may begin developing a plan, asking for support, or building confidence.
- Action: The person consciously makes an effort towards changing their behaviors. This can include going to rehab or engaging in self-directed change efforts.
- Maintenance: The person has developed self-control and healthier behavioral patterns. They can maintain these changes with less effort as well.
- Termination: The person has established full lifestyle and behavior changes. They don’t succumb to urges or impulses and make healthier life decisions.
It’s important to remember that relapse can occur at any stage in this model. Furthermore, not all patients come to rehab out of their own will. Sometimes, especially in the case of youths, they are mandated by a court or their parent(s) gives them an ultimatum. It is not their internal dialogue that is motivating them – it is their external environment.
This means they usually enter treatment at Stage 1 or Stage 2. In this case, the purpose of therapy should be developing motivation rather than trying to change behaviors. One way this can be achieved is through motivational interviewing (MI).
Motivational Interviewing
MI is a technique in which a trained interviewer becomes a facilitator of the change process and expresses acceptance towards an addict. MI has two primary goals: 1) to increase a person’s motivation and 2) to guide the person towards a commitment to change. MI works just like any other therapy session. A motivational interviewer tries to influence a dialogue towards why the person needs or wants to change. This method can be effective for those who do not voluntarily seek treatment, as the interviewer reflects the person’s thoughts back to them to initiate introspective thinking.
Empathy is an integral part of MI. It establishes a safe and accepting environment that allows a person to examine their behaviors and talk about their addiction. An empathetic approach to MI involves listening rather than telling, offering sincere compliments rather than criticism, encouraging a non-judgmental collaborative attitude, and communicating respect for the addict. Motivational Interviewing is more successful when there is a relationship of trust between the interviewer and patient.
Supporting Self-Efficacy
A person’s belief in their own ability to change is essential in motivation toward addiction recovery. Self-education is one way to foster self-efficacy. Credible, understandable, and timely information helps people understand how their addiction drives some of their behaviors or impacts their life. This gives them an idea of where to start changing their behaviors. They begin to see which actions trigger their cravings the most, or which ones help them overcome their triggers the best.
There are a few techniques to help support self-efficacy in recovery:
- Give the patient hope by explaining there is no “right way” to change.
- Help the patient believe that they can improve by inquiring about other successful changes they’ve made in the past and complimenting their success.
- Explore barriers that may cause low self-confidence in patients such as trauma or psychological issues.
- Share examples of others’ success in addiction recovery. No one wants to feel like they are the only one experiencing something.
Ultimately, teens and adolescents need an empathetic, non-judgmental entity that will help them develop motivation toward recovery. A motivational interviewer becomes this person as they approach their patient with respect and act as a reflector of thoughts and behaviors. It’s also vital that patients understand their role in recovery as an active player – they are responsible for their own success. By supporting them with empathy and education, we can help them overcome their own ambivalence.
To learn more about motivational-based therapies and how they can be used to foster recovery and improved mental health, contact Sustain Recovery today at (949) 407-9052.
