Chapter 9

1. Chapter 9 Motivation and Intervention for Substance Abuse Problems

2. Chapter Objectives • Describe the dimensions of motivational interviewing. • Define the six stages of change in motivational interviewing. • Describe effective motivational strategies and the ingredients of effective brief counseling. • Describe the eight common defense components of resistance to change. • Describe interventions at each stage of alcohol/drug use.

3. Chapter Objectives • In intervening, describe the do’s and don’ts of emotional reaction, communication, trust in actions – not words, avoidance of distractions. • Describe some obstacles to reaching families and parents of alcoholics/addicts. • Outline and describe the four basic stages of a formal intervention. • Describe the kind of information to be elicited at the assessment stage of a formal intervention.

4. Chapter Objectives • Describe the need for and importance of caring, behavior-specific communication, as well as the avoidance of generalized and blaming statements. • Outline the script format and tasks of the preintervention phase. • Explain the bottom-line script. • Explain why there is the need for a postintervention session for the family.

5. Motivational Interviewing • Overview • Stages of changes and therapist tasks • Client-Centered Motivational Strategies • The counselor’s top priority is to elicit and understand the client’s view.

6. Motivational Interviewing • Effective Motivational Strategies • Giving advice. • Remove barriers. • Providing choice. • Decreasing desirability. • Practicing empathy. • Providing feedback. • Clarifying goals. • Helping active.

7. Motivational Interviewing • Active Ingredients of Effective Brief Counseling • Express empathy. • Develop discrepancy. • Avoid argumentation. • Roll with resistance. • Support self-efficacy.

8. Intervention • Common Defense Components of Resistance to Change • Denial • Minimization • Projection • Rationalization • Compliance • Conflict avoidance • Obsessive focusing • Acting out

9. Intervention • Interventions at Various Stages of the Alcohol/Drug Use Continuum • Stage 1 – Nonuse Interventions • Stage 2 – Initial Contact Interventions • Stage 3 – Experimentation Interventions • Stage 4 – Interventions at the Integrated Stage • Stage 5 and 6– Interventions at the Excessive Use and Addiction Stages

10. Obstacles to Intervention • Denial of family dysfunction/imbalance. • Skepticism about alcohol/drug messages that don’t fit parents’ own experience. • Assumption by parents that children’s alcohol/drug use will be O.K. • Distorted, depressed view of life by dysfunctional families. • Fear of loss of confidentiality. • Narcissism of parents. • Lack of insurance resource for parenting/counseling services.

11. Obstacles to Intervention • Lack of energy/time by parents. • Distrust of the system. • Lack of credible message sources for minorities. • Lack of concern/respect for experts’ opinions. • Lack of awareness of community resources. • Overwhelming need for services for basic survival. • Cultural mores.

12. Intervention Services • Alcohol/drug intervention is a process that prevents, alters, or interrupts progression of the disease. • Intervention services are offered by most chemical dependency inpatient and residential treatment centers. • A trained interventionist with an expertise in chemical dependency treatment must lead or facilitate the intervention.

13. Goals of Intervention • Provide an opportunity to express concern about the impact the alcoholic/addict’s behavior has had on them. • Provide information on addiction and family patterns of interaction. • Promote the development of a healthy family system and provide resource information.

14. Stages of Formal Intervention • Assessment • Preintervention • Intervention • Postintervention