OCCDHE 2005

1. OCCDHE 2005 Breaking the Cycle of Addiction Using Motivational Interviewing Mary Peracca, MFT Cal Poly, San Luis Obispo Counseling Services

2. The Cycle of Addiction • Abstinence • Use: low quantities, no adverse effects • Overuse: one time overuse with negative consequences • Abuse: Continued overuse despite negative consequences, party lifestyle • Dependence (Addiction):Same as abuse but unable to cut back or stop when desired, loss of control

3. Risk Factors for Chemical Dependency • Family history of alcohol/drug problems • Age of 1st Abusive Use • Emotional & social coping skills • Environment: exposure to AOD

4. Motivational Interviewing • A client centered, directive approach for enhancing motivation for change • A method to manage resistance and help people commit to change • The therapist’s non-judgmental stance allows the client to freely choose to change or not William R. Miller & Stephen Rollnick

5. Components of Motivational Interviewing • Express empathy • Develop discrepancy between present behavior and client’s stated goals (Cognitive dissonance) • Avoid argumentation or debate • Roll with resistance • Support self-efficacy

6. Stages of Change James Pochaska & Carlo DiClemente • Precontemplation: Minimizing or denying a problem • Contemplation: Awareness about the problem • Preparation: Planning to take action • Action: Commitment to time and energy to change • Maintenance: Relapse prevention, making adjustments to the plan of action

7. Ineffective Treatment Methods • Confrontation: breaking down denial • Labeling, diagnosing • Advice-giving • Cheerleading

8. Effective Interventions • The First Session • Build Rapport- humor can help ease the client’s anxiety • History taking can give information about a client’s potential motivators • Manage resistance: therapist style does make a difference in outcomes & reducing dropout rate • Clients may feel disempowered by complying with a mandate from others, help to identify choices

9. Assessing Motivation • What motivates you? • The severity of the consequence doesn’t necessarily create motivation • Each student has unique motivators • Be curious about what might motivate the client: grades, sports, relationships, money, addiction risks? • Goals and values • Using the e-CHUG to identify priorities

10. Effective Interventions • Using Reflection: disarms defensiveness by listening rather than the expectation getting advice • Simple reflection: Rephrase what you have heard • Amplified reflection: Exaggerate the feeling underlying the content • Double-sided reflection: Reflect the dilemma of possible choices

11. Rolling With Resistance • Use with the “Help-Rejecting Complainer” aka “Yes, but….” • Psychological martial arts: let the resistance pass by and give the responsibility back to the student • Do……Don’t approach • Respectful of client’s autonomy

12. Solution Focused Interventions • What are the student’s goals? • What positive coping skills or activities did the client use in the past? • What have they tried recently? • Addressing the need for social contact: alternative activities and friends • Define in positive & measurable terms, eg. Go to the gym 3 times a week or go to the movies one night instead of partying rather than I won’t drink tonight • Refer to adjunct resources: Student Support Services, ASI, etc. • Empathize with the challenges of changing

13. Maintenance • Follow up on goals & what was successful or not • Problem-solve possible triggers to return to old behaviors & what steps to take if relapse occurs • Normalize the process of change & the need to continue to reassess the plan • Give appropriate feedback, predict successes & pitfalls