Objectives What do we want from this session? What experiences and resources can we share today? Theory of addiction: Stages of Change Model Treating addictive behaviours: Motivational interviewing Goals, applications, principles Other treatments Gambling addiction References and resources Where to from here?
Stages of Change Model (DiClemente & Prochaska, 1998) Health behaviours Addictive behaviours
Stages of Change Model Pre contemplation Contemplation Preparation Action Maintenance Relapse Change is circular NOT uni-directional
Motivational Interviewing Denial, resistance, poor motivation, ambivalence are features of many client presentations Hypothesis: The way clients are spoken to can either enhance or minimize motivation to change (Miller, 1983)
Goals The goal is not to change the client’s behaviour but to allow the client to argue for their own change. Prepares people for change
Motivation to change Every therapist knows that motivation is a vital element of change. Nowhere is this clearer than in the treatment of addictive behaviours, which are, if one thinks about it, fundamentally motivational problems. …When one continues to act despite personal risk and cost, something is overriding common sense. In the context of war, we call it bravery or heroism. In the context of pleasure, we call it addiction.. (Miller, 1998).
Motivation to change Ambivalence is normal It is the inter-relationship of ambivalence about change and the client’s goals and core values that is the substance of motivational interviewing (Rollnick & Allison, 2001)
Motivation to Change Resistance: observable behaviour that arises when the counsellor loses demonstrable congruence with the client (Miller & Rollnick, 1991) I know..but I can’t……………
Motivational Interviewing is Empathic Non-confrontational A constructive conversation about behaviour change Technique secondary Directive (vs non-directive) Clear structure Coaching to explore and resolve ambivalence to behaviour change
Other applications Motivational interviewing strategies may be applied in situations where insight is impaired, e.g. Eating disorders Other mental illness e.g.schizophrenia, bipolar disorder, depression Enhance medication compliance Enhance treatment commitment
Principles of MI Express empathy Avoid arguments Roll with resistance Support self-efficacy Deploy discrepancy
Present, past, and future oriented questions If you continue to drink at this level, what will be the benefits in a year’s time? Could there be any disadvantages? So, on one hand, you love the feeling and the taste, but you are less pleased with the way you act and the things you say? What was it like when you stopped drinking last time?
More questions……… What are some of the good things about your cannabis use? What are some of the less good things? What do you enjoy most about poker machines? What are some of the side effects of the medication? What are the benefits of it?
More questions………. On a scale of 0 to 5 how important is it for you to give up alcohol? On a scale of 0 to 5 how confident are you about giving up? What will keep you at this level? How high does it have to be before you make an attempt to change?
Other treatments Cognitive behaviour therapy: e.g. psychoeducation, behaviour monitoring, contingencies, managing cravings, social situations (saying no), controlled drinking, relapse prevention, needle exposure, lapses vs. relapse Abstinence vs controlled use 12 Step Programs Medication
References: Motivational Interviewing Rollnick, S. & Allison, J. (2001). Motivational interviewing. In Heather, N., Peters, T.J. & Stockwell, T. (Eds.).The International handbook of alcohol dependence and problems. Wiley & Sons. Institute of Psychiatry Kings College London (2004). A General practitioner’s guide to eating disorders. www.iop.kcl.ac.uk/IoP/Departments/psychMed/EDU/GPguide.shtml www.iop.kcl.ac.uk/IoP/Departments/psychMed/EDU/GPguide.shtml Dept Veteran Affairs. Key ideas underlying motivational interviewing. www.dva.gov.au/health/younger/mhealth/alcohol/training/appendk.ht m
Gambling facts 2.1% of Australian adults have a problem, i.e. 293,000. On average 7 other people are affected by the gambler’s behaviour, i.e. 2 million people (Source: Relationships Australia).
Qld gambling facts 2003-4 Per capita expenditure: Total $967.96 p.a. Gaming machines $866.25 p.a.
Qld gambling facts 2003-4 Growth rates Gaming machines 7% per annum Most others declining Total expenditure $2.79 billion Gaming machines 53.66% Casino 21.2% Lottery 12.18% Racing 10.28%
Qld gambling facts 2003-4 Total government revenue $719.92 million Gaming $688.63 million TAB $30.58 million Increased household disposable income spent on gambling 1993-4 2.34% 2003-4 3.17% (Source: ANU Centre for gambling research-Fact sheets 2005)
Gambling treatment In general: Individual, group, relationship, financial counselling, self help kits. Includes… Understanding factors such as false beliefs, motivations for gambling, triggers Relapse prevention strategies Underlying issues: anxiety, depression, relationship problems Financial: budgeting, legal issues, coping with creditors, reorganising finances.
Resources: Gambling www.monkeysee.com.au. No more bets please! Overcoming problem gambling. Presented by HG Nelson (DVD). www.gspot.org.au. Gambler’s Help Ph 1800 156 789 www.gspot.org.au www.problemgambling.net.au. Problem Gambling Service (incl. Chinese, Greek, Italian, Tagalog, Spanish language) www.problemgambling.net.au www.gambling.anu.edu.au. ANU Centre for Gambling Research. Research, fact sheets, journals www.gambling.anu.edu.au Gamblers Anonymous. Ph 33560117 (Brisbane)
Resources: Gambling www.relationships.com.au. Relationships Australia Gambling Counselling Service and Gambling Help Line www.relationships.com.au FREE Redlands, Mt Gravatt, Gympie, Caloundra, Noosaville, Gold Coast, Ipswich, Rockhampton, Gladstone, Logan, Mackay and Whitsunday, Spring Hill.
Summary What we did in this session Theory of addiction: Stages of Change Model Treating addictive behaviours: Motivational interviewing Goals, applications, principles Other treatments Gambling addiction References and resources Where to from here?