screening, brief intervention, and referral to treatment assessing readiness to change in substance use interventions Lecture 3.1

effective interventions meet patients where they are

stages of change originally developed by Prochaska & DiClemente (1983) 6 stage model: Precontemplation Contemplation Determination Action Maintenance Recurrence

stages of change: intervention matching guide Offer factual information Explore the meaning of events that brought the person to treatment Explore results of previous efforts Explore pros and cons of targeted behaviors Explore the person’s sense of self-efficacy Explore expectations regarding what the change will entail Summarize self-motivational statements Continue exploration of pros and cons Offer a menu of options for change Help identify pros and cons of various change options Identify and lower barriers to change Help person enlist social support Support a realistic view of change through small steps Help identify high-risk situations and develop coping strategies Assist in finding new reinforcers of positive change Help access family and social support Help identify and try alternative behaviors (drug-free sources of pleasure) Maintain supportive contact Help develop escape plan Work to set new short and long term goals Frame recurrence as a learning opportunity Explore behavioral, psychological, and social antecedents Help develop alternative coping strategies Explain SOC & encourage person to stay in the process 1. Pre- contemplation 2. Contemplation 3. Determination 4. Action 5. Maintenance 6. Recurrence 4

measuring readiness to change SOCRATES validated tool measuring one’s readiness to change built upon the stages of change 19 items; 5-7 minutes to administer and score self report; patient completes pencil & paper 2 versions (drug & alcohol) 3 domains: recognition of their problem ambivalence about changing; wondering if they have a problem taking steps are they already doing something to change their substance use

brief interventions educational brochures or handouts education using visual aides (standard drink sizes, risky drinking levels, etc.) recommendations for cutting back (after seeking permission) readiness rulers tips & hints: consider the stages of change to inform your approach ideally, the conversation would incorporate a motivational interviewing style

education Do… Avoid… review results of screener ask permission to provide information (i.e. Elicit-Provide-Elicit) provide pamphlets, brochures, or have a verbal exchange provide factual information about the health consequences of engaging in the use of that particular substance check back in with them…what do they think? Avoid… advising, warning, utilizing scare tactics (if you want to be consistent with an MI approach) educating without permission

SBIRT is not an abstinence only model; SBIRT is a harm reduction model

cutting down vs. abstinence which clients should be encouraged to abstain from drugs and alcohol? pregnant women dependent individuals; those at high risk for dependence those susceptible to a medication interaction those with a health or mental health condition exacerbated by alcohol encourage cutting down if they are not open to abstinence

interventions: readiness rulers designed to assess a patient’s willingness/readiness to engage in the healthy behavior can be used by a behavioral health provider or medical provider

utilizing readiness rulers Steps ask permission to engage in a conversation about their drug/alcohol use review drinking limits and/or review their score from the screening tool provide the visual aid (ruler) 3 domains Importance? Confidence? Readiness? ask why they selected the number they chose inquire about what it would take to move up or down the ruler set goals