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

2. effective interventions meet patients where they are

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

4. 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

5. 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

6. 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

8. 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

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

10. 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

11. 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

12. 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