I.
Should substance abuse screening tools be easily available on websites that are often visited by members of your community? Why or why not?
Yes, screening tools should be available for an individual to assess themselves in the privacy of their home. Prochaska (2003) found that most emergency room physicians and clinicians are often trained in a passive-reactive manner. They are trained to respond to resolve the crisis, but not plan past the resolution of the crisis. Thus, the immediate responses to resolve the crisis when the alcoholic or addict reaches out goes no further than the first visit or resolving the presenting crisis. The example stated above is an illustration and failure to take a proactive approach which rarely reaches the addiction population in need of an intervention. The stage of change paradigm allows for such a proactive approach by recognizing where the person is at in their beliefs about changing behavior. The use of online screening tools will allow the individual to make their own informed choices and move from precontemplation to taking some type of action. It is not always necessary for the client to see a clinician to make behavioral changes.
2. How does this change in paradigm affect your thoughts about substance abuse prevention?
As a graduate student years ago, I originally thought that I could be the change agent and that people should be at their bottom or in a crisis before they become open-minded to accept help. This would be the passive-reactive school of thought when it comes to treating addiction (Prochaska, 2003). I agree with the article in that the in-person intervention is not reaching enough people. Society should make self-assessment tools and give the public a better understanding of the research on the stage of change paradigm. This practice would allow more people to become aware of their issues and take action.
How does this study challenge your understanding of the first contact between patient and professional? Please explain your answer.
Perkinson (2017) states that treatment works and that highly motivated people can quit on their own usually after multiple attempts and self-evaluation (p.2). The first contact with a client should be focused on developing a rapport and assisting the client in determining how to go about recovery. It is surprising to see that the research shows that people prefer home-based therapy over clinic therapy (Prochaska, 2004).
One important way the study challenges me is to accept that people can change without my skills and counseling processes. The use of motivational interviewing matched to the stage of change will improve client experiences producing more outcomes than the passive-reactive approach discussed earlier. What I found interesting in this article was that there are greater outcomes using motivational interviews and recognizing the stage of change the client is experiencing. Lastly, building trust with the client should be of paramount importance. By making programs to guide the stage of change process the client will have increased self-efficacy in the environment they are most comfortable with.
Can trust play an important factor in the development of the relationship with a patient during the first interview? If yes, please explain.
Without the presence of trust, there will be no therapeutic relationship where you will be able to assess stages of change with the client or utilize motivational techniques. Perkinson (2017) states that a client must trust you. To establish trust, you must be open, genuine, and do what you say you will do. Always be open and honest about everything.
II.
How do individual struggles with addiction determine a person’s motivation for treatment?
As I have stated in the introduction and a few responses to classmates, Da Silva Cardoso, Fong Chan, Berven and Thomas, (2003) state that the construct of self-efficacy and later the construct coherence allows the individual to cope, solve problems and engage in healthy behaviors to explain readiness to change devastating behaviors of addiction. Self-efficacy is considered and expanded through the defining term coherence. Often the struggle to change is based on the person and their coherence on their ability to change. What they believe they can do and accomplish is a determining factor. Change is usually hard for many due to their inability to know where to start, past failures, and the use of natural defense mechanisms (Prochaska & Prochaska, 2016). If a person is not able to see the struggles and problems caused by their addiction, their motivation to change that behavior is based on their readiness to change (Da Silva Cardoso, Fong Chan, Berven, & Thomas, 2003).
Should a treatment plan be based on the outcomes of standardized assessment tools? Why or why not?
Yes, the treatment plan should rely on three things. First, a standardized assessment is a research-based instrument that can assist in the diagnosis of the patient. Second, client self-report will expound the problems identified and add more value to a final diagnosis. Third, the assessment of standardized tests instruments, client self-report, and clinician observation can provide a comprehensive report for client problems. Perkinson (2017) wrote that a treatment plan is a road map of helping the client resolve problems. Without effective assessment tools or structured methods to assess client problems, it will be almost impossible to develop an effective road map to resolve client problems with a treatment plan.
3. How can clinicians improve the cost-effectiveness of treatment?
Accept the fact that not all clients who enter treatment are ready to change. Either they have no clue on how bad their alcohol and drug use or they are being forced into treatment by family members, child protective services, or legal issues. According to Prochaska (2004), our systems are designed to assist people who already know and are willing to make behavioral changes. This is how the stages of change paradigm, and the communication model of motivational interviewing can assist in effective outcomes for patients who enter treatment. So, clinicians can improve cost-effective treatment by assessing the stages of change and utilizing motivational interviewing to assist the client with making the necessary changes to improve their lives, thus cost-effective treatment.
Can the assessment of the stage of change and motivational interviewing play into the relationship established by the clinician and the patient? If yes, please explain.
Yes, the assessment of where the patient is at during the first interview allows for the planning of the relationship with the patient. When you know a person is in the pre-contemplation stage it is very important to not push or confront too much until you have discussed the problem and understand what the patient has tried to quit before. Looking at treatment options should be a client choice through the motivational interviewing action of the clinician. If you are not aware of where the patient is in terms of deciding to change self-defeating and destructive behaviors. Trust through rapport will not be established (Perkinson, 2017). In closing, once a clinician knows the practical knowledge and can use motivational interviewing strategies based on what stage of change the patient is experiencing with thoughts, beliefs, and actions.
References
Da Silva Cardoso, E., Fong Chan, Berven, N. L., & Thomas, K. R. (2003). Measuring readiness to change among individuals in residential therapeutic community programs for treatment of substance abuse. Rehabilitation Counseling Bulletin, 47(1), 34–45. https://doi.org/10.1177/00343552030470010501
Perkinson, R. R. (2017). Chemical Dependency Counseling: A practical guide. SAGE.
Prochaska, J. O. (2004). Population treatment for addictions. Current Directions in Psychological Science, 13(6), 242–246. https://doi.org/10.1111/j.0963-7214.2004.00317.x
Prochaska, J. O., & Prochaska, J. M. (2016). Changing to thrive: Using the stages of change to overcome the top threats to your health and happiness. Hazelden Publishing.
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