stages
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files (3)StagesofChange.docx
Chapter3.pptx
Lassiter_PPT10.pptx
StagesofChange.docx
GUIDELINES/REQUIREMENTS FOR STAGES OF CHANGE PROJECT
Go over the materials regarding the Stages of Change Model (The Transtheoretical Model originated by Prochaska and DiClemente in the 1970s) and become familiar with each stage. Read Lassiter and Culbreth, chapter 10 as well as Faulkner, chapter 3, pp. 36-38 as preparation for this assignment.( PowerPoints Attached) Select one substance (caffeine, nicotine, alcohol, marijuana, etc.) or food (chocolate, sugar, soda, cookies, bread, etc.) or behavior (watching television/Netflix, playing video games, shopping, texting, being on Facebook, online gaming, negative self-talk, sex, etc.) and completely abstain for at least a 4-week period. Keep a journal of your daily experiences. Be sure to give yourself a full 4 weeks and then another week to read it over before submitting. Keep in mind that I am the only person who will read your work.
Formatting your journal; finished product to be in a Word document:
· Include the date and time of each entry
· Number your days, #1- #30, or more
Make your first entry a description of your project
· Include why you chose the substance, food, or behavior from which to abstain
· Explain where you are in the Stages of Change model and why
· Describe what you expect to gain or learn from this experience
Make the last entry a detailed summary of the experience
· Describe your physical, emotional, and spiritual experiences
· Describe any insight regarding the physical, emotional, or spiritual need the substance, food or behavior served for you
· Relate this to addiction and relapse
· Explain where you ended up in the Stages of Change model and why
Content:
· Use a 1-10 scale (1=easy—10=hard) to describe the difficulty or ease of abstaining that day
· Explain where you are in the Stages of Change model and why
· Describe any physical or emotional withdrawal symptoms experienced
· Describe how your mood was affected by abstaining or relapsing
· Describe your thoughts related to addiction and relapse
· Discuss any source of support
· Discuss anyone’s attempt to sabotage your efforts
Grading
· You will need to have at least 30 entries minimum to receive full credit
· There is no set length for each entry but no less than 3-4 sentences
· Some entries may be 10 sentences, and some may be a full page depending on what you have to say and how you are feeling that day
Your final grade will reflect the following:
· Correct formatting
· First and last entry
· All items were addressed
· Insight as it relates to substance use and relapse
· Description of the stages of change experienced
· Depth of entries
Follow the format from this example:
Day #, Date, Time:
Quite the opposite of the night before last, I had one of the best night’s sleep ever last night. I woke up to my alarm, ready to get out of bed. I had morning energy that I have not had in a long time. I really think that wine was affecting my sleep, and in turn, my next day’s energy and clarity of thinking. When I came home from work and began to cook however, my cravings for wine returned. I think it was the association of chopping and sautéing food that made me crave a glass of wine while cooking. Instead, I filled a stem glass with club soda and lime. Honestly, once I was finished cooking and sitting down to dinner with my family, the cravings went away. (Only 3 to 4 sentences – Not this long)
· On a 1-10 scale (1=easy—10=hard) today’s difficulty or ease of abstaining was an 8.
· Stage of Change: I am currently in the action stage in the Stages of Change model because I am abstaining from drinking wine.
· Physical or emotional withdrawal symptoms: I have had a headache all week, but I’m not sure if that is related to me experiencing withdrawal symptoms.
· Mood: I felt a little frustrated that I couldn’t open a bottle of wine, but the feeling passed after dinner.
· Thoughts: I am hopeful that I can abstain for 4 weeks, but I’m not entirely optimistic for some reason. Habits are so hard to break. Especially when there are other people relying on you to follow through with a certain behavior. How do you go about finding that fine line in not wanting to let people down but also maintaining your sobriety? What if the only way to calm my thoughts would be to drink wine? Addicts use substance as a coping mechanism. What happens when they are taken away?
· Source of support: My colleagues are supportive of my choice to give up wine.
· Sabotage: No one attempted to sabotage my efforts today.
Chapter3.pptx
Addictions Counseling: A Competency-Based Approach
Cynthia A. Faulkner, Ph.D., LCSW-S
Samuel S. Faulkner, Ph.D., LCSW
CHAPTER THREE – Assessment
Chapter Competencies and Standards
CSWE—Competencies 6 and 7
IC&RC—Domain I: Tasks 1–6
SAMHSA—Competencies 11, 16, 24–36, 28, 33, 75–76, 111
Seven Elements of Assessment
rapport building and engagement
drug use inventory
readiness for change
biopsychosocial assessment
assessing for suicide
screening tools
mental status impressions
Definitions
Engagement. The ability to join with a client to develop a working relationship.
Intake/Comprehensive Assessment. A comprehensive, holistic, and multi-faceted system of engaging with the client while collecting the information needed to make treatment decisions.
Professional Self. The combination of knowledge, skills, and attitudes/values gained through education combines with the counselor’s personality traits, belief systems, life experiences, and cultural heritage (Dewane, 2006).
Protective Factors. Strengths, skills, resources, supports, and coping strategies that reduce risks and enhance recovery.
Rapport. The relationship that is developed between the counselor and the client.
Element 1: Rapport Building and Engagement
Rapport is the relationship that is developed between the counselor and the client. The intensity, or closeness, of the rapport increases when concern and understanding of the client’s feelings or ideas are well communicated.
Engagement is the ability to join with the client that is needed to develop trust.
Skills for building rapport and obtaining engagement include:
genuineness (being open and authentic),
reflective listening to convey empathy and understanding,
remaining nonjudgmental,
demonstrating warmth (being inviting),
focusing on strengths using affirmations to build a positive relationship.
Professional self is the combining of knowledge, skills, and attitudes/values gained in education with aspects of the counselor’s personality traits, belief systems, life experiences, and cultural heritage (Dewane, 2006 ).
Element 2: Drug Use Inventory
Eight Domains
substance abuse patterns
substance dependence (as defined by the DSM-5)
life functioning problems
functional analysis (stimuli and events that trigger use and consequences afterward)
biomedical effects of use
family history of use
neuropsychological effects (example: impaired memory)
other psychological problems
(SAMHSA, 2008 , pp. 66–67)
Aspects of a Drug Inventory
age of first use
patterns of use (i.e., only weekend, during lunch, etc.)
frequency, amount, method of use (e.g., daily, 2 g, intravenously)
triggers to using (fight with spouse, hanging out with friends, cravings)
history of drug use/abuse in the family
consequences of drug use behavior:
legal involvement (i.e., DUI)
trouble at work, home, in social settings, or with friends
financial consequences
physical health consequences (“meth mouth,” liver disease)
mental health consequences (depression, anxiety)
cognitive consequences (i.e., blackouts, episodes of paranoia)
history of withdrawals
other problems as a result of use
length of time over the past six months that they have gone without using
prior attempts at treatment/recovery
Element 3: Readiness to Change
Stages of Change
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
Element 3: Readiness to Change, II
Element 4: Biopsychosocial Assessment
The biopsychosocial assessment is a holistic tool used to collect information about the major biological, psychological, and social issues that a client is experiencing.
Substance use disorders can affect physical functioning, health, and social interaction and create psychological instability; each client has his or her own unique experiences.
Addiction Severity Index (ASI) 5th ed. (McLellan et al., 1980)
Mental Status
Employment/Support Status
Alcohol/Drugs
Legal Status
Family History
Family/Social Status
Psychiatric Status
American Society of Addiction Medicine
Dimensions of Assessment
Acute Intoxication and/or Withdrawal Potential
Biomedical Conditions and Complications
Emotional, Behavioral, or Cognitive Conditions And Complications
Readiness to Change
Relapse, Continued Use, or Continued Problem Potential
Recovery/Living Environment
Element 5: Assessing for Suicide
Identify risk factors
Identify protective factors
Conduct a suicide inquiry
Determine the risk level and intervention
Immediate or high risk;
Threatening to hurt or kill self
Looking for ways to kill self: seeking access to pills, weapons, or other means
Talking or writing about death, dying, or suicide
Serious or moderate risk
Talking about feeling trapped or in unbearable pain
Talking about being a burden to others
Increasing the use of alcohol or drugs
Acting anxious or agitated; behaving recklessly
Sleeping too little or too much
Withdrawing or feeling isolated
Showing rage or talking about seeking revenge
Displaying extreme mood swings
Element 6: Screening Tools
A screening is used to identify people who are likely to have a disorder, as determined by their responses to certain key questions.
CAGE and CAGE-AID
Michigan Alcoholism Screening Test (MAST)
Drug Abuse Screening Test (DAST)
Substance Abuse Subtle Screening Inventory (SASSI)
Alcohol Use Disorder Identification Test (AUDIT)
Columbia–Suicide Severity Rating Scale (C–SSRS)
Element 7: Mental Status Impressions
Orientation to person: “What is your full name?” “What is your daughter’s name?”
Orientation to place: “What city and state are we in?”
Orientation to time: “What is today’s date?” “What year is it?”
Orientation to situation: “Can you explain why you came here today?”
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Lassiter_PPT10.pptx
Transtheoretical Model for Change
Chapter 10:
1
Overview
Introduction
Basic Tenets of the Theory
Philosophical Underpinnings and Key Concepts of the Theory
Application
Counselor’s Stance
Assessment
Strengths and Weaknesses
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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2
Introduction
Transtheoretical Model (TTM)
Often referred to as the stages of change model
6-stage theory of change
Used across a broad spectrum of theoretical orientations
Change can happen when an individual is socially, psychologically, and behaviorally ready
Counselors need to gauge level of readiness for change
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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3
Basic Tenets of the Theory
6 stages of change readiness that are essential to the process of change
Process of change are the interventions counselors use to elicit change
Helps clients move from one stage to the next
Stages cannot be skipped
Experience the stages as recursive
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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4
Basic Tenets of the Theory, II
Precontemplation
Lack of awareness that a problem exists
Resistance to change
Denies problem
Many precontemplators think others are the problem
Some may wish they could change without having any intention to do so
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
5
Basic Tenets of the Theory, III
Contemplation
Knows a problem exists
Admit that they want problem to change
Spend time trying to understand problem:
Gathering information
Weighing pros and cons of how to address it
Examine energy needed to accomplish change
Talking about change
Not ready to make a commitment
Some can spend years in the contemplation stage
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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Basic Tenets of the Theory, IV
Individuals who successfully move out of the contemplation stage do two things differently:
1. Think about solutions rather than problems
2. Think about the future rather than the past
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
7
Basic Tenets of the Theory, V
Preparation
Made a commitment (intention) to taking action (behavioral criteria) at some point in the next month
May have unsuccessfully taken action in the past year
May still have ambivalence
Made slight behavior modifications
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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8
Basic Tenets of the Theory, VI
Action
Busy stage
Individuals modify behavior and environments to achieve change
Considered to be in this stage if individual has modified behavior from between 1 day and 6 months
Changes that occur:
Increase and change awareness of problem
Self-image
Emotions, thinking, and self-esteem
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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9
Basic Tenets of the Theory, VII
Maintenance
May last 6 months to a lifetime
Continuation of the change process
Must work to prevent slips and relapse
Relapse is the return to addiction
Recycle implies that learning and new opportunity is possible and can be followed by action
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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Basic Tenets of the Theory, VIII
Termination
This is the ultimate goal for those seeking change
Former behavior or addiction no longer presents a challenge, temptation, or threat
Concept of termination has caused significant debate
Some argue for a 5-stage model that does not include termination
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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Philosophical Underpinnings and Key Concepts of the Theory
Prochaska defined change as “any activity that you initiate to help modify your thinking, feeling, or behavior”
Processes of change:
Consciousness raising
Emotional arousal
Self-reevaluation
Self-liberation
Stimulus control
Counterconditioning
Reinforcement
Certain change processes are more appropriate for certain stages than others
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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Application
Stages of change are when people change
Processes of change give us how people change
Effective when experiential, cognitive, and psychoanalytic theories are used in earlier stages
Effective when existential and behavioral theories are used in later stages
Many common myths about change
Question of ethical treatment
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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13
Termination
Demonstrated when individual no longer identifies with self-image that includes the problem behavior
No temptation to slip into old behaviors
New or renewed self-confidence and self-efficacy that the old problem is outdated
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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14
Counselor’s Stance
Shifts as a client moves through the stages
Earlier stages—parental in nature
Contemplation—Socratic role
Preparation—Coaching and encouraging
Action and maintenance—Consultant
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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Assessment
Formal written or computerized instrument is an approach to assess client stage of change
Types of instruments:
University of Rhode Island Change Assessment (URICA)
Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES)
Readiness to Change Questionnaire (RTCQ)
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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Strengths and Weakness
Strengths
First measurable, linear, and functional description of how individuals change
Reliably predicts client outcomes, tailoring treatment, and dropout rates
Easily integrate into any theory
Developmental design
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
17
Strengths and Weaknesses, II
Weaknesses
Difficult to empirically distinguish between the stages
More experimental research needed
Lack of research on the stages of change among different cultures and with low-income individuals
Lassiter, Theory and Practice of Addiction Counseling. SAGE Publishing, 2018.
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