STAGES OF CHANGE Pre Contemplation La ps eR

STAGES OF CHANGE Pre. Contemplation La ps e/R ela n it o a ps e e nc a ten pl em t n o C Pr ep ar at io n in a M Action

Stages of Change Pre. Contemplation

PRE-CONTEMPLATION Characteristics • “No problem” • See no reason to change • Lack of awareness Pre. Contem plation

PRE-CONTEMPLATION Tasks of Change: Pre. Contem plation • Information: Both factual and personal • Consider circumstances which indicate a need for change • Engagement of client, create positive relationship

Stages of Change Pre. Contemplation n a tio em t n o C pl

CONTEMPLATION Characteristics • • Ambivalence Fear of change Wishful thinking Interest in “the problem”

CONTEMPLATION Tasks of Change • Examine the ambivalence • Weigh and consider alternatives • Examine “pros” and “cons” of particular actions

Stages of Change Pre. Contemplation n tio a pl em t n o C Pr ep ar at io n

PREPARATION Characteristics • Readiness to consciously engage in change process • Temporal imminence of change

PREPARATION Tasks of Change • Gather information about options • Make initial contact

Stages of Change Pre. Contemplation n it o a pl m e nt Co Pr ep ar at Action io n

ACTION Characteristic • Change in behaviour

ACTION Tasks of Change • Understanding factors supporting the behaviour • Strategies which will support behavioural change • Communication with others

Stages of Change Pre. Contemplation n tio a pl em t n o C Pr ep ar at io n e nc a ten in a M Action

MAINTENANCE Characteristics • Consolidation of changes • Need for support • Skills development

MAINTENANCE Tasks of Change • Establish support system • Practice behavioural changes • Act on relapse prevention plans

Stages of Change La Pre. Contemplation ps e/R n ela ps e m e nt Co Pr ep ar at ce n a Ma pl io t a n e t in Action io n

LAPSE/RELAPSE Characteristics • Initial return to use • Re-establishing previous pattern

LAPSE/RELAPSE Tasks of Change • Reconnecting with supports • Examining and learning from lapse experience • Reviewing and modifying relapse prevention strategies

EMPOWERMENT AND SELF CHANGE • • Understanding motivation Autonomy Motivational interventions FRAMES

FRAMES • • • F eedback R esponsibiltiy A dvice M enu of options E mpathic style S elf efficacy

How does it balance?

Case 1 Rod • 19 year old • Smokes cannabis 3 out of 7 days in a week. Takes Es on weekends. Drinks 5 units alcohol day • Spends most of his spare cash on drugs and alcohols • Impulsive and suffers with depression

Case 2: Jane • 45 year old restaurant manager • Taking nitrazepam (prescribed by GP) for 2 years • Anxious and depressed

Case 3: Freddy • 29 year old • Crack cocaine user past 5 years • Using heroin ‘to come down off the crack’ past 2 years • Initially smoking, now injecting

Addiction as: • • A biological (disease) model A psychological model A social model BIOPSYCHOSOCIAL MODEL

Summary – Addiction • Behaviour is no longer a matter of considered choice

Summary – Addiction as a function of: • THE DRUG – Positive and negative re-inforcers • THE PERSON – Impulsive, sensation seeking • THE SITUATION – Opportunity, lack of alternatives, social influences

The End How do you detox a patient with opiod dependency syndrome? Blow to the head rehabilitation Straitjacket chocolate Any questions ? bhagat. sharma@nepft. nhs. uk