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Concepts

Brief Interventions

Often times there are people who do not abuse drugs or alcohol but still may need help in reducing their use.  Brief interventions is when a healthcare professional educates a person who is heading down a path of heavy Alcohol and Other Drug abuse of the potential harm it could do to them in the future.  Brief interventions can occur anytime or anywhere and typically don’t last very long (anywhere from 5 minutes to an hour).  Many different professionals can do a brief intervention such as a Family Doctor, teacher, or counselor.   The purpose of brief interventions is to help light to moderate or at-risk users to accept and acknowledge their behavior.  Sometimes brief interventions help heavy users reduce their use especially when a health problem arises.   The five steps are: introduction (getting the client to understand the purpose), screening, evaluating and assessing, providing feedback, assessing the client’s stage, and summarizing.  Brief interventions can be premeditated or can also happen as part of a casual conversation.  The amount of resistance from a client all depends on the way the intervention is presented and communicated.  For example, if a Doctor tries to do a brief intervention by scolding a patient for their use it would not be as effective as a doctor showing compassion and educating a patient on how their use is affecting their health.   This is a lot of information to cram into such a short meeting but if done correctly it can be very effective.  Sometimes a series of brief interventions are necessary and other times one brief intervention can do the trick.

Client Engagement

Client engagement is a term that is used to try and actively engage a client in a treatment plan or a plan that can reduce the harm that alcohol and drugs may be causing.  Client Engagement is different than intervention in that in an intervention other people are making the choices for the client.  In Client Engagement it is the professional’s responsibility to help the client make a choice for them and to engage the client in making their own decisions.   The goal is to try to encourage clients to be engaged in the treatment process as opposed to feeling as if they were forced into it.  This can be difficult especially in court appointed cases but it is the professional’s job to create client engagement.   For example, if a client is referred by the law then they may only be showing up to appointments because the alternative is going to jail.  In the clients mind, going to counseling is better than going to jail. Since the client has already decided that going to jail is not an option then by using client engagement a professional will try to help make the client realize that there are two options; the client can go with it and better themselves or resist and waste everyone’s time.  If the professional is good at client engagement they can eventually break down the barriers and get the client to understand that change is going to be beneficial for everyone involved.

Defense Mechanisms

There is a theory that confrontation and the defense mechanism are not necessary for a person to be motivated to seek treatment.  Miller and Rollnick stated that their research does not show that denial is a characteristic of a person who uses or abuses alcohol or drugs and that it is merely a perception of the professional who is interviewing them.   They also think that most professionals use this technique as something that they have learned rather than having the knowledge or research to understand that the defense mechanism actually helps clients.  When interviewing in a confrontational way, a client is more likely to resist and be defensive and not because they’re in denial but because of the professionals routine perception of a user.  Most professionals believe this is the only way for a client to see and understand the uncomfortable reality.  But is it really?   If a professional believes only this then of course the client is going be resistant because it may not be the truth for some.  For example, I drink one cup of coffee per day.  If someone came up to me and insisted that I needed help for this caffeine addiction and that I should never drink coffee again I would immediately resist.  If my professional helper believed this “denial” was normal, they would keep on going until I either quit or gave in.  My resistance wouldn’t be denial because I do understand that it may not be the best choice however, I would immediately put on this defense mechanism because someone is trying to take away my freedom of choice.  This theory goes on to state that the defense mechanism is typically an action from a client that is given merely because of their lack of freedom being threatened and not because they are in denial.

Motivational Interviewing

Motivational interviewing is when a professional assesses the client’s inclination to change.   Motivational interviewing is done by a professional who can express empathy and avoid confrontation.  Some clients are more ready to change than others so using motivational interviewing can be a key factor in their treatment plan and whether or not their goals will be accomplished.  A professional should be able to carefully assess without preaching or trying to teach the client a lesson.   There are many characteristics that a motivational interview should include.  For example, the professional who is interviewing should actively listen to what a client has to say rather than thinking the client falls into a typical user range.  There is such large scale to which a client may fall under and if the interviewer doesn’t see the client in the correct light than this could compromise the future of the client.  Also, the interviewer should not dictate or assume anything.  Compassion, understanding, and making the client feel that you really do care are critical to the interview process.

Stages of Change

There are six stages of change.  The first state is precontemplation which is generally before the client realizes he or she has a problem.  When confronted they may not really comprehend or understand the negative effects that alcohol or drugs play in their life.  This stage is typically brought on by someone other than themselves.   The next stage is contemplation.  During this stage the client is usually understanding or at least willing to acknowledge that there could possibly be a problem.  Then the determination stage is when the client is facilitated towards an action plan and it’s up to the professional to figure out what type of action the client is going to respond to.  The professional must be very careful with the linking between the determination stage and the action stage.  If not done correctly the client may be bounce back to the precontemplation stage.  The action stage is next and this when someone intentionally acts on a plan of help.  Meaning; creating a plan and actually making an effort to change.  Once the action stage has taken affect the Maintenance stage comes into play.  The client will maintain their action throughout and most likely would need help in doing so.  If the client is able to maintain with or without help then relapse is not a stage of change.  However, without the support and help, many alcohol or drug users fall into relapse.  Once the relapse is over they will have to start all over but hopefully the next time they can skip the precontemplation and contemplation stage.

 

Fisher, Gary L., and Thomas C. Harrison. Substance Abuse: Information for School Counselors, Social Workers, Therapists, and Counselors. Boston: Pearson/Allyn and Bacon, 2005. Print.