Why do some people change and other’s don’t with regards to addictions? From the motivational interviewing model, change is up to the clients. The main obstacle to overcome is the ambivalence about change. Some resistance I believe is to be expected. Some people may not change with regards to addictions because may still be in the precontemplative phase of Prochaska’s and DiClemente’s model (Miller & Rollnick, 2002). They may not be ready to change. The pros of their substance abuse may be weighing heavier than the cons at the point they are at in their lives. According to Prochaska and DiClemente’s model, there are stages of change. These include the pre-contemplation stage where there is no awareness of the negative aspects of the problem. Contemplation is the next stage that includes some awareness that there may be some consequences associated with the problem. Then the action stage where there are goals set up and a plan that is being set into action. The maintenance stage then includes a consolidation, and finally the relapse stage may follow that may move the client back to the precontemplative stage of the cycle. I feel that to guide clients through these changes it is important to emphasize the role of self-efficacy. It is the therapist’s role I think to help the client move through their uncertainty around wanting to change, not by persuasion or confrontation, but by a therapeutic relationship that is empathetic and respectful. Readiness to change is seen on a continuum. It is in a state of flux and is affected by interaction with the therapist (Weegmann, 2002).
In addiction treatment, I do not believe that it is my role as a therapist to try to convince a client who is resistant that he or she must change. I don’t think that it is therapeutic to preach about the ill effects of drug or alcohol use, for instance, but rather to simply offer up some statistics when appropriate. I believe that it is futile to try and break through any type of supposed denial about the harmful effects of addictions with the use of labeling. Arguing is also counterproductive as it can lead to increased resistance.
What is beneficial to the process of overcoming addiction is a technique used in CBT and motivational interviewing called a cost/benefit analysis (CBA). It essentially involves a discussion around what the pros and cons are of the addictive behavior. The goal of this would be to produce the reasons, the desire, and ultimately the need for change from the client’s perspective.
I welcome any thoughts you may have on this topic.
Miller, W.R., & Rollnick, S. (2002). Motivational Interviewing: Preparing People to Change Addictive Behavior. 2nd Ed. London, The Guilford Press.
Weegmann, M. (2002). Motivational interviewing and addiction: a psychodynamic appreciation. Psychodynamic Practice, 8(2), 179-195.
Author: Dr. Masha Godkin,Psy.D, MFT is a professor of counseling psychology, a licensed Marriage and Family Therapist in the state of Ca. with an Online Therapy Practice, as well as a former child actor. One of her specialties is in addictive behavior and counseling those in the performing art professions. Visit http://www.onlinetherapywith-dr-masha.com to learn about the Online Therapy service options that are available.