Relapsing back to problem use

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STAGES OF CHANGE
Relapsing back to problem use
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Stages of Change
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PRE-CONTEMPLATION Characteristics

• No problem
• See no reason to change
• Lack of awareness

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PRE-CONTEMPLATION Tasks of Change

• Information Both factual and personal
• Consider circumstances which indicate a need for
  change
• Engagement of client, create positive relationship

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Stages of Change
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CONTEMPLATIONCharacteristics

• Ambivalence
• Fear of change
• Wishful thinking
• Interest in the problem

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CONTEMPLATIONTasks of Change

• Examine the ambivalence
• Weigh and consider alternatives
• Examine pros and cons of particular actions

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Stages of Change
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PREPARATIONCharacteristics

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

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PREPARATION Tasks of Change

• Gather information about options
• Make initial contact

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Stages of Change
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ACTION Characteristic

• Change in behaviour

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ACTIONTasks of Change

• Understanding factors supporting the behaviour
• Strategies which will support behavioural change
• Communication with others

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Stages of Change
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MAINTENANCECharacteristics

• Consolidation of changes
• Need for support
• Skills development

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MAINTENANCETasks of Change

• Establish support system
• Practice behavioural changes
• Act on relapse prevention plans

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Stages of Change
Relapsing back to problem use
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LAPSE/RELAPSE Characteristics

• Initial return to use
• Re-establishing previous pattern

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LAPSE/RELAPSE Tasks of Change

• Reconnecting with supports
• Examining and learning from lapse experience
• Reviewing and modifying relapse prevention
  strategies

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EMPOWERMENT AND SELF CHANGE

• Understanding motivation
• Autonomy
• Motivational interventions
• FRAMES

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FRAMES

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

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How does it balance?
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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

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Case 2 Jane

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

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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

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Addiction as

• A biological (disease) model
• A psychological model
• A social model
• BIOPSYCHOSOCIAL MODEL

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Summary Addiction

• Behaviour is no longer a matter of considered
  choice

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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

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• The End
• Any questions ?
• bhagat.sharma_at_nepft.nhs.uk