The intention of a young person in ‘preparation’ is to make changes in the immediate future. The model’s underpinning theory holds that people form this intention when the costs associated with substance use substantially outweigh the benefits, and/or the benefits of changing outweigh the costs.
Intending to change is very different from making changes. A strong sense of self-efficacy increases the likelihood of transition from the ‘preparation’ to the ‘action’ stage. This transition is particularly challenging when substance use has been ubiquitous in a young person’s life and when it continues to be for others in their immediate social network.
Practitioners are advised to be mindful of how demoralising it can be for young people who have formed the view that change is required but not possible. Substance use might be used as a mechanism for coping with these feelings and there is a strong possibility of regression.
A young person at this stage of change is making a commitment to participate in focused interventions targeting behaviour change around AOD use. Thus interventions at this stage can move past engagement and motivation building and extend to building the personal strengths and social assets that can be drawn upon in order to enact change.
The process of self-liberation is concerned primarily with a client’s self-beliefs and perceptions about environmental circumstances in relation to the capacity of the person to make and sustain changes in their life.
‘Self-liberation’ focused interventions enable clients to develop new, empowering, schemas or narratives that both influence and are influenced by skill building and establishing support structures and helping relationships. Young people in preparation have decided to change but are still using substances so harm reduction interventions may still be required.
Even though a client is preparing to change, it is crucial that youth AOD practitioners still express interest in and understand their particular motivations for using substances. This empowers the practitioner to work with a young person to identify desirable alternative or substitute behaviours that will address the antecedents and rewards of previous substance using behaviour. Also, it helps the practitioner to develop insight into what a young person might expect to give up as they change and gauge the significance of what could be lost. Together, practitioners and clients can identify ‘high risk situations’ post-change that can trigger lapse and relapse, thus providing rich information for future relapse prevention efforts.
Intervention guide: Preparation stage
The primary intentions at this stage are:
- Set realistic goals for change
- Support self-efficacy
- Ensure young person has an adequate level of stability
- Mobilise supportive relationships
- Help young person plan to deal with unhelpful relationships
- Plan for participation in rewarding activity that relieves boredom
- Assertive linkage to AOD or other helpful services
- Support ability to cope effectively with underlying issues
- Relapse prevention planning
The key change processes are:
- Self liberation
- Helping relationships
The key therapeutic models are:
- Motivational interviewing
- Solutions focused therapy
- Narrative therapy
- Community Reinforcement Approach
Motivational interviewing can be used to strengthen and deepen the young person’s commitment to change commitment to change.
Elements from Motivational Interviewing
A Solutions Focused approach offers practitioners guidance in how to:
- Elicit, affirm and reinforce a clients commitment to change
- Help young people envisage the future and set achievable goals when they are finding it difficult to make the ‘big changes’ such as stopping or reducing substance use, have lost confidence in their ability to change, or when significant barriers to changing exist
- Supporting a young person’s self efficacy through helping them identify their competence, particular when it has previously gone unnoticed
Solutions Focused Elements
The application of a Community Reinforcement Approach can enable clients to identify:
A range of potential options for action so that a young person can make well-informed decisions about how to take the first steps in changing;
- Clear, simple and obtainable goals
- Personal skills that need to be developed to counteract the antecedents of problematic AOD use and facilitate the uptake of alternative behaviours (e.g. assertiveness, coping and problem-solving skills, communication skills, anger management)
- Significant persons in the young persons family or community who could be engaged to provide encouragement and reinforcement for desirable alternative behaviours
Further, Narrative Therapy might be employed to:
- Encourage learning from experience and enhance self efficacy by inviting clients to identify times when they have been effective in dealing with their substance use and felt more in control’
- Foster a belief that change is possible by eliciting stories from the client (or sharing stories with them) of other people who have successfully achieved change (without breaching confidentiality)
- Identify and elaborate on ‘unique outcomes’ or ‘exceptions’ that are inconsistent with problem-saturated narratives
- Clarify and elaborate strengths and assets underlying ‘unique outcomes’ that can form the basis of an alternative positive narrative
- Encourage and assist the young person to link and contextualise unique outcomes, strengths and assets into the form of a coherent alternative narrative
Narrative Therapy Elements