This aspect focuses on how practitioners can create the conditions that maximise the potential for young people to identify the function of their substance use, set and achieve their goals, develop and practice strategies. Many practices outlined in this aspect are also included and elaborated on in the module Relapse Prevention.

Practitioner and young person view change as a learning experience
Depending on the nature of the young person’s attachment to particular substances and the associated lifestyle, young people can face a daunting challenge in trying to make lasting changes. Some young people find it difficult to imagine life after making changes to their substance using behaviour.  This combined with a lack of experience can make it very difficult for them to predict how they will cope with or respond to the changes being made.   

Making changes to patterns and habits involves trying new strategies and evaluating the outcome.  Not just once, but perhaps many times. When thinking about strategies for controlling, reducing or ceasing substance use, it is likely that the young person will already have identified and tried some strategies that do and don’t work.  Harnessing positive experiences, existing strengths and skills will assist in managing behavioural change.

Practitioners and young people can work closely together to tailor specific strategies suited to the individual’s experience, skills, resources and preferences.  Practitioners focus can be on; helping the young person prepare to try a new strategy, supporting them in putting that strategy in place and helping the young person assess how well it worked for them.   Furthermore, the practitioner plays an important role in bolstering and encouraging the young person if things don’t go to plan in the first instance.

Practitioner provides guidance rather than answers or instructions
While it can be tempting for a practitioner to make plans for the young person and predict high risk situations for them, it is important to give the young person as much control over these issues as possible.  Hence the practitioner is best positioned to provide guidance rather than solutions. 

Guidance is about striking the right balance based on an understanding of the young person’s capacities and the challenges they face. Young people in general prefer to project a competent image even if their limitations are obvious. This means that at times young people will set plans that practitioners believe are not realistic or achievable.  This insight can be conveyed by a practitioner, who should at the same time reinforce that they respect the young person’s choice of plan and their responsibility to enact it.  Practitioners can position themselves to assist young people to foresee and plan for the potential consequences and implications that might be the result of each step within a plan aimed at modifying their substance use.

Spend time on preparation and planning
Psycho-education (or “foundation knowledge”):  When a young person decides to control, reduce or cease substance use, it is useful for them to be aware of the possible impacts of doing so.  Knowing what to expect will assist the young person in managing, interpreting and tolerating how they feel, physically and emotionally.  Practitioners can ensure the young person has accurate information regarding tolerance and withdrawal effects, along with any risks associated with this.  This also provides an opportunity for the young person to identify people and other resources in their lives that can support them to change. 

Tips for practitioners

  • Skilful practitioners can create the space for a young person to reflect on and learn from their experiences. This involves being clear with the young person that:
  • The practitioner role is to guide and support, not to take control of the change process or judge them harshly when things don’t go to plan
  • Changing is a process of trial and error. Ensure that young people understand that people generally learn more from what doesn’t work that from what works well
  • Feeling overwhelmed at times is natural for all people making significant changes and that it is a sign of maturity to negotiate for or ask for help
  • Support and assistance will continue to be provided if their plans (including goals, strategies and timeframes) change

Encourage positive commitment 
The practitioner can spend some time developing the commitment of the young person to their change plans. Below are some suggestions to help with strengthening commitment.

A8. Planning and deepening the commitment to change from Motivational Interviewing can enhance motivation to attempt new strategies. 

Five questions for change:  These very simple questions, when put to a young person can crystallise the reasons and motivations for change. 

Importance/ confidence scale:  can enhance a person’s belief that their choice is important and that they have the confidence to carry out the task that they set for themselves. 

B3 Exception seeking
This element is focused on enabling young people to explore times when the problem was not present, when it was not as bad, or times when they were managing the problem more effectively. This can unearth particular strengths and resources that the young person might put to good effect in modifying their substance using behaviour.

B7 Competence seeking / Looking for strengths
This element describes how practitioners can continually be alert to times when a young person reveals or demonstrates competencies or strengths.  The practitioner brings these to the attention of the young person, and affirms or reinforces them.

Build reinforcement into plans for change
Young people who have formulated (or have been involved in formulating) their own plans are most likely to invest their effort into changing their substance using behaviour.  Positive feedback and rewards will enhance a young person’s motivation to continue investing effort in behaviour change. Each step within a plan ought to be linked with some kind of reinforcement and the practitioner can be well positioned to encourage the young person to recognise these. 

The Adolescent Community Reinforcement Approach (ACRA) is a therapeutic model focused on increasing the family, social, educational and / or vocational ‘reinforcers’ that make life without substance use attractive to the young person. The benefits of change are positively reinforced. Change might also result in the removal of adverse experiences associated with substance using behaviour. This is known as ‘negative reinforcement’.

Practitioners can maximise the potential of young people to change by finding out the kind of reinforcement (negative and positive) that they value the most and building this into plans.

It is equally important to understand the reinforcers of the young person’s substance using behaviour (such as feeling bonded to a peer group or relief from anxiety) and to help the young person to remove or avoid them (at least for a brief period) or to develop alternative ways to gain reinforcement.  A ‘functional analysis’ of a young person’s substance using behaviour can reveal how it is reinforced.

Incorporate constructive and enjoyable ways of spending time
Substance use and the associated lifestyle can provide young people with a way of spending time, often with others, that can be stimulating and rewarding. Relief from boredom or having fun are reasons young people often give for using substances. These are reinforcers for substance using behaviour, despite any unwanted complications.

Modifying substance use, particularly ceasing, without proper planning can result in loneliness and boredom. This increases the risk that a young person will use substances in an unplanned way.

The most effective activities that can act as an alternative to substance use are those that complement the young person’s abilities, preferences and immediate needs. A practitioner and young person can brainstorm a list of suitable activities, write them down and keep them as a reminder. Examples or prompts may be; play video games, go for a walk or run, play basketball, read comics or magazines, watch TV, chat on Facebook, go to the local youth centre or Day Program, ride a bike, listen to music, etc.

Building constructive and enjoyable ways to spend time into a plan has an immediate benefit of relieving boredom and providing stimulation.  It can introduce, or reintroduce,  activities that a young person might be motivated to engage in over the long term.

The following 2 elements drawn from ACRA can be applied to help young people find enjoyable ways of spending time as a part of a plan to change. The first demonstrates how inherently rewarding activities that compete with substance using behaviour can be scheduled as part of a plan. The second concentrates on how to encourage a young person to take up an activity that they have chosen to pursue.

D7. Activity scheduling & creating opportunities for achievement
This element focuses on helping young people identify one or more fun, prosocial activities that they have enjoyed in the past or would like to try. These activities are scheduled at times of the week and / or occasions when potential for unplanned substance use is high.

D8. Systematic encouragement
Where a young person is interested in trying a new activity there can be a risk that they will not follow through. This element describes three basic ways to encourage a young person to participate.

Elicit constructive involvement of support people and services
Young people need to have a strong sense that people and services involved in their care understand them and are prepared to support the implementation of their own goals and plans.  Young people need to trust and feel comfortable with support people who might include parents, siblings, relatives, partners, friends or service providers. 

Young people might require guidance in determining who is an appropriate support person and how best to approach them. It is important that support people don’t have a problem with substance use at the same time as trying to help the young person with their substance use. It is useful for a young person seeking support to identify the role that they would like a person to perform as a part of their plan.  There may also be rewards for support people. 

The following element from ACRA can be applied to help young people arrange the involvement involvement of support people.

D9. Recruit support people in the young person’s life who can provide reinforcement
This element suggests that young people identify people in their family or social network that have previously or could potentially support them in working towards their goals. This should include people who the young person participates with in recreational, educational or vocational settings.