So far, this package has concentrated specifically on what we know. What we know about substances, what we know about young people, what we know about how some young people develop problems with their use, and what levels of use are currently occurring amongst the youth population of today. Then we looked at what we need to offer young people in order for the assistance to be helpful to them.
We will now concentrate more specifically on the young person, their presentation and what that might indicate to us regarding their desire or readiness to change. In order to do this we use a model called the "Stages of Change".
This model was proposed by Prochaska and DiClemente (1996) to describe the process of change that anyone goes through. It needs to be noted that this model can be applied to any decision to change, not simply to someone wanting to give up their substance use. It could equally be applied to a decision such as, "Should I decide to move to the country to live? Or should I stay in the city?"
AOD treatment has used it, as it allows workers to look at people's choices regarding their substance use.
Figure 1: Stages of Change Model
Understanding the model
The key to understanding the stages of change model is that there needs to be a match between the stage of change and the intervention offered. For example, if a young person is at the "precontemplation" stage, then it would be useless for a worker to give them a referral to an outclient counselling service. It is the equivalent of giving a country real estate guide to someone who's quite happy to live in the city!
Stage 1: Precontemplation
- The positives of the behaviour far outweigh any perceived costs
- Consequently, there is no desire to change the behaviour.
What do you think your role might be if encountering a young person at this stage?
Some of the tasks for a worker encountering a young person at this level:
- To engage the young person
- To raise awareness of risks involved in use.
If you are able to appropriately engage with a young person, this will mean that the young person is more likely to come to you if / when they are thinking of doing something about their use.
Raising awareness can be achieved by utilising motivational interviewing techniques. Lecturing and sermonising does not "raise awareness", nor does it assist the engagement process. If a young person makes a decision to change or to think about change, they are less likely to do this with someone who has "read them the riot act".
Stage 2: Contemplation
- the young person is beginning to think about change, often characterised by ambivalence
- often induced by someone or something external (eg parents, school, juvenile justice, etc)
What do you think your role might be if encountering a young person at this stage?
Some of the tasks for a worker encountering a young person at this stage:
- Continue to raise awareness of perceived risks of continuation of behaviour
- Assist young person to make informed choices (using Motivational Interviewing techniques)
- Offer continued support, assistance and encouragement.
Stage 3: Determination and Action
- Young person's attitude tips towards change and they decide to change (Cognitive)
- The stage at which behavioural change begins (Behavioural)
- Change in pattern / level of use
- Plan made and instituted.
What do you think your role might be if encountering a young person at this stage?
Part of a worker's task might be to:
- Undertake a full assessment
- Advise on options
- Assist the young person in making a plan
- Assist in maintaining motivation
- Assist in skill development and use of appropriate strategies
- Provide feedback.
Stage 4: Maintenance
During this stage the person maintains their changed behaviour, working to keep from (re)lapsing.
What do you think your role might be if encountering a young person at this stage?
Part of a worker's task might be to:
- Provide reinforcement in difficult times
- Assist young person maintain status
- Teach self-reinforcement skills
- Teach self-monitoring skills.
Stage 5: (Re)lapse
Where an individual returns to (previous patterns of) use. May be one-off or continued use.
Due to the relapsing nature of substance use, this is the most likely initial outcome.
What do you think your tasks might be if encountering a young person at this stage?
A worker's task might include:
- Prepare person for this in advance; explain that this is often the most likely outcome
- Assist young person to reframe experience
- Assist young person to remake plans.
Stage 6: Re-entry
After a (re)lapse an individual may enter the change model at any stage. Where they enter largely depends on the way they perceive their (re)lapse. This perception will often be coloured by our own responses and beliefs about what should happen.
What might be appropriate responses and options to the following (re)lapses?
A young person goes back to full-on use after finishing a "rehab" program:
A young person begins to dabble and use intermittently:
Some appropriate responses would be to:
- Reinforce gains, don't assume all is gone
- Keep them connected to our services
- Bring them back in for a "top up" or full program
- Encourage them to access other appropriate services.
Obviously you cannot make a full decision of what might be most appropriate unless you have other information. What other information should be considered in making this determination?
Some things that will need to be considered, amongst others, are client's thoughts (of course), current levels of support, appropriateness of living options, and physical and mental health.
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Working with Young People with Alcohol or Other Drug Issues: A self-paced learning package Published: 2006 Funded by NSW Drug & Alcohol Workforce Development Council. Written & compiled by Kristy Delaney, YAPA, and Matt Stubbs & John Howard, Ted Noffs Institute. Additional material by Nick Manning, YAPA, & by Shopfront Youth Legal Centre. Opinions are the author's.
Be careful! YAPA and the authors took reasonable care to ensure that this information was correct at the time of publishing. However health information, and government regulations, laws and standards are complex and changing. The authors may not have health, safety, or legal qualifications, and information provided is general - it is not specific health, legal or professional advice. Do not rely on it - check with other publications and authorities and if necessary get qualified, medical, legal or professional advice for your situation.
