Stages of change, by José Luis Vázquez Martínez
Hello everyone. My name is José Luis Vázquez Martínez. Today I will share with you information on the stages of change.
What mechanisms can change drug consumption behavior?
People change their behavior in very different ways and for multiple reasons. Some attain to stop using alcohol, tobacco, and other drugs without professional help, while others make unsuccessful attempts, leading them to request assistance.
Behavioral change is influenced by motivation, a state of proneness or desire to change, which shifts along with time and situations, affected by multiple factors.
As a dynamic component, motivation is determinant to alter unhealthy behaviors, seek and comply with treatment, and achieve long-term goals. The level of motivation is a significant predictor of adherence, dropouts, and treatment outcomes.
Service providers can increase people's motivation by using the appropriate interventions. During the treatment and recovery processes, individuals transit through several stages until achieving a solid self-efficacy.
Self-efficacy refers to the own confidence in the ability to perform a specific task and achieve it when facing a demanding or risky situation. People with higher self-efficacy are much more likely to take control and make changes.
From the different theoretical approaches in the field, the Prochaska and DiClemente Transtheoretical Model of Change is currently the most disseminated and used to describe recovery from various drug use disorders. This model provides three categories of concepts: levels, stages, and processes of change.
Levels of change indicate to what extent is necessary to strive to achieve either reduction or suspension of drug use. Stages of change are the different degrees of willingness to modify substance consumption behavior. And finally, processes of change are the tools used by each person to face problems and achieve behavioral modifications.
We will now focus on stages or phases, which are the degrees of readiness to change that people go through when modifying a problematic behavior, such as drug use.
In any change process, the person goes through the different stages several times before achieving a stable change.
Precontemplation - In this stage, people do not intend to take action in the foreseeable future, let's say the next six months. They are often unaware that their behavior is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behavior and emphasize the cons of changing behavior.
Contemplation - In this stage, people intend to practice healthier behavioral alternatives within the next six months. People recognize they may have a problem and are more thoughtful of the pros and cons of behavioral change. Even so, people may still feel ambivalent towards conduct modification.
In the preparation or determination stage, people are ready to take action within the next 30 days. People start to take small steps toward their behavior change, recognizing it can lead to a healthier life.
People in the action phase have recently changed their behavior, say within the last six months, and intend to keep progressing towards their behavioral goal.
Maintenance is the stage when people show sustained behavior change for more than six months and intend to keep going forward. It is a critical period to prevent relapse. People are in the maintenance stage from six months after stopping using drugs to an undetermined long-term period, which in some cases can last a lifetime. During this stage, people can be free of drug use and committed to staying that way for more than six months. Success can be easier to achieve with the proper support and guidance.
Despite their efforts, some people will continue or reinstate drug use. It is fundamental to consider that people who relapse do not fail.
When someone begins to consume drugs again, it is necessary to establish new strategies to consolidate change.
It is crucial to identify the weak or missing links in implementing the action plan to modify the individual's conduct and learn from this experience to attain successful future interventions.
Processes of change are the ways people modify their feelings, behavior, cognition, and relations with others and include cognitive and behavioral activities that help move forward towards change. The transtheoretical model considers ten processes of change:
Consciousness Raising focuses on increasing awareness about the healthy behavior alternative.
Self-reevaluation is a process that helps people realize the healthy behavior alternative is part of who they want to be.
Environmental reevaluation refers to the social reappraisal people go through to realize how their unhealthy behavior affects others.
Dramatic relief refers to whether positive or negative emotional arousal regarding the healthy behavior alternative.
Self-Liberation is about the commitment to change behavior based on the belief that achieving the healthy behavior alternative is possible.
Social liberation comprises the environmental opportunities that exist to show society is supportive of the healthy behavior alternative.
Reinforcement Management consists of rewarding healthy behavior and reducing the rewards that come from unhealthy behavior.
Helping relationships refer to finding supportive relationships that encourage the desired change.
Counter conditioning is about substituting unhealthy behaviors with the healthy behavior alternative.
Stimulus Control is the re-engineering of the environment to have reminders and cues that support and encourage healthy conduct and remove those that promote unhealthy behavior.
The cognitive processes of change (consciousness-raising, self-reevaluation, environmental reevaluation, dramatic relief, and self-liberation) relate to the initial stages of change: pre-contemplation, contemplation, and preparation, which demand further development of self-efficacy.
Behavioral processes of change (social liberation, reinforcement management, helping relationships, counter-conditioning, and stimulus control) are related to action and maintenance stages.
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My case about a 16 yrs old boy named Erick who was brought to the Social Worker`s office for assistance by the parents. According to the parents, they have observed changes in the behavior of the boy that are worrisome. He is hanging around with boys who are known to be naughty in the area. On several occasions the school principal indicated that Erick has skipped school and does not complete the assignments on time. At home the mother observed that his clothes smell of dagga when she was doing doing laundary and he neglect his household chores.
The parents confronted him and he became defensive and indicated that the parents are picking on him.
On the first two sessions, Erick did not see that smoking dagga is a problem because it is a natural herb. The social worker motivated him and provided facts on effects of dagga until he realised that he has problem.
He confessed that now that the Social Worker has provided indepth information on harmful effects of dagga , he is willing to change his behavior. He even asked if there is a programme that he can attend to meet peers who experience the same problem as him
The social worker provided information on an outpatient programme and how it works. He will attend the programme after school for a maximum of two hours for a period of three months every Tuesday and Monday.
Erick is now enrolled in the outpatient programme. He attends regularly after school and is always on time. His school grades has improved and he communicates well with his parents. He no longer hang with the older boys. He has since stopped smoking dagga.
He attends support group one a month to maintain his drug free lifestyle.
In the last support group meeting that he attended he indicated that he is sometimes tempted to use dagga again because he misses the feeling high. Erick was reassured that the feeling will not go away overnight and that it was normal to feel that way. Erick was provided with support and was encouraged to remain drug free. He was also allocated a mentor who will be available for him anytime he feels the temptation to use dagga again.
He is now enrolled in the local soccer team and has made ne friends and no longer complains about the temptations to use.
He has recespoke to hin and described their observationsleeps
A.E, an 18 years old adolescent boy, brought to the OPC by his parents, because he is using hash for a while, after interviewing the patient he sees that all the problems at home is not due to using hash because he is not using it regularly, but the problems are due to his father attitude with him (precontemplation), as he always criticise him and tell him what to do and what not to do. After further assessment the patient was more aware about other problems that might be related to hash, like his scholoatic achievemt and that he steel money from his mother to get hash, but he still see that he can't cut it down now as this is the only.thing that makes him releived from his quarrels with his father who always sees him as doing nothing right (contemplation).
Pre-contemplation. Kevin is a 16-year-old boy who have been using marijuana for the past 2 years. He usually smokes it twice a day. He also drinks alcohol with his friends on the weekend after school. He doesn’t think he has a problem as he states that it is his choice to smoke and he can start and stop at any time he chooses.
Contemplation. After being given a warning from the school of being expelled. Kevin feels as though that the time he spends smoking and drinking with his friends is interfering with his relationship with his family and also his school work. He decides that he will see the school counselor but consistently forgets to do so.
Preparation. However, he eventually self-referred after getting another warning letter from the school about being expelled and went to see the school counselor. He stated that he has been trying to cut down on his marijuana use by using it once a day and have gone without it for two weeks at a time. He however appears to be high during his screening with the counselor.
Action. Kevin got involved with a day treatment drug programme. He regularly sees the counselor also and has been staying away from his drinking friends and has reported, he has now been clean for the past 2 months.
Maintenance. Kevin has remained drug fee for the past 8 months and continuously attends support group.
Pre- Contemplation to contemplation case sudy
Ignacio is a boy from Aguascalientes, Mexico. Family and friends call him Nacho, and they describe him as a very charming and extrovert boy since he was very little, also he’s always being very sensitive and good at drawing. Nacho is now 17 years old, he loves music, dancing, composing song lyrics (specially rap) and hanging around with friends.
For Nacho, like many of his friends, life has not been easy because he was born in Barranca neighborhood, known as one of the most dangerous of Aguascalientes. His mom name is Ruth, she is 31 years old, she works from Monday to Saturday, 10 hours a day cleaning a house and taking care of other children, and his dad name is Gonzalo, he is 37 years old, he has problems with drug addiction, depression and impulse control (he is described as a very violent guy). Ruth and Nacho are divorced.
Despite this, Nacho is very proud of his dad because he is part of one of the most dangerous gangs in Aguascalientes called “888 Boyz”, so he feels protected and respected for being the son of a “powerful man”.
Nacho doesn’t like school very much, he finds it very boring and he often fails because he prefers to be out of classroom doing some skateboard, writing songs or drawing. Sometimes you can see him chatting with Sofia, a girl form school that he likes since they were 15. Sofia is Mormon, and she is waiting to be 18 to have a boyfriend… Nacho is willing to wait for her and learn about her religion because he says he will marry her.
He has been referred to me (as an adolescent counselor) from school because he was caught smoking marijuana at the back of the soccer field. He says he's been smoking for 2 years and recently he does it at least twice a day because he can't sleep if he doesn't smoke before he goes to bed.
He tells me he's been invited to be part of a gang called “los mas cholos”. He feels very confused about it because since he hangs around with those guys, he’s been using more marijuana than before (he used to do it only once a day)… and also he’s been experimenting with other substances such inhalants, crystal-meth and cocaine.
He is ambivalent because knows that Sofia would never be his girlfriend if he do drugs, but at the same time, he feels honored to be invited to be part of a local gang and that means is very probable to keep doing drugs. He is not yet very aware of the heath issues he could have because of the consumption of these drugs, but he feels really concerned about Sofia getting away from him.... So we start from this exact point to motivate him to the change and to choose a healthy life.
For someone to change they have to want to change. If a person does not see their action/behaviour as problematic or detrimental to them or to the ones they love there is little motivation to change behaviour. It is not until some major life crisis accrues that some people who are struggling with abstinence for example even consider seeking after abstinence in a serious way. Only when there is a clear benefit for them do some people desire change. The big issue though is what do guide them to replace this behaviour that brings some benefit to them with.
Pearson
Case:
TJ is a nine year old male. He has been in conflict with the law since he was five. He is highly intelligent and street smart, To to his drug use and nomadic behaviour he has to be placed in a secure facility. His father is not in his life. No one knows who he is due to the fact that before her death his mother did not seem to know who the father was. His grand mother is unable to offer the structure and guidance needed to manage his behaviour. In session TJ seems oblivious to a needed to change he was refrerred to aggression replacement training which seems to have assisted in helping him with some impluse control behaviours but has a long way to go unless he sees the need for change.
Marvin is a 13 yr. old boy living in rural community in Jamaica where several families are struggling financially. He is the oldest and only male child for his mother with 4 siblings, all girls. Marvin’s mother is in a long- term relationship with the girls’ father for the last 10 years. His own father died when he was 3 years old. Marvin recently entered high school in September but due to the pandemic and limited device access, as his sisters are given priority, he misses half his classes. His mother warns him not to smoke “weed” but regularly sends him to the shop to purchase her daily pack of cigarettes. She ensures Marvin completes chores and provides his meals but maintains minimal interaction with him. Marvin’s stepfather works all week and relaxes by drinking alcohol on the weekends. Marvin stated feeling like a misfit at home and spends a lot of time idling with his male cousins and other boys in the community who introduced him to alcohol a few months ago. He has been told he knows how to “hold his liquor” and that makes him proud. His friends also smoke cannabis, and he is curious, but the fear of a beating from his stepfather has stopped him. His paternal Uncle Max is a mechanic and recently started to keep Marvin occupied with learning the trade after school hours. His uncle Max, with the permission of Marvin’s mother, carried him to a counselling centre to address his alcohol use. Marvin expressed being willing to stop drinking but is worried he cannot as it makes him feel better. He expressed willingness to return to counselling as he does not want to be the next “community drunk.”
Marvin is ambivalent as he is concerned about his ability to cope with his life stressors without alcohol consumption. Alcohol consumption for Marvin, has proved to be a “positive” boost in his standing among peers, and getting the attention he craves. He is in the contemplation stage as there is ambivalence but willingness to “try” treatment. He acknowledges there is a problem and has identified a potential negative consequence if he continues.
I am presently counseling a client who is dependent on Crack-cocaine, he was taken to the psychiatric doctor by his parents since the past 6 months when he fell sick because of his use, he works at the state ministry of transportation as an administration officer, he claimed that he does his work diligently and has never been found wanting. After the doctor's treatment, he was sober for some time but went back to his use of crack. During our sessions he continue to claim that he was passing through the stages of change and that he is at the relapse stage and he is not doing anything wrong, "after all it that can happen to anyone". He claimed that the stages are in cycle and that he has to pass through all stages, even the Relapse Stage. I sometimes wonder how someone who was at the maintenance stage could go back and found himself in the Pre-contemplation or the contemplation stage. Sometimes it can be frustrating when you had to start over again when you are starting to be happy that a client is changing!
My case is about a 16 year old girl.
Rebecca (16) is a high school student who has begun abusing Opioid prescription drugs with some other teens after school. Her best friend tells her the behavior is dangerous but Rebecca insists she is having fun and the drugs are safe because they came from a pharmacy. Pre-contemplation – Rebecca does not believe there is anything wrong with her behaviors and incorrectly views the drugs as “safe.”
After a while Rebecca begin to knows that her behavior is dangerous but still takes comfort in the intoxication the opioids produced. Contemplation – Rebecca is aware of the problem and recognized the risk involved with her continued use. She has not reached the next stage because she continues to use regardless of risk.
Rebecca has been taking these opioids for 1 year and is addicted to this medication. She has recently realized the impact it is having on her life and she has made up her mind to discuss this with her mother because she wants to quit. Preparation – Rebecca recognizes that she has a problem and has taken steps to get her to the Action stage
After Rebecca discussed her drug misused with her mom the make an appointment with a therapist. She agreed to go in to treatment. After completing a one-month stay in an inpatient treatment center, she has remained sober for the last 11 months. She attends outpatient support groups and is celebrating one year of sobriety with a renewed vow never to use again. Maintenance – Rebecca has maintained sobriety for nearly a year. She is aware of her addiction and has taken steps to avoid relapse
Rebecca (16) is a high school student who has begun abusing Opioid prescription drugs with some other teens after school. Her best friend tells her the behavior is dangerous but Rebecca insists she is having fun and the drugs are safe because they came from a pharmacy. Pre-contemplation – Rebecca does not believe there is anything wrong with her behaviors and incorrectly views the drugs as “safe.”
After a while Rebecca begin to knows that her behavior is dangerous but still takes comfort in the intoxication the opioids produced. Contemplation – Rebecca is aware of the problem and recognized the risk involved with her continued use. She has not reached the next stage because she continues to use regardless of risk.
Rebecca has been taking these opioids for 1 year and is addicted to this medication. She has recently realized the impact it is having on her life and she has made up her mind to discuss this with her mother because she wants to quit. Preparation – Rebecca recognizes that she has a problem and has taken steps to get her to the Action stage
After Rebecca discussed her drug misused with her mom the make an appointment with a therapist. She agreed to go in to treatment. After completing a one-month stay in an inpatient treatment center, she has remained sober for the last 11 months. She attends outpatient support groups and is celebrating one year of sobriety with a renewed vow never to use again. Maintenance – Rebecca has maintained sobriety for nearly a year. She is aware of her addiction and has taken steps to avoid relapse
Anil is a 16 year old teenager living with his mother and two sisters. His mother works as a nurse in a hospital and have to do shifts. His older sister also lives in the home with her husband and two children. He dropped out as a junior high student and started hanging out with the youth from the neighborhood that are known for doing drugs and drinking and fighting. His mother tried to keep him on the right path by going to church but without much avail because there was some talk with the youth leader but no structural guidance. and NGO started a program for out of school youth and he was selected as s participant.
the program has a multi disciplinary and sectoral approach. During his years with his buddies her tried to stop smoking cannabis and was only able to stop 3 or 4 days and he'll start smoking again.
Pre-contemplation: he just entered the program because maybe it could help him find a job and most importantly get his mother off his back
Contemplation : because of the very diverse program consisting of alcohol and drugs information and guidance, he seriously started thinking of stop smoking completely. he was assigned a personal counselor whom he liked and opened up about his personal problems and smoking cannabis.
Preparation stage: in the program all the participants were also subject to random testing and this also encourage and strengthen his decision to quit smoking
Action stage: the program lasted 10 months and he succeeded to stay clean during the program and even avoid meeting his old friends from the neighborhood.
Maintenance: he receives a certificate and everybody was proud of him especially his mother. They had to wait six months to enter employment and every time he was on the verge to smoke again he called his counselor. His counselor talked him through is and even spend " special bounding weekends" with him to get him out of the neighborhood. this helped him to stay clean.
Relapse: he relpase after just starting work because his sister dies and he could not cope with it . with the helped of this counselor he managed
Isabella is a 17-year-old female from a lower middle-class community in St Lucia. She lives with her 35-year-old mother. She has just exited secondary school having sat her Caribbean Examination Council (CXC) exams and performing poorly in all of the five subjects she chose. Isabella loves dancing and hanging out with her friends but Isabella has developed a reputation for soliciting favours and money from her male peers and older men. This behaviour has paved the way for many men to take advantage of her and as a result, she has engaged in many unwanted activities in order to get what she wants.
Isabella started her drug use at age 13 with alcohol. At age 14 she was introduced to marijuana by one of her boyfriends. She currently smokes weed occasionally but binge drinks regularly. Isabella has indicated that when she is drunk she often finds herself engaged in sexual encounters with one or multiple men.
Isabella’s mom referred her to treatment citing that she is worried about her daughter’s health and wellbeing. Isabella agreed to sit with a Counsellor at the treatment centre for an assessment to keep her mother happy. Isabella does not believe she has a drug use issue but has confessed that she never wants to be a part of the frequent sexual encounters she experiences but when she is drunk she is unable to say no to the men who coerce her. She says that she does not want to stop using but would like to be able to control her alcohol use so that she won’t get drunk and end up in unwanted situations. Isabella is sad and embarrassed by the effect that her bad decisions have had on her and her mother as there are several photos and videos circulating of her sexual escapades while drunk.
My case study is a 35 year old woman who is a doctor in the US. She was in recovery for 10 years (from alcohol) and her father has passed away in the last month. Her background: she started alcohol at age 14 and by age 18 she was an alcoholic. At this time -- she starts drinking when her father has passed away (now for 4 weeks), and she is hiding it from her AA support person (like her AA coach). She is hiding it from everyone in her personal life and in her work life. She continues to work (40 hours per week) but anytime there is stress - she drinks alcohol. Sometimes, she drinks with one friend that likes to drink and does not judge her at all for drinking. She drinks alone too.
She is very strategic: she has now convinced her AA support person to no longer prevent her from drinking. For now, the AA support person says she will remain her Friend and she will NO LONGER serve as the AA support advisor (for now, she may change her mind later).
Some key ideas to share:
As part of relapse - she currently has no intention to change her current behavior and she no longer has the internal motivation to no longer consume alcohol (for this week).
Case: 15 year old Ashter recently relocated from his home town by his mom to live with a family friend to attend high school in that town. The reason his mother use is so that he does not have t wake up early and travel to school. In his last school Ashter was caught with marijuana along with some friends and so that was reason for him having to relocate to the other school. While at the school he was found with marijuana as well and his mother taught it was time to get some help. After speaking with him he states all the positive aspects of marijuana and why it's no problem for him to use. He also consider himself as a loner as he has spend most of his time by himself and would reach out at times to kids his age to hang around sometimes. He uses the drug as a from to relax and deal with most of issues that he does not verbalize. A safe space was create for him at the office where he can talk about his problems and different ways of coping with being far from home and making better decision was strategize.
Case Summary
Tony is a 15-year old student who lives with his parents and three siblings, aged 17, 12 and 5years old. The family is considered to be “old-fashioned” Christian and is deeply involved in the activities of their local church.
Tony stated that he began smoking cigarettes around the age of 13 at secondary school due to peer pressure. He lives in a low-income area, and drug abuse is rampant in his community. He was encouraged by his peers to try smoking weed. He did it for the first time, and although he was not certain if he really liked the effect of the drug, it did not do him any harm, so he decided to try to use it again when encouraged by his peers. He continued using regularly.
On this occasion Tony was with his friends on the way home from school, when they all stopped by one of his friends’ houses to smoke some weed and a terrible thing happened. Tony's only memory is that he passed out and, when he awoke, he was in the Accident and Emergency department of the hospital. After testing, it was determined that the joint was laced with cocaine and some adulterants. Tony was fortunate in that he survived that incident.
Tony was referred to the NCSA for substance use counselling and rehabilitation and the local Juvenile Liaison Scheme of the Police Force for monitoring and specific behaviour modification.
During the assessment Tony volunteered that he believed in a God and that he had “learned his lesson”. He believed that God saved his life for a reason. However, he is convinced that he can be more careful in the future until he decides to give up smoking weed. He says that he knows that his parents are disappointed and is willing to enroll in the sessions basically because they have threatened to put him out of the house. He really is not too convinced of the possible long-term impacts as his grades have remained basically the same.
Assessment
Tony is currently at the stage where he is aware that a problem exists and also of the effect of his actions on his parents as a result of their value system. He has also indicated that he is prepared to undergo counselling. He has simultaneously expressed the view that he can give up smoking weed at some indeterminate time and has made no firm commitment to stopping.
Tony has clearly recognized that his substance use is problematic in terms of family dynamics, but still shows some ambivalence towards conduct modification (learned his lesson but feels he can continue until he decides to give up smoking).
Based on the foregoing, I would assess Tony as at the stage of CONTEMPLATION.
Tony's case is an example of how adolescents have the idea that they are somehow invincible. They very often seem to take care of their immediate needs and tend not to think of long-term consequences. Tony therefore would benefit from counselling to involve the six processes below to achieve self-efficacy:-
I would also note place emphasis on activities highlighting building decisional balance and self liberation, as these would be key to maintaining sobriety as Tony moves through the levels and stages presented by this model.
Case study: Charles is a 17-year-old boy referred to our center for drug counselling. This visit represents his first admission to the center. Charles was referred to us by his school's Guidance Counselor after his teacher found marijuana in his backpack during school hours. During the assessment, it was noted that Charles had been using marijuana since he was 14 which often causes him to miss school, neglect his chores at home and ignore his parents. Charles also admitted that his grades have dropped drastically, that he had stop playing the sports that he loves and no longer hangs out with his friends. He expressed that it makes him sad and that he would like to live a “normal” life.
Precontemplation: Before coming to the center, Charles did not even notice that there was a problem with his marijuana use. He was uninterested and disengaged but he felt as though no one else noticed or knew that he used because he felt as though his habits weren’t "that bad”.
Contemplation: When Charles got in trouble at school and had to visit his Guidance Counselor, he realized the gravity of the situation. However, the only negative consequence that he could see was that he would be expelled from school if he ever did it again.
Preparation: After coming to the center, Charles was able to realize how much his habits have affected his academic and social life, as well as his interpersonal relationships and family connection. He agrees to participate in the drug treatment program to fix his relationships and his grades, and to avoid being expelled from school.
Action: Charles spent 90 days in the program, attending sessions weekly and virtually checking in with his case manager daily. Since he stopped smoking completely, he reports that he has noticed his life and relationships improving. He showed that he is excited to continue with limited supervision.
Maintenance: Charles agreed to check in with his therapist once a month for a full year to discuss any notable updates. He mentions that it has been difficult over the last 7 months but feels capable enough to continue so that his life can continue to improve
My case is about a 16 year old boy named Marco. Marco comes to assessment in company of his mother. Marco lives with his mother, grandmother, a 5 year old brother, and his stepfather. Until two weeks ago, he spent 7 months in a residential program, but he ran away and came home demanding explanations from his family and accusing them of wanting to get rid of him because of the constant arguments with his stepfather during the last year. Since he returned home, Marco goes out every day and returns extremely late at night, in addition to the fact that his family has been noticing that many of Marco's belongings are disappearing from the house, he has constant mood swings and, in a few days, he has lost a lot of weight. His mother has told him that she is afraid that he could be using alcohol, marijuana, crack and / or codeine again. When Marco listens to this, he becomes violent and yells at his family that they are exaggerating, and that he does not intend to get back into the residential program because he is in control of the amount of substances he is doing. He also says that using drugs does not cause him any problem, and on the contrary, it helps him to be more relaxed and he is sure that it will help him in his studies and he will be able to become an engineer. Marco is in a precontemplative stage. Two processes of change that can be considered are Consciousness Raising and Self-reevaluation.
N.D is an 18y/o college drop out who was sent by court order for an evaluation through the Family Affairs division under the Ministry of National Mobilization.
N.D admits he has a serious problem, he smokes "weed" regularly (over 7 blunts per day). It is affecting his "home-life" drastically as his relationship with siblings is next to naught, and he is constantly getting into arguments with his parents who blame his recent aggressive nature on the "weed-smoking". This poor relationship with family saddens N.D!{contemplation}
Through this admission the interviewer was able to not only conduct a proper evaluation but also begin the the journey for change to take place in N.D life.
N.D began a series of sessions under the psychosocial department and at the end of same, preparation was evident by client.
At age 25y/o presently N.D is now enrolled in college with major in psychology! He would consider his self now substance free (just drinks occasionally/socially) >>>>ACTION You see N.D now wants to help other youths who are currently in his prior position abusing substances (in his case cannabis) in hopes of bringing about the CHANGE in them!!!
All the best to N.D
@Shalen Dennie-Richardson
Case Study.
Daniel is a 16-year-old whose father brought him to a counselling centre after catching him with marijuana paraphernalia in his bedroom. During the intake, Daniel admitted to using marijuana which he started at the age of 15. During his first counselling session, he admitted to smoking marijuana during the day and every day in the past week. Furthermore, he told his counsellor that he can still go to school and smoke marijuana, but he would like to limit his drug use to when he is home instead of smoking both at school and home to avoid getting in trouble at school. While he said he wants to attain a secondary school education he said he needs marijuana to put a balance to his life.
At the second session, time was spent administering a drug screening inventory. The therapist shared the results him. On hearing his score, which suggested his marijuana use was at a substantial level, placing him at risk for health problems and being dependent, he became concerned. In addition to this, he along with the counsellor watched a video on the effects of marijuana use on the teenage. While he has not experienced any of these effects, he became a bit concerned and began wondering if all this stuff is true. He started to look at the lives of his friends who were using marijuana and realized that a few of the mentioned effects in their lives. He wondered if he should make some changes.
After that session, he did some thinking and considered how his substance use could hinder his aspirations. At that session, he made the decision that by the end of that week he was going to cut down on his marijuana use and he would do a bit more exercising instead of smoking on evenings.
After two weeks passed, Daniel revealed that he did not smoked any marijuana. In fact, he decided to hang out with new friends who are into chess instead of hanging out with his friends who use marijuana.
At a 6-month follow-up session, it was revealed that Daniel is still not using marijuana and a drug test was administered which came back with negative results for marijuana and other tested substances. Daniel was praised for tremendous effort to have come this far.
Anastasia is a 15 year old female who was recently suspended from school for use of alcohol on school premises. When it was brought to the attention of the school authorities, it was revealed that it was not the first incident, and that Anastasia had been habitually consuming alcohol and often brought to school and shared among her peers. Her group of friends were in the habit of sneaking alcohol onto school premises and did so quite often. When she was caught, she did not reveal that her friends were involved as well. She was referred to the school guidance counsellor as a condition for re-entry to the school and demonstrated great resistance to attending the sessions. At her first session, she insisted that there was nothing wrong with her alcohol consumption and did not see a need for any changes. She was sullen and very rude to the guidance officer (Pre-Contemplation). As the guidance officer began working with her, building rapport and helping her connect with the negative consequences of the alcohol on lite and its impact on her future opportunities she began to recognize the need to make changes in her patterns of behavior. She was shocked to learn about how it impacted her brain development. By the third session, she started becoming very engaged in the sessions. She admitted that she had a hard time quitting alcohol use despite her new understanding of the negative implications and finally acknowledged that she was ready and willing to take steps towards changing her behavior (Contemplation). Whilst she was engaged in counselling already, it was easy for her to transition to preparation stage as the counsellor worked with her on developing a ‘Quit Plan’ and a behavioral contract. Her family was also working closely with her and her parents were spending more time with her, proving much needed support as they were now aware of her problem subsequent to the school suspension. Anastasia was fortunate to have much needed support at the school administration and family level and this motivated her to commit to the positive behavior changes. After she completed her initial sessions with the school guidance counsellor and achieved all the behavioral goals set as well as stayed away from alcohol, she returned to school. The challenge will now be whether she will be able to maintain the behavioral changes in the presence of her peers.