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Posted: Sep 15, 2008 14:11


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By Bob Pegler, CAS

Over the past two decades there has been a movement to integrate various models of addiction into a more comprehensive approach. There are several themes that have changed the way we see our patients. These themes include emphasizing the patients’ strengths and competencies rather than simply focusing on their limitations.

There has also been a movement away from authoritative standardized treatment approaches to an approach based entirely on the patient’s individual needs. In the traditional medical model patients received treatment from practitioners. Now the client is seen as a partner who works with the staff on treatment goals. There has also been an increased understanding of the need for empathy rather than authority and power to encourage change. Finally, there is greater integration of treatment approaches for patients with co-occurring disorders.

Beginning this spring, Peninsula Village has embarked on a more client-centered approach which incorporates the changes mentioned above. This approach is called Motivational Interviewing (or Motivational Enhancement). We are currently training our staff in this approach. As the name applies, the focus of this counseling technique is to utilize each young person’s own motivation to help them change.

There are five stages of change in recovery according to this model (Prochaska & DiClemente, 1984).

  1. Precontemplation – the patient is not considering change and is at least partially unaware problem exists.

  2. Contemplation – the patient is aware that problem exists, but is ambivalent about change.

  3. Preparation – the advantages of change outweigh status quo.

  4. Action – the patient chooses strategy for change and begins to pursue it.

  5. Maintenance – the patient learns to detect and guard against triggers. Relapse can be part of this learning process.

Relapses are simply understood as a recurrence to one of the earlier stages of change and are a normal process of change. This helps us understand why our patients so frequently return to old behaviors soon after experiencing success with new behaviors.

Research into this approach compared to other treatment methods has been very positive. Project MATCH was the largest clinical trial ever conducted comparing different alcohol treatment methods. It consisted of a variety of patients with different severities of problems, most of whom met the diagnostic criteria for Alcohol Dependence. Short sessions of Motivational Enhancement Therapy yielded long term outcomes as good as or better than longer outpatient methods (Project MATCH Research Group, 1997a).

The central element of Motivational Enhancement is the FRAMES approach:

  • Feedback – assessment of the patient’s substance abuse or other destructive patterns

  • Responsibility – responsibility for change lies with the patient

  • Advice – advice on how to change is presented to patient in non-judgmental manner

  • Menus – change and treatment options are offered to the patient

  • Empathy – warmth, respect and understanding are emphasized

  • Self-Efficacy - optimistic empowerment helps patient encourage change

Just as change is difficult for our patients, treatment centers like Peninsula Village are often challenged when we try to make changes. Over the past couple of months Peninsula Village has experienced some staff loss as we have begun to make these changes. Teaching and practicing a new treatment approach with over 100 staff has been both exciting and challenging. For the Village, as for our patients and families, change is a process and it will not occur overnight. The difficulties and setbacks that we experience will provide us with experiences we can learn from and are not failures.

We appreciate the feedback and support we have received from our staff, patients, alumni, families and referral sources during this process. Your feedback helps us navigate these changes.

About the Author:
Bob Pegler is Program Director of Peninsula Village. He is a Certified Addiction Specialist, a Certified ROPES Facilitator, and a Certified Interventionist. Pegler is a member of the Tennessee Association of Alcohol & Drug Abuse Counselors and the National Association of Alcohol & Drug Abuse Counselors. He founded the Family Relapse Prevention Group for patients and families nearing program completion. Currently, Pegler co-facilitates alumni and family support groups in Atlanta, GA, and Raleigh, NC. This article is reprinted from the Summer 2008 Village Vision Newsletter published by Peninsula Village, Louisville TN, 865-380-4452 and used with permission.

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