Stages of Change and Harm Reduction; Abstinence Models Psychotherapy
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When are people able to change?
Readiness, willingness, able!! (RAW)
Structure of change, what are the stages?
• Precontemplation (perhaps denial, just not contemplating) • Contemplation (uncomfortable stage where people are questioning what they’re doing) • Preparation (do I have th tools to make change, like making my house a cocaine-free zone?) • Action (tell people it’s hard to change but you can do it • Maintenance
Structure of change, what are the processes?
• Precontemplation to contemplation (consciousness raising, emotional arousal/dramatic release, social liberation/environmental reevaluation) • Contemplation to Preparation (self-evaluation: damned if you do, damned if you don’t) • Preparation to Action (self-liberation/commitment) • Action to Maintenance (Countering/counterconditioning, environmental control, rewards, helping relationships)
Abstinence means
stop all drugs, not use them at all, EVER
Example of Socratic teaching: when you take in nicotine, how do you die?
• COPD (dirt over alveolar capillary membrane and “air trapping”) • Arterial damage (heart, brain, pudendal artery) • Cancer (irritation locally and hematogenous spread to pancreas, kidney, bladder, bone marrow)
Ways of implementing Socratic teaching?
Clarification/reflexive listening (see example); confrontation/double-sided reflection (allow patient to educate you on why they do what they do)
Harm reduction is
aim to reduce harmful consequences of certain human behaviors
Ways to approach harm reduction?
• Can tell them smoking is harmful to health • Could person find way to smoke healthier? • Tell patient to smoke certain amount/day and enjoy each puff! • If you ask them if they want to smoke healthier, they’ll probably be less resistant