This the third and final section of this latest series. I continue to pray that it has brought some information that has help you and your family. I am aware as a parent myself that these are difficult and scaring times for all. We are facing issues that no one could have conceived of even 20 to 25 years ago. Thank you for letting me share with you insights and writing that may help. Next series is on parenting-and relationships with one or more people in your life that are using. Thank you for the comments that you have sent me. I appreciate them.
ROLE OF THE COUNSELOR/PARENT
As described above, there are many factors which impact on the state of mind and level of motivation of substance users. Counselors are often faced with clients who are unsure of themselves, and unsure of their ability to cope with life without drinking or taking drugs. In simplistic terms, the counselor's role is to help the client work through their ambivalence, and motivate him or her towards gaining control of their substance use.
Aspects of the role:
(1) Assessment: To assess the extent of the person's "problem" - how bad is it?
(2) Mental health issues: To assess whether there is an underlying mental health problem; a referral may need to be made for further assessment.
(3) Identify triggers: Help identify the situations, thoughts and feelings that trigger the client's drinking or drug taking.
(4) Life style changes: Help the client make appropriate life style changes - paying particular attention to the people they mix or socialize with who may draw them into substance use.
(5) Self-soothing activities: Help the client find distractions or self-soothing processes to cope with cravings.
(6) Suggest treatment options: Make referrals to residential treatment programs when this is appropriate. Those with substance dependence problems will usually require more intensive "treatment" than those with substance abuse problems
(7) Provide support: Help support and motivate those that want to change, but are finding it hard.
THE CYCLE OF CHANGE
Given that so many alcohol and drug users are in fact ambivalent about wanting to stop, may be lacking in trust, or may just be in denial, the support of a professional counselor becomes essential. Helping someone in this situation can sometimes be a difficult task. However there are a number of tools at the practioner's disposal.
The following is a model or theory of change developed by two social scientists (Prochaska & Diclemente), and may be used to explain the different decision-making stages that we tend to go through when trying to make a significant lifestyle change. Whether the desired change is to give up alcohol & drug use, or perhaps to get fit and lose weight, the process is basically the same.
The diagram below demonstrates the decision-making process of someone wanting to take control of their substance use.
It begins here (moving your mouse over each part of the diagram will activate different messages):
(awareness of consequences)
(looking at options)
(putting your plan into action)
RELAPSE PREVENTION STAGE
A fuller explanation of this model is provided below.
THE STAGES OF CHANGE
Pre-Contemplation Stage: A state of unawareness where the user has no concerns about the consequences of their alcohol or drug use. Teenagers are generally in this stage and some people may be stuck here for years.
"Denial" might describe this stage for people who have a long history of alcohol or drug use but insist they can handle it.
Contemplation Stage: The stage where the person has become aware that there are problems associated with their substance use, has begun to think about the issue, but is not yet ready to deal with it.
The consequences are not yet so bad that they feel the need to take action; or the consequences are serious, but the person feels that getting control of the situation is just too hard.
Preparation Stage: The stage where the client is beginning to try things such as going to AA, looking at the options, and making a plan to stop or cut down.
The preparation stage is perhaps the most important in the process. If you move too quickly and stop using without a proper plan or without putting the necessary support in place, the chances of long term success are not great. Finding the right support is the key to success in any significant personal change.
Action Stage: The stage where the person is actively attending counseling or AA/NA or both, and has committed to an attempt to cut back or stop using (preferably on a certain date.)
Maintenance Stage: The stage where the person uses 'relapse prevention' strategies to ensure new behaviors are maintained. Strategies in this stage might include:
• On-going counseling
• Attending a support group such as AA , NA , Ala-Non
• Telling friends and family of their plan
• Avoiding friends they used to "use" with
• Self-esteem building processes
• Finding replacement activities
Relapse: The process of learning to cope with a "slip" to prevent it turning into a full-blown relapse. Few people are able to get on top of substance abuse or dependence without a "slip", where they start using again. However some of the best learning comes from having a slip which is brought under control before the user relapses completely. In the process of stopping quickly, new skills are learnt which then become part of the user's relapse prevention repertoire.
Final Comment: This is a theoretical model. Everyone is unique with different skills and strengths, and few people go through the stages from start to finish in a systematic manner. People enter the cycle at different points and many people go through different stages of the cycle a number of times before they finally achieve the outcome they want.