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Competency 4: Prevention

Addiction Disorders in Women

Brief Intervention and Motivational Interviewing

Research indicates that brief interventions can be effective in reducing alcohol use during pregnancy.3 Brief interventions can also be effective in reducing alcohol use among women of childbearing age.7 The intervention typically involves one or two 15-minute counseling visits with a physician. The sessions include advice, education, and use of a scripted workbook to develop a contract to reduce alcohol use.

Brief interventions often use motivational interviewing, which is based on stages of change theory. Motivational interviewing helps people make decisions along the stages of change.8 The diagram shows the stages of change, which are described below.

Stages of Readiness for Change (read from bottom to top)

Stages of Readiness for Change/Motivation for treatment

Source: Prochaska, J.O.; DiClemente, C.C.; and Norcross, J.C. 1992. In search of how people change: Applications to addictive behaviors. American Psychologist 47(9):1102-1114.

  • Precontemplation. The person is not considering change. He or she does not see the need and may be surprised to find that others think a problem exists.
  • Contemplation. The person is ambivalent. Part of the person wants to change and part does not. The characteristic response of the contemplator is “Yes, but...”
  • Preparation. The person feels ready to change. He or she may express feelings such as “Something’s got to change. I can’t go on like this.” If determination does not lead to action, the individual may temporarily return to the precontemplation stage.
  • Action. The person has begun doing something about his or her behavior. This is usually when treatment starts.
  • Maintenance. This is the hardest part of change. The challenge is to maintain the gains and avoid relapse.
  • Relapse. Approximately 90 percent of problem drinkers will drink again after treatment. 9 They need to recover from the lapse as quickly as possible and reenter the change process. Relapse is not formally considered a stage. It is included because many individuals relapse and repeat stages.

Motivational interviewing helps people recognize their problems and increase their motivation to change. It is especially useful in resolving ambivalence. It is a supportive, respectful approach that is persuasive but not coercive. One useful model for understanding motivation is FRAMES.10

FRAMES stands for six key elements that are effective in assisting persons with at-risk or problem drinking to change their drinking behavior:

  • Feedback: Provide useful feedback based on screening.
  • Responsibility: Emphasize personal responsibility and freedom to choose.
  • Advice: Give specific advice about how to change drinking patterns.
  • Menu: Provide the person with options.
  • Empathy: Show an understanding of the person’s situation and be supportive.
  • Self-efficacy: Convey the message that the person is capable of change.

Motivational interviewing strategies can help people stay focused and avoid getting sidetracked. It is important to reinforce statements that indicate a willingness to consider change. Resistance may indicate a different stage of change than previously thought. The goal is to understand where the person is and guide the process accordingly.

Motivational interviewing has been shown to be effective with pregnant women and women of childbearing age. However, it has not been tested at length with these groups and has not been specifically tested with women with an FASD.

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