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Module 5: FASD Prevention

Selective Prevention Strategies

Motivational interviewing is a way to help 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.

The following are the stages of readiness for change and their definitions.5

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.

The person is ambivalent. Part of the person wants to change and part does not. The characteristic response of the contemplator is "Yes, but..."

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.

The person has begun doing something about his or her behavior. This is usually when treatment starts.

This is the hardest part of change. The challenge is to maintain the gains and avoid relapse.

More than 90 percent of problem drinkers or drug users will drink or abuse drugs again after treatment. They need to recover from the relapse 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.

One useful model for understanding motivation is FRAMES.6 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.2 However, it has not been tested at length with these groups.

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