1. Contemplation Lapse/Relapse Maintenance Action Preparation Pre- Contemplation STAGES OF CHANGE

2. Pre- Contemplation Stages of Change

3. PRE-CONTEMPLATION Characteristics “No problem” See no reason to change Lack of awareness Pre- Contem plation

4. PRE-CONTEMPLATION Tasks of Change: Information: Both factual and personal Consider circumstances which indicate a need for change Engagement of client, create positive relationship Pre- Contem plation

5. Pre- Contemplation Stages of Change

6. CONTEMPLATION Characteristics Ambivalence Fear of change Wishful thinking Interest in “the problem”

7. CONTEMPLATION Tasks of Change Examine the ambivalence Weigh and consider alternatives Examine “pros” and “cons” of particular actions

8. Preparation Contemplation Pre- Contemplation Stages of Change

9. PREPARATION Characteristics Readiness to consciously engage in change process Temporal imminence of change

10. PREPARATION Tasks of Change Gather information about options Make initial contact

11. Action Contemplation Preparation Pre- Contemplation Stages of Change

12. ACTION Characteristic Change in behaviour

13. ACTION Tasks of Change Understanding factors supporting the behaviour Strategies which will support behavioural change Communication with others

14. Maintenance Contemplation Action Preparation Pre- Contemplation Stages of Change

15. MAINTENANCE Characteristics Consolidation of changes Need for support Skills development

16. MAINTENANCE Tasks of Change Establish support system Practice behavioural changes Act on relapse prevention plans

17. Lapse/Relapse Contemplation Maintenance Action Preparation Pre- Contemplation Stages of Change

18. LAPSE/RELAPSE Characteristics Initial return to use Re-establishing previous pattern

19. LAPSE/RELAPSE Tasks of Change Reconnecting with supports Examining and learning from lapse experience Reviewing and modifying relapse prevention strategies

20. EMPOWERMENT AND SELF CHANGE Understanding motivation Autonomy Motivational interventions FRAMES

21. F eedback R esponsibiltiy A dvice M enu of options E mpathic style S elf efficacy

22. How does it balance?

23. Case 1 Rod 19 year old Smokes cannabis 3 out of 7 days in a week. Takes Es on weekends. Drinks 5 units alcohol day Spends most of his spare cash on drugs and alcohols Impulsive and suffers with depression

24. Case 2: Jane 45 year old restaurant manager Taking nitrazepam (prescribed by GP) for 2 years Anxious and depressed

25. Case 3: Freddy 29 year old Crack cocaine user past 5 years Using heroin ‘to come down off the crack’ past 2 years Initially smoking, now injecting

26. Addiction as: A biological (disease) model A psychological model A social model BIOPSYCHOSOCIAL MODEL

27. Summary – Addiction Behaviour is no longer a matter of considered choice

28. Summary – Addiction as a function of: THE DRUG –Positive and negative re-inforcers THE PERSON –Impulsive, sensation seeking THE SITUATION –Opportunity, lack of alternatives, social influences

29. The End Any questions ? bhagat.sharma@nepft.nhs.uk How do you detox a patient with opiod dependency syndrome? Blow to the head rehabilitation Straitjacket chocolate