Enhancing Motivation for Change in Substance Abuse Treatment Post-Test

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by McGinnis & Reid Associates

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Enhancing Motivation for Change in Substance Abuse Treatment Post Test

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Text: Screening and Assessing Adolescents For Substance Use Disorders Treatment Improvement Protocol (TIP) Series No. 35.

Following your reading of the course material found in TIP Series 35, please read the following statements and indicate the correct answer. A score of 25 correct must be obtained to pass the course (you may miss 9). The test may be taken as many times as necessary to obtain a passing grade. The online test supports automated scoring for quick results. You will need to write down the numbers of the questions you may miss from the pop-up screen. No permanent record will be automatically provided of your score.

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1. Motivation is defined in the text as purposeful, intentional, and positive--directed toward the best interests of society.

2. Specifically, the TIP states that motivation is considered to be related to the probability that a person will enter into, continue, and adhere to a specific change strategy.

3. Treatment staff can influence change by developing a therapeutic relationship that respects and builds on the client's autonomy however, the treatment clinician is never a real partner in the change process.

4. One obstacle to the implementation of motivation-focused interventions in the United States may be ideological because it places greater responsibility on the clinician, whose job is now expanded to include engendering motivation.

5. Rather than dismissing the more challenging clients as unmotivated, clinicians should be equipped with skills to enhance motivation and to establish partnerships with their clients.

6. Motivation for change is an important (but secondary aspect) component in addressing substance abuse.

7. Having a positive attitude toward change and being committed to change are associated with positive treatment outcomes.

8. The client is ultimately responsible for change, and the therapeutic relationship with the primary clinician is generally irrelevant to the recovery process so long as the client is motivated to change.

9. To incorporate the assumptions about motivation while encouraging a client to change substance-using behavior, the clinician can use the following strategies:

· Focus on the client's strengths rather than his weaknesses.
· Respect the client's autonomy and decisions.
· Make treatment individualized and client centered.
· Do not depersonalize the client by using labels like "addict" or "alcoholic."
· Develop a therapeutic partnership.
· Use empathy, not authority or power.
· Focus on early interventions. Extend motivational approaches into nontraditional settings.
· Focus on less intensive treatments.
· Recognize that substance abuse disorders exist along a continuum.
· Recognize that many clients have more than one substance use disorder.
· Recognize that some clients may have other coexisting disorders that affect all stages of the change process.
· Accept new treatment goals, which involve interim, incremental, and even temporary steps toward ultimate goals.
· Integrate substance abuse treatment with other disciplines.

10. The transtheoretical stages-of-change model, described in Chapter 1, emerged from an examination of 18 psychological and behavioral theories about how change occurs, including components that make up the biopsychosocial framework for understanding addiction.

11. The five stages of change are precontemplation, contemplation, preparation, action, and maintenance. These stages are experienced in a linear fashion, such that clients enter into one stage and then directly progress to the next as they experience the recovery process.

12. For most people with substance abuse problems, recurrence of substance use is the exception, not the rule once they enter into the recovery process.

13. Recurrence is not considered a stage but an event that can occur at any point along the cycle of recovery.

14. The Consensus Panel considers the following elements of current motivational approaches to be important:
· The FRAMES approach
· Decisional balance exercises
· Developing discrepancy
· Flexible pacing
· Personal contact with clients who are not actively in treatment

15. The FRAMES approach consists of the following components: Feedback, Responsibility, Advice, Menu, Empathic, Self-efficacy.

16. Advice about changing substance use should be given forcefully and with conviction so the client clearly understands the seriousness of the need to change.

17. Clinicians should be thoroughly familiar with the populations with whom they expect to establish therapeutic relationships.

18. Motivational interviewing is a therapeutic style intended to help clinicians work with clients to address their ambivalence. While conducting a motivational interview, the clinician is directive yet client centered, with a clear goal of eliciting self-motivational statements and behavioral change from the client, and seeking to create client discrepancy to enhance motivation for positive change.

19. The Consensus Panel recommends that motivational interviewing be learned as a set of techniques or tools to use whenever necessary with a particular client.

20. The Consensus Panel recognizes that successful motivational interviewing will entail being able to:

· Express empathy through reflective listening.
· Communicate respect for and acceptance of clients and their feelings.
· Establish a nonjudgmental, collaborative relationship.
· Be a supportive and knowledgeable consultant.
· Compliment rather than denigrate.
· Listen rather than tell.
· Gently persuade, with the understanding that change is up to the client.
· Provide support throughout the process of recovery.
· Develop discrepancy between clients' goals or values and current behavior, helping clients recognize the discrepancies between where they are and where they hope to be.
· Avoid argument and direct confrontation, which can degenerate into a power struggle.
· Adjust to, rather than oppose, client resistance.
· Support self-efficacy and optimism: that is, focus on clients' strengths to support the hope and optimism needed to make change.

21. Clinicians who adopt motivational interviewing as a preferred style have found that the following five strategies are particularly useful in the early stages of treatment:

1. Ask open-ended questions.
2. Listen reflectively.
3. Summarize.
4. Affirm.
5. Guide.

22. The assessment and feedback process can be an important part of the motivational strategy because it informs clients of how their own substance use patterns compare with norms, what specific risks are entailed, and what damage already exists or is likely to occur if changes are not made.

23. Considerable research shows that involvement of family members or significant others (SOs) can enhance the recovery process.

24. An SO who is experiencing hardships or emotional problems stemming from the client's substance is likely to be a suitable motivator to use in family counseling to motivate and support the client.

25. Goal-setting is part of the exploring and envisioning activities characteristic of the early and middle preparation stage.

26. Following are a number of potential competing reinforcers that can help clients:

· Doing volunteer work, thus filling time, connecting with socially acceptable friends, and improving their self-efficacy
· Becoming involved in 12-Step-based activities and other self-help groups
· Setting goals to improve their work, education, exercise, and nutrition
· Spending more time with their families and significant others
· Participating in spiritual or cultural activities
· Socializing with nonsubstance-using friends
· Learning new skills or improving in such areas as sports, art, music, and other hobbies

27. The way you, the clinician, interact with clients has a crucial impact on how they respond and whether treatment is successful.

28. Spiritual models give more weight to spiritual etiology as a path to recovery.

29. Spiritual models all share a recognition of the limitations of the self and a desire to achieve health through a connection with that which transcends the individual.

30. Research has demonstrated that there is a characteristic personality (addictive personality) among substance-dependent individuals.

31. Research suggests that the more frequently clinicians use adversarial confrontational techniques with substance-using clients, the more likely clients will change.

32. Whereas the treatment field has historically focused on the deficits and limitations of clients, there is a greater emphasis today on identifying, enhancing, and using clients' strengths and competencies.

33. A functional analysis probes the situations surrounding drug and alcohol use. Specifically, it examines the relationships among stimuli that trigger use and consequences that follow.

34. Since its introduction in the 1960s, the approach developed by the Johnson Institute has been modified from a confrontational technique to a much less harsh strategy with numerous permutations (Stanton, 1997). The Johnson Intervention is a well-known technique in which family members and others from the user's social network, after considerable formal training and rehearsal, confront the substance user in a clinician's presence. They take turns telling the user how substance use has affected them, urge the user to seek help, and specify what consequences will occur if change--usually treatment entry--does not happen. An element of surprise is usually part of the plan. The basic assumptions outlined by the originator of this method are as follows (Johnson, 1973):

· Meaningful, influential persons present the user with facts or personal information.
· The data presented must be specific and descriptive of actual events or conditions, not opinions.
· The tone of the confrontation should not be judgmental but reflect concern.
· The evidence presented should be tied directly to drinking or other substance use and given in some detail.
· The goal is that the substance user will see and accept enough facts to acknowledge the need for help.
· The user should be offered appropriate and available choices of treatment so that dignity is retained and decision making capabilities are respected.

Course Evaluation Form (Required)

Thank you for your participation in this continuing education course. We are required to collect evaluation data on each course completed prior to the issuance of your certificate. Please complete the following and return with your post-test.

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