Precontemplation - "Why should I change?" or "Get off my back?"
What follows is a description of the “Model of Change” or “Transtheoretical Model of Change” and variety of techniques that can be applied to help facilitate change behavior. The model of change is often labeled as a stage model, as it looks at progress as points along a continuum of change. What must also be kept in mind is that the stages generally blend into each other, and there is always dialectical tension (ambivalence or wavering back and forth) involved in moving from one stage to another. This struggle to change the person’s thinking, feelings, and behaviors, at each point is as significant or more significant than the “stages” themselves.
Taking a look
One of the ways of looking at substance use or any other dysfunctional behavior, is to examine what is going on with the person at various times.
In other words:
1. Where are they “at” in their daily life?
2. What is going on with them? (and)
3. How can we help the person start to make personal changes towards a healthier lifestyle?
In the beginning
Precontemplation (PC) is the first stage, and about 40% of substance users at any given moment, are thought to be in this stage. Precontemplation is when the individual is actively abusing chemicals and it has not occurred to him or her to try to abstain from chemical abuse. This phase can continue for years or even decades, and it is during this phase of chemical use that denial is most prominent. Clients in this stage will over estimate the problems inherent in quitting and under estimate their available resources for change. The substance user at this point has no desire to cut down or quit.
Helpers and Users
As a HELPER, try to get the user to THINK about the pro & cons of using and the short and long term consequences of using. Is it worth the risks? Be non-judgmental.
As a USER, recognize that “yes,” it is your choice to use or not; but realize too that you are making a choice and you are responsible for the consequences of the choices that you make!
How does the user move to the next stage? A number of interventions can be provided, and personal development encouraged, such as: drug education information, awareness of the harmful effects of the drug, personal consciousness raising, and encouraging the user to “look in the mirror”—take an honest look at them self.
Therapeutic challenge
The therapeutic challenge is to teach the client about the effects of the drug(s) of abuse, to make them aware of the dangers associated with continued use, and to help awaken within the client a desire for a different lifestyle. The client will need help identifying the barriers to their recovery, and to help them identify routes (pathways) by which they might enhance their self-esteem. One goal for the therapist working with such clients is to address their ambivalence about change. Working with the clients to give them a chance to be honest about their substance use and behaviors.
Precontemplation – A closer look
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The user is not (yet) willing to make changes.
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Magical thinking period. The drug is all I need.
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The user either denies using or denies responsibility for the consequences of their use.
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This is a relatively safe position for the user.
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They are choosing not to face the full reality and personal responsibilities of their situation. “If I don't think about it, then it's not a problem.”
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The user does not feel guilty because they do not let themselves think about how they might be hurting themselves or others.
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They will try to minimize their drug use to themselves and often compare themselves to others who appear to have a more serious problem. “I'm not as bad as so and so.”
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They will also try to rationalize or intellectualize the problem behaviors associated with their drug use.
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Persons in this stage, will do almost anything to avoid dealing with emotionally painful situations, and will often become very angry and defensive when confronted. Their drug use becomes a way to “not feel” any real emotions other than anger; and angry outbursts become more frequent.
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Other defense mechanism may be: projection, displacement, and internalization. Often when they try to break out of their artificial reality, they feel defeated, or trapped, begin to suffer from physical, or psychological withdrawal and fearfully retreat back into their “safe” drug world. “If I don't try to quit - I can't fail.”
Believing their own lies, causes reality blindness
Precontemplators cannot see the problem. A person in this stage usually has no intention of changing their behavior and typically denies they have a problem. Precontemplators usually show up in treatment programs because of pressure from others.
They may change in response to the pressure, but tend to return to old ways once the pressure is off. They often feel demoralized because they feel their situation is hopeless.
The main task of this stage is increasing awareness. The processes most helpful in this stage are consciousness-raising and creating more alternatives for the individual.
A non-judgmental presence of a friend or helper can assist in providing an opportunity to express doubts and increase understanding. Open-ended questions can help a person look at their behavior.
What's going on with the precontemplator?
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Magical thinking, “It's O.K. to use.”
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Denial and lies, social contacts shrink to other drug users.
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Apparent lack of guilt or remorse, “controlled” thinking and feeling.
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Lack of visible empathy, the user's only concern is getting or using the drug.
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Defense mechanisms active are: rationalization, minimization, projection, and intellectualization.
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The user demonstrates emotional (angry/violent) outbursts to avoid dealing with their situation.
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User may feel trapped and afraid to make changes. They need outside help to start the process.
Help for precontemplators
The methods used to get a person to move out of this first stage are: Provide realistic information about the drug being used, how it is affecting the user, and basic reassurances that the user can successfully stop and return to a normal life. Interventions will rely on non-judgmental observations, gentle confrontations, and re-interpretations of magical thinking.
Helping the user learn to substitute healthy activities for drug related ones are a very important first step to changing their drug environment, and their ability to gradually make better decisions. If an intervener pushes too hard the drug user simply refuses to talk, leaves, creates a scene, or gets angry; and the intervener quite readily backs off - and the drug user is safe again. Being non-judgmental and carefully addressing the users defense mechanisms are crucial at this point. Generally most precontemplators remain trapped at this stage without help from others.
Do treatment programs help the precontemplators?
Treatment programs tend to be geared toward helping the less than 20% of the population that are prepared to make serious changes - not the 80% of the drug using population that are not yet ready to make changes. So, an effective drug treatment program needs to be geared towards helping the 80% of precontemplators realize that it is in their “best interest” to make changes; and to “reassure” them that with help, they can “get better.”
A good way to approach talking to a precontemplator is to get them to talk you about the pros and cons of using the particular drug. Try to get them to focus on the pros (what benefits they get from using the drug). This generally leads to the person talking a lot more about the cons, and the generally negative consequences. In other words, get them to tell you what's good about the drug. If they can't convince you - they will never be able to convince themselves!
Further helping points
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Provide realistic information about drug effects and the possibilities of make changes.
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Be nonjudgmental, and offer gentle confrontations.
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Deal with the user's fear of change (defense mechanisms).
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Help the user to occupy time with healthy activities.
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Let the user tell you why they should quit. If they can't then they're not serious!
Clients who do not want treatment
A client who is resistant to treatment may have any of the following perceptions: They are forced to attend, they do not know what services are available, they do not know how the agency works, they feel unsure themselves about how to solve their problems, their pride interferes with their willingness to ask for or receive help, they expect instant results (they want to feel better NOW), they do not understand that lasting change often takes time, they may feel that they are not respected as a person, they may feel that they are being judged.
Successfully dealing with client resistance and ambivalence is the only way to help the person progress through to the next stage in the model of change.
