Chapter 8 in Tip 35 recognizes; “motivation as multidimensional, not a single domain that can be easily measured with one instrument or scale. Clients are often at different points of readiness with regard to different substances. A person may be in the action stage for cocaine, the contemplation stage for alcohol, and the pre-contemplation stage for marijuana and tobacco.” TIP 35 presents five methods for conceptualizing and measuring dimensions of client motivation.
Readiness to change
Motivations for using substances
Goals and values
Understanding clients in terms of motivation level(s) helps clinicians apply motivational principles and appropriate strategies for different stages of change concerning one or more problem behaviors.
Recovering individuals in may experience very differing levels of confidence regarding ability (selfefficacy) to change and abstain from substances. Tools available in TIP 35 offer guidance in assessing client self-efficacy. By using these tools, clients gain insight to individual risk factors and situations in which they have low self-efficacy. This information can be useful in setting realistic goals, developing individualized change plans, and providing a sound base to self-monitoring processes.
Readiness to Change
Readiness to change is a strong indicator of a positive response to treatment. Motivational states however, are not binary-with clients being either motivated or not motivated. Rather, readiness exists on a continuum of levels that can vary rapidly, sometimes from day to day. Depending on the level of readiness- or change stage, different motivational intervention strategies will be more or less effective.
Decisional Balancing investigates positive and negative aspects of a particular behavior. The benefit(s) of continuation are weighed against the cost(s), allowing clients to appraise the impact of behavior and to make more informed choices regarding changing it. Such a purposeful comparison of costs and benefits appears to facilitate the recognition and resolution of associated problems.
Motivation for Using Substances
Research suggests expectancies play an important role in the progression from use to abuse. Knowledge of client expectations regarding the effects of substances may help clinicians understand the rationale for their substance-using behavior. Clients who expect good things from substance use in most situations, are likely, to continue using at the same level until there is a change in perspective.
Goals and Values
Clients must value a treatment goal to progress toward it. In fact, unless clients value them, they are not goals from the clients’ perspective. From a motivational standpoint, you should understand clients’ goals and what they value in life. It is usually best to start where your clients are-with what is important from their perspective (Tip 35 Consensus Panel, United States Department of Health and Human Services Substance Abuse and Mental Health Services Agency, 1999).
Submitted by Eric Moss SAS II