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Substance use: Interventions and stage of change



Table 6.1 Matching interventions to the stage of change


stage of change

indicator of the stage

appropriate intervention for the stage

sample questions

Pre- contemplation

May be defensive or uninterested in change


May feel hopeless about change

Develop trusting relationship


Raise doubt


Increase percep- tion of risk

"How do you feel about your use of …?"


"What does using

… do for you?"




Aware of pros and cons but has not acted

Acknowledge am- bivalence and try to tip the balance


Evoke reasons for change


Strengthen self- efficacy

"What are some

of the good things about using …?"


"What are some

of the not-so-good things about

using …?"


Committed to change


Starting to make plans

Help plan: identify strengths, barri- ers, vulnerabilities


Provide informa- tion and treat- ment choices

"What was difficult last time you tried quitting?"


"What are other changes you've successfully made?"


Implementing plans and making genuine efforts to change

Help patient take steps toward change


Focus on the positive


Help plan for high-risk situations

"How do you feel about the changes you've made so far?"


"What would you do in a triggering situation?"

Maintenance Has had a period of time not using and is trying not to relapse Help patient iden- tify strategies to prevent relapse

"What are changes you've made in your life to help

you continue not using?"

Relapse Stopped for a pe- riod of time, but is now using the substance again

Help minimize degree and dura- tion of relapse


Assist patient in identifying rea- sons for relapse

"What was hap- pening in your life when you started using again?"