This document provides an overview of enhancing motivation to change among substance-using adolescents. It discusses the challenges adolescents face at home that could contribute to drug use. Motivation is presented as fluid rather than a fixed trait. Motivational interviewing is outlined as an effective approach that minimizes resistance by accepting different stages of change. The stages of change are defined as precontemplation, contemplation, preparation, action, maintenance, and relapse. Clinical strategies are suggested for each stage, such as raising doubts in precontemplation and helping resolve ambivalence in contemplation.

1. Enhancing Motivation to Change in
the Substance-Using Adolescent:
…What the Non-Specialist Needs to Know
By Elizabeth Kotkin, MA, LMFT
Clinical Standards Coordinator

2. What Do You Do to
Relax?

7. What If Someone Said NO
• Took away all the ways
you relax.
• Told you that you have
to do something else.
• Told you that you have
to stop doing what you
like to do to relax, but
everyone you know can
continue.

8. • Just think about some of the family dynamics
that ‘our’ kids go ‘home’ to.
o Do their parents use? Where they born
addicted?
o Are they safe?
o Have they witnessed the un-imaginable?
o Are there any mental health or learning
disabilities?
o How early did they start using?

9. So Why Do Adolescents Use
Drugs?
• To try new things
• To be oppositional
• To be accepted
• To get away from
negative emotions or
feelings
• To try to be in
control

10. The Cycle Of Addiction
Tension
Inability
to
control
affective
state
Behavior
Drug &
Alcohol
Use
Return of
Negative
Feelings
Negative
Emotions
Move to coping
mechanism to
reduce tensionTemporary
Relief

11. Definitions
According to Gold and Miller (1994), recent research indicates that drugs
are addictive because they “reinforce drug-taking behavior…addiction
arises because prolonged use of the drug alters the basic neurochemistry of
the brain, leading to physiological and psychological changes…(which) in
turn result in continued and accelerating use of the drug.”
The American Psychiatric Association’s DSM-IV (APA, 1994) now
reflects this updated research-based definition of addictive disorder,
with core concepts including:
(1) Compulsion
(2) Loss of control
(3) Continued use despite negative consequences

12. What Do Adolescents Really
Want?
To be accepted

13. Motivational Interviewing
“Motivation can be understood not as something one has but rather
as something one does. It involves recognizing a problem, searching
for a way to change and then beginning and sticking with that
change strategy” Miller (1995)
o Motivational Interviewing is a way to minimize resistance,
resolve ambivalence and induce change.
o Readiness levels are accepted starting points for treatment rather
than reasons for elimination from treatment services.

14. Motivation: The Old Way

15. o Motivation is key to change and it is constantly in flux
o Motivation is influenced by social interaction, namely
the counselor’s style
o At all stages of change, ambivalence is seen as normal
and not pathological
o Confrontation is a goal, not a therapeutic technique
CONCEPTUALIZING MOTIVATIONAL
INTERVIEWING

16. Client Resistance
Involves feelings-actions-behaviors of an interpersonal nature
where there is a lack of collaboration

17. Stages Of Change
• Precontemplation stage
• Contemplation stage
• Preparation stage
• Action stage
• Maintenance
• Relapse

18. “There is a myth…that more is always better. More education,
more intense treatment, more confrontation will necessarily
produce more change. Nowhere is this less true than with
precontemplators. More intensity will often produce fewer results
with this group. So it is particularly important to use careful
motivational strategies, rather than mount high-intensity
programs…We cannot make precontemplators change, but we
can help motivate them to move to contemplation.” DiClemente,
(1991)

19. Stage 1: Precontemplation
• The client does not consider change. Seeks treatment due to
outside pressures such as family, job, etc., or due to legal
and/or medical concerns

20. Motivational Interviewing Tasks
Building Readiness
• A) Raise doubt about client’s belief that AOD use is
harmless
• B) Increase the client’s perception of risks and problems
with current behaviors

21. Clinical Interventions
• A) Establish rapport and trust and explore what brought
client into treatment
• B) Summarize: link the information together, especially
focusing on the client’s ambivalence. Educate about
possible links to AOD use

22. “Contemplation is often a very paradoxical stage of change…
Ambivalence is the archenemy of commitment and a prime
reason for chronic contemplation. Helping the client to work
through the ambivalence, to anticipate barriers, to decrease the
desirability of the problem behavior and to gain some increased
sense of self-efficacy to cope with this specific problem are all
stage-appropriate strategies.” DiClemente, (1991)

23. Stage 2: Contemplation
o The client is highly ambivalent about change. The client both
considers change and rejects it. The client will seesaw
between reasons for concern and justifications for continued
AOD use

24. Ambivalence
• A state of mind in which a person has coexisting but conflicting
feelings, thoughts, and actions about something
• The “I do but I don’t” dilemma

25. Motivational Interviewing Tasks:
Increasing Commitment
• A) Tip the decisional balance and strengthen self-efficacy
• B) Evoke from the client reasons to change and risks of not
changing

26. Clinical Interventions
• A) Show interest in how AOD use affects all areas of the
client’s life
• B) Reframe resentment: validate the client’s observations, but
offer a new interpretation of the data

27. Stage 3: Preparation
• The client is committed to and planning to make a change in the
near future but is still considering what to do
• Goal: Help client to get ready to make a change
• Elements of Change:…Ready….Willing….Able

28. Strategies For Preparation Stage
• Clarify goals & strategies
• Menu of options
• Offer advice
• Negotiate change plan
• Identify barriers
• Get social support
• Treatment expectations
• Publicize change plans

29. Stage 4: Action
• Client has decided to make a change
• Client has verbalized or demonstrated a firm commitment to change
• Efforts to modify behavior and/or environment are being taken
• Client demonstrates motivation and effort to achieve real change
• Client is involved in, and committed to, the change process
• Client is willing to follow suggested strategies and activities to change

30. Maintenance and Relapse

31. You Can Make A Difference