From Ambivalence to Action: Facilitating Change in Substance-Abusing Teens
Association for Experiential Education International Conference 2009 - Montreal, Canada
Presented by David Flack
Workshop Premises
• Change is a process, not an event.
• Only the changer can do the changing.
• Everyone is motivated by something.
It is common for teens to deny having a problem with alcohol or other drugs, at least initially. With your help, these teens are often able to identify other problems that do motivate them. For example, teens on probation will usually agree they have a legal problem, even if they don’t think they have a drug problem. Start the process of change where your client is at, not where you want them to be.
GRAY MATTERS
Change is hard because brains are lazy
• More accurately, brains are efficient.
• One way that brains stay efficient is by using cognitive scripts.
• A cognitive script is one example of a neuronal network.
What wires together fires together
• Once a sequence of neurons fires together, it will likely be repeated.
• Neuronal networks become strengthened through this repeated use.
• Repeated firings lead to habits of thought and behavior.
Cognitive scripts are habits of thought
• If wired with maladaptive scripts, the person is probably “stuck” some way.
• Substance-abusing teens have 3 basic scripts: Act Up, Shut Down, Use.
• Maladaptive scripts + Reinforcement = Substance abuse problem.
STAGES OF CHANGE
Change is a process with clearly defined stages
• Pre-contemplation – I don’t have a problem.
• Contemplation – Maybe I have a problem, but I’m not sure.
• Preparation – I have a problem and am thinking about what to do.
• Action – I am doing something about my problem.
• Maintenance – My new behavior has become habit.
There’s also the Recycle Stage. During Recycle, the individual repeats some of the earlier stages. Recycling isn’t necessarily failure. It can be an essential part of the change process and an important teachable moment.
GROWTH ZONES
Change only happens when you leave your Comfort Zone
• Comfort Zone – Most people spend most of their time in their Comfort Zone, where risks and challenges are minimal, but so is growth or learning.
• Change Zone – When you leave your Comfort Zone, you enter your Change Zone. This is where learning occurs. Neuroscience tells us that the moderate stress felt in the Change Zone increase retention of this learning.
• Crisis Zone – In the Crisis Zone, stress is too high for effective learning.
RISKING CHANGE
Taking action always involves risks
Breaking the Cycle of Stuckness requires your clients to leave their Comfort Zones and confront the real risks involved in making change. Help your clients prepare to take action by:
• Acknowledging that change is risky – Increased awareness is one of the first step to changing any behavior or belief.
• Exploring good risks vs. bad risks – For most substance-abusing teens, using and related behaviors are part of their Comfort Zone.
• Providing opportunities to practice safe risk-taking – Despite all evidence to the contrary, most substance-abusing teens are risk adverse.
CO-OCCURRING DISORDERS
Recent studies indicate that 80% or more of all substance-abusing teens have one or more diagnosable mental health conditions. In addition, these youth frequently present with histories of trauma, abuse, and/or neglect. If these co-occurring issues aren’t addressed, they are likely to become insurmountable obstacles to the process of change.
A BIT ABOUT AMBIVALENCE
To do or not to do
• Ambivalence – Simultaneously believing two seemingly contradictory ideas.
• Most teens start treatment ambivalent about change, believing “I have a problem” and “I don’t want or need to do anything about my problem.”
• Ambivalence is indicative of the Contemplation Stage of Change. It comes from being stuck in your Comfort Zone.
Ambivalence is not the same as denial. Denial is a defense mechanism that develops to psychically protect someone from their own maladaptive behavior or situations beyond their control. In most cases, substance-abusing teens haven’t been using alcohol or other drugs long enough to develop such a complex defense mechanism.
Ambivalence has two possible outcomes
• Reinforce the Cycle of Stuckness – By trying to ignore the contradiction, the person becomes more stuck. This leads to thinking errors such as blaming, minimizing, and ultimately denial.
• Create dissonance – Dissonance is an uncomfortable feeling caused by simultaneously holding contradictory ideas. This discomfort results in an urgency to change in order to resolve the discomfort.
USING EXPERIENTIAL LEARNING TO GET UNSTUCK
Getting unstuck requires a believing there is a reason to change, believing you have the ability to change, and possessing the desire to change. Experiential learning is an excellent methodology for building all three of these conditions.
Reason to change
Help your clients identify their own reasons for making change by manufacturing dissonance. Some ideas for this:
• Go new places – Hold learning experiences in unfamiliar environments. When not possible, think of ways to make the familiar seem new.
• Present experiences with uncertain outcomes – Don’t be afraid of failure. Activities should be achievable, but outcomes shouldn’t be guaranteed.
• Address contradictions – Challenge thinking errors as they happen, explore pros and cons, and coach clients in problem solving.
Ability to change
Clients are successful when they believe they will succeed. Self-efficacy can be increased in three ways:
• Magnitude – This refers to the level of certainty the individual has for success and is influenced by perceptions of risk and difficulty.
• Strength – This reflects how long a person holds onto expectations of success, even when contradictory information is present.
• Generality – This refers to the degree of a client’s transfer of new learning from one situation to another.
Desire to change
Motivation is a requirement for doing all this hard work. Continue to build motivation on three fronts:
• Autonomy – Autonomy refers to independence and self-determination. When given true autonomy, motivation increases dramatically.
• Mastery – Mastery is the belief that you can be effective. This is, of course, closely related to self-efficacy.
• Purpose – Purpose means commitment to something larger than yourself.
RECOMMENDED READING
The Art of Changing the Brain, by James Zull
This book is an easy to understand introduction to the neuroscience of change. It is packed with practical ideas that’ll change the way you facilitate!
Drive, by Daniel Pink
This book is groundbreaking in the area of motivational enhancement. It has a business focus, but is highly applicable to other fields.
Changing for Good, by James Prochaska, John Norcross & Carlo DiClemente
These authors created the Stages of Change model and this book presents that model stripped of clinical jargon.
Motivational Interviewing, by William Miller & Stephen Rollnick
This book presents an evidence-based approach to overcoming ambivalence. Not the easiest read around, but definitely worth the effort.
