Pre-contemplators are not intending to change their substance-using behaviour in the foreseeable future. Young people in this stage are not interested in changing and will either be or appear unconcerned about their substance-using behaviour. This can be the case even when the adverse consequences of their substance use are obvious and concerning to others.
Young people’s apparent motivation can be influenced by a range of factors associated with developmental stage and level of vulnerability. Young people may:
- Not care about the consequences of substance use
- Intentionally give the impression that they don’t care about the consequences of substance use to project an image that they are in control even when they clearly are not
- Be uninformed or under-informed about the consequences of their substance use
- Have limited experience and are only beginning to develop the capacity for insight into the link between actions and consequences.
Further, young people with backgrounds of social disadvantage who continue to live at the margins of society often develop a capacity to tolerate adversity. For such young people and those closest to them, problems stemming from substance use can be seen as a natural part of life.
In general, young people who don’t believe that change is possible are also likely to be pre-contemplative. This orientation towards change can be reinforced when a young person is unaware that programs and services exist that cater for their needs and preferences.
The first task is to engage clients in a relationship where communication is open and honest. Approaches that close down communication restrict meaningful engagement and limit the health promoting influence of practitioners.
To open lines of communication with young people, youth AOD practitioners are advised to begin any discussion about a young person’s substance use with questions exploring what they like about it. This puts the attention on what motivates the young person and is a question that pre-contemplators are usually able to answer given that they are either unaware of, or give no weight to, the downside of their substance use. It also demonstrates to the client that the practitioner is interested in understanding their opinion rather than lecturing or judging them; an assumption young people often make as they engage with AOD services.
Once the practitioner’s orientation is clear and the young person feels comfortable to talk, a number of very useful and important details concerning their substance use and lifestyle can be elicited (even if they don’t want to change). This includes which substances are being used, how, where, when and with whom. This information positions practitioners to accurately assess and respond to immediate or ongoing risk and develop insight into the nature of a young person’s attachment to substances used, particularly the function served. In collaboration with clients, practitioners can devise and implement feasible, context sensitive harm reduction strategies and set to work on addressing the issues of most pressing concern.
Practical and useful responses made by practitioners can strengthen engagement and can put a young person in a better position to deal with the determinants of their AOD problems should they find the motivation.
Intervention guide: Pre-contemplation stage
The primary intentions at this stage are:
- Engagement
- Assess function and meaning of AOD use
- Build awareness of reasons for AOD use and impacts
- Risk assessment and harm reduction
- Address determinants of problematic AOD use
- Support activities that complete with problematic substance use
The key change processes are:
- Consciousness raising
- Dramatic relief
- Environmental re-evaluation
The key therapeutic models are:
- Motivational interviewing
- Solutions focussed
- Narrative therapy
Commencing collaborative work with a client provides opportunities to employ Motivational Interviewing or Narrative Therapy for the purpose of:
- Discovering the young person’s passions and interests (that might compete with substance use) while exploring how substance use fits in their life
- Stimulating awareness of the harms of AOD use and the potential benefits of change (consciousness raising)
- Facilitating emotional connection with past harms to self and / or others (dramatic relief)
- Building client insight into the impact of their AOD use on opportunities and current circumstances (environmental re-evaluation)
- Building a stronger therapeutic alliance and confirming the availability of further assistance should it be required
Elements from Motivational Interviewing
A2. Person-centred guiding and active listening
Elements from Narrative Therapy
E2. Hearing the client's story
A Solutions Focused Therapy (SFT) approach can help when young people attend in a crisis and feel overwhelmed by problems, even though their goal is not to make changes to their substance use. It is also useful when the client is reluctant or sceptical about the value of help that could be offered by a professional. Effective use of SFT does not presume that the client is already engaged and committed to a project of change. Because it can yield small practical wins swiftly, this offers immediate relief from distress and helps to promote engagement.
There are times when the solution-focused approach is not appropriate. Bruun & Mitchell (2012) warn that an excessively proactive shift to solutions may risk alienating young people who are not yet ready.
Elements from Solutions Focused Therapy
