‘Action’ is the stage in which people apply themselves to the task of changing a behaviour and make observable modifications to their lifestyle. Action requires considerable commitment and an investment of energy into change processes. It involves implementing viable strategies to achieve goals set in the preparation stage.
Clients in the action stage are pursuing the goals set when they were preparing for change. It is the most intensive stage in terms of the application of psychosocial interventions targeting behaviour change. A client will probably need to take time out from their previous lifestyle in order to have sufficient time to actively participate in therapeutic activities. To make significant changes to entrenched patterns of behaviour, therapeutic interventions will ideally target individual/psychological and environmental factors simultaneously. The Community Reinforcement Approach and Family Focused Interventions target environmental factors, while Cognitive Behaviour Therapy and Dialectical Behaviour Therapy primarily work on individual psychological factors.
Family focused work can include:
- Engaging parents/caregivers as supporters of the young person in their change process
- Building the skills of parents/caregivers to provide support to the young person
- Modifying transactional processes within the family system to promote developmentally conducive family dynamics
It is common for young people, particularly those in the early and middle adolescent stages, to move into action with little preparation and with unrealistic expectations of what it takes to make lasting changes. Practitioners can position themselves to provide timely guidance and enable young people to learn from experience. This can promote better problem solving and more realistic goal setting. A client therefore might decide to reorient their goals or make them clearer and more immediate. Practitioners are encouraged to celebrate with clients as they achieve desired outcomes but must remember that change can also have a downside. Practitioners are advised to regularly offer a young person in the process of changing the opportunity to discuss the challenging aspects of change, which can involve working through grief reactions. It is also worth remembering that change may not involve giving up all substance use, so attention still needs to be given to harm reduction strategies.
Intervention guide: Action stage
The primary intentions at this stage are:
- Enact treatment plan and continue goal setting and review
- Life skill development
- Build and reinforce helpful beliefs and values
- Support helpful relationships and reinforce positive participation
- Recognise and celebrate achievement but offer the option of discussing the downside of change
- Relapse prevention
The key change processes are:
- Reinforcement management
- Counter conditioning
- Stimulus control
- Helping relationships
The key therapeutic models are:
- Community Reinforcement Approach
- Cognitive Behaviour Therapy
- Dialectical Behaviour Therapy
- Acceptance and Commitment Therapy
The Community Reinforcement Approach can be used to:
- Establish an activity schedule to reduce exposure to the antecedents of problematic AOD use and increase exposure to the antecedents of alternative prosocial behaviours
- Establish a schedule to reinforce pro-social behaviours that compete with AOD use and other problem behaviours
- Assist the young person to engage with significant persons in their family or community who can provide encouragement and reinforcement for desirable alternative behaviours
Elements from ACRA
D7. Activity scheduling and creating opportunities for achievement
D9. Recruit support poeple from the young person's life who can provide reinforcement
A wide range of Cognitive Behaviour Therapy techniques can be employed to enable a young person to enact change. Consequently numerous CBT elements could have application depending on the young person’s goals and capacity to achieve them. CBT is most useful when unhealthy patterns of thoughts, feelings and behaviours, or a lack of certain skills are interfering with a young person’s progress. For example CBT could be used to:
- Develop skills in assertiveness, coping, problem-solving, communication or anger / aggression control
- Reduce depression or anxiety that may have contributed to and exacerbated problematic AOD use
- Teach skills in relapse prevention (coping with cravings, etc)
Similar to CBT, multiple elements of Acceptance and Commitment Therapy can be used to help young people deal more effectively with the experience of painful emotions that can make moving on and changing difficult. More specifically, techniques from Dialectical Behaviour Therapy can be used to:
- Develop skills in mindfulness, distress tolerance and emotion regulation that help the young person to both tolerate and moderate strong emotions without needing to turn to substance use for answers
Elements from DBT
