Maintenance is the stage in which people consolidate the achievements attained during the action stage. The transition from ‘action’ to ‘maintenance’ is gradual, requiring sustained change for a sufficient period. Maintenance is signified by a young person feeling relatively stable and more confident in continuing to pursue their goals.
The maintenance stage for many clients is a very active period of consolidation. Even where substantial gains have been made and their sense of self efficacy strengthened, the realities of life without substance use as a coping mechanism can be difficult to manage. The therapeutic interventions applied during the action stage continue to apply but the focus shifts to embedding the changes that have been made by clients and in their family and other social systems.
Together with continued application of relapse prevention strategies, young people can benefit from practitioner’s sustained interest in their progress and help to set and purse longer term goals for the future. This can offer reason for optimism and engender further ‘approach’ motivation.
Relapse involves regression from action or maintenance to an earlier stage and is evidenced by a return to previous problematic patterns of behaviour. Relapse is both an outcome and a process that at some stage involves an initial setback or ‘lapse’. A lapse is a brief or limited incident of substance use. This brief return to substance use does not constitute a relapse. Further, lapse does not automatically lead to relapse but is a step in that direction.
In times of vulnerability, clients in the action and maintenance stages might ‘lapse’ or ‘slip’. Depending on the quality of the support available at these times and the decisions made by clients a lapse can evolve into a relapse. Should either lapse of relapse occur, the critical task for practitioners is to engender a belief that change is still possible. This can be achieved through explaining that lapse and relapse are common and not a sign of failure but rather an opportunity for learning and the development. It can be helpful for clients who have previously lapsed or relapsed to consider their own decision in the past to again initiate a process of change. For other less experienced clients, knowing that other people have lapsed and relapsed and gone on to achieve their goals can be comforting and motivating at a time when they are prone to feeling deflated (take care to ensure this does not breach the confidentiality of others).
If the young person is set to continue using substances harm reduction strategies should be investigated and their stage of change assessed. Practitioners can then proceed to match interventions appropriately to the young person’s circumstances.
Intervention guide: Maintenance stage
The primary intentions at this stage are:
- Reinforce helpful beliefs and values- reasons to be hopeful
- Embed new knowledge and skills
- Strengthen connections with helpful relationships and constructive activity
- Help young person set and pursue long term life goals
- 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
Techniques from Cognitive Behaviour Therapy, Dialectical Behaviour Therapy and Acceptance and Commitment Therapy can all be used to help young people maintain change and continue pursuing goals. Skills learned in the action stage for dealing with unhealthy patterns of thoughts, feelings and behaviours can be practiced and reinforced.
During the maintenance stage the Community Reinforcement Approach can be used to:
- Revisit and revise the activity schedule to maintain opportunities for, and reinforcement, of alternative behaviours and substitutes
- Assist the young person to engage with social systems such as education, training, employment, sport and cultural pursuits and that provide intrinsic reinforcement of new behaviours in the form of meaningful activity
- Assist the young person to make new, healthy connections with peers and caring adults
Elements from ACRA
D10. Implement systems of positive reinforcement
D11. Regular evaluation or review
