Spirit

Micro Skills

Change Talk Commitment Talk

Behaviour Change

Principles

Autonomy

Collaboration

EvocationExpress Empathy

Develop Discrepancy

Roll with resistance

Support Self-Efficacy Open ended questions

Affirm

Reflection

Summary

Desire

Ability

Reason

Need

Confidence

I will…

The Flow of Motivational Interviewing

Stages of Change Model

Prochaska & DeClemente

Around since 1979

DEFINITIONS: Brief interventions

• Brief interventions are “practices that aim to investigate a potential problem & motivate a client to begin to do something about his/her substance abuse, either by natural, client-directed means or by seeking additional substance abuse treatment

• A brief intervention is not a substitute for individuals Brief interventions are “practices that aim to investigate a potential with addiction/mental health disorder but can be used to engage clients to seek further help.

Status Quo or Change?

• Brief advice (usually less than 5

minutes) given opportunistically by a

health professional during routine

consultations with people who

smoke, whether or not they are

seeking help with stopping

Steps for Intervention

Cooperative

• ASK

• ADVISE

• ASSESS

• ASSIST

• ARRANGE FOFOLLOW

UP

Uncooperative

• RELEVANCE

• RISK

• REWARD

• ROAD BLOCK

• REPETITION

Skills Training before Eliciting Commitment to change

Because of variety of cognitive neurobiological social deficits particularly executive functioning in clients - adapt the traditional models to

• Brief sessions

• Slower question pace

• Pauses for questions

Some argue that client’s serious mental disorders cannot sustain intentional behaviour (following through with commitment) before they have the skills to do so

• Suggestion that skill training with client’s can enhance goal attainment = before any commitment to not using is reached

Bellack & Di Climente (1999)

BRIEF INTERVENTIONHow it works

•The phase-by-phase interventions from "denial" to "abstinence" or harm minimisation begin by assessing the client's readiness to engage & contemplate changeReadiness levels are accepted as starting points for treatment, rather than points of confrontation or criteria for elimination

Brief Intervention-Principles• The objective in the engagement phase - develop

comfortable & trusting relationships

• Information about aetiology & processes of illness in an empathic & educational manner

• The interaction effects between symptoms of mental illness & substance disorders, included in this exploration

• Clients are not required to disclose personal experiences or to admit they use or abuse substances until they are comfortable doing so

Can I get through this?

Feedback is given to the individual about personal risk or impairment

Responsibility for change is placed on the client

Advice to change is given by the provider

Menu of alternative self-help or treatment options is offered to the client

Empathic style is used in counselling

Self-efficacy or optimistic empowerment is engendered in the client

Source: Miller & Sanchez, 1993

A BI Model ‘FRAMES’

The Brief Negotiation Interview4 MAJOR STEPS

1) Raise The Subject

• Establish rapport

• Raise the subject of alcohol/other drug use

2) Provide Feedback• Review client’s drink/drug amounts & patterns

• Make connection between drink/drug & amount of hospital, or doctor’s visit, or trouble with mental health (if applicable)

• Compare client’s level of drink/drug with national norms

The Brief Negotiation Interview4 MAJOR STEPS cont……..

3) Enhance Motivation

• Assess readiness to change

• Develop discrepancy between patient’s drink/drug

& problems or potential problems related to

alcohol/drugs

4) Negotiate & Advise

• Negotiate goal

• Give advice

• Summarise & complete drink/drug agreement

A Brief Intervention…1. Introducing the issue in the context of the client's

health

2. Screening, evaluating, & assessing

3. Providing feedback

4. ‘Change Talk’ Talking about change & setting goals

5.Summarising & reaching closure

Providers may not use all five of these components in every session- reflect the needs of the client.

Must be good reason to eliminate steps in the brief intervention process

Socratic Enquiry: Introducing the Issue

• Would you be willing to talk to me briefly about how alcohol/drug fits into your life? Whatever we talk about will remain confidential."

• Or, "This must be tough for you. Would it be OK with you if we take a few minutes to talk about your drug/drinking?"

• "Would it be OK with you if we discuss some of the difficulties you may have because of your drinking/drug use meetings

• May be we can work together to help you take advantage of getting the balance back in your life through a supportive treatment process?"

Exaggeration Question

• ‘Would you have drunk 6 bottles of whisky (or

50 joints) this week?’

• “Because of your drinking did you stop taking your medication for ten days?”

Sampling Sobriety

• “a 2-week trial when you don't drink alcohol at all would be helpful in determining whether or not drinking makes things worse and if stopping use works for you. What do you think?"

What we can do?• ACKNOWLEDGE-your

problem/do not neglect it

• ASK-for help/do not

worry/panic.talk to family

member/professional

• ALLOW-yourself to develop

alternative activities/hobbies

• If you come across

Sextortion:do not delete any

evidence-chat,mails,image or

recording

• Do not give in to demands

• Talk to family /counselor or

seek help

• Life style changes are

easy to achieve

• Start working on their

sleep, appetite, out

door activities ,

communication (for

decrease indulgence

in pornography) &

relaxing exercise if

usages exceed more

than hour

• School can work

on explaining:

• Relevance of

control use

• Reward associated

with control use

• Repetition of

messages through

lecture/house

discussion/informa

tion material

• What parent can do ?

• Allowing use at

certain time

encourage control use

• Blocking use during

specific times

decrease online

temptation

• It will leads to

increase involvement

in offline activities and

communication with

parent

How to avoid texting neck?• Maintian correct posture-

keep neck in line with

trunk

• Hold smartphone at the

eye level-avoid bending

neck forward for a

prolonged period.

• Take a break

• Work ergonomic-if

necessary change to

comfortable posture while

working

• Avoid prolonged static

posture

• Change the hand:avoid

holding large or heavy

devices in one hand

continuously

• Neck exercise

• Massage:gentle

rubbing can give

relief from

stiffness.

• Change

hands_avoid

holding large or

heavy devices in

one hand

continuously

Ways to out smart smartphone• Limit Notification:use you

phone setting to avoid

these/push off notification

on app

• Detox regularly:limit or

schedule your without

phone

• Turn off autoplay:to avoid

binge watching like you

tube,use your phone

setting to off the automatic

play of next serial

• Set a schedule:Set

aside specific time to

check face book or

message/resist the

urge till the next

scheduled time. try

delete if possible

social media from

phone & use from

computer.

• do not use phone as

an alarm”:it will help

in not keeping mobile

with you.34% user,

sleep with mobile and

complaints of

distraction.

Phone company are also working on smartphone

• User can turn off notification,phone will alert for

lone use of phone.

• App limit:you can add limit how much you will

like to use app

• Do not disturb:turn on the feature before going

to bed until next morning.

• Parnetal control:parent will get notification about

children phone use,can limit use of certain app as

wellas control over unwanted material.

• Screen time available In IOS 12)it will help to

mange your screen time

Use yoga to manage the technology use• Joint loosening with breath synchronization-

10mins

• Moving head forward & backward as well as clock

wise and anticlockwise-10 times each

• Blinking of eyes-20 times

• Stretching of hand/legs and moving the wrist.

• legsclockwise and anticlockwise-10 times each

• Nadi shuddhi pranayama( alternate nostril

breahing-5 times

(Sharma & Bhargava, 2015)

Summary• Clear evidence high incidence of co-existing disorders

• Recent focus on co-existing disorders generated the need for new approaches to engage and treat client’s

• Considering the limitations of mental illnesses i.e. the variety of cognitive neurobiological social deficits -Teaching skills prior to commitment to change considered valuable

• Frames model and Brief motivational methods can elicit client motivation and change in co-existing clients

• Understanding attitudes and empathic approaches of enquiry

• With adequate training, brief intervention can be delivered in both the addiction & mental health care settings

Aalto M.; Pekuri P., Seppä, K. (2001).Primary health care nurses' and physicians' attitudes, knowledge and beliefs regarding brief intervention for heavy drinkers; Addiction, Vol 96, N0. 2, Feb. 2001 , pp. 305-311(7): Carfax Publishing.

Adamson S. J, Todd, F.C., Sellman, J.D, Huriwai, T, Porter, J. (2006). Co-existing psychiatric disorders in a New Zealand Outpatient Alcohol and other drug clinical population Australian and New Zealand Journal of Psychiatry; 40:164-170.

Lock, C. A. Kaner, Lamont, E., Bond, S. A qualitative study of nurses' attitudes and practices regarding brief alcohol intervention in primary health care Research Associate, School of Health Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK

Wells, E., Baxter, J., & Schaaf, D. (2006, November). Substance use disorders in Te Rau Hinengaro:the New Zealand mental health survey : final report. Prepared for ALAC. Auckland: Auckland Uni-services Ltd.

Vellman, Richard & Baker 2008 Moving away from medicalised & partisan terminology: a contribution to the debate, Mental Health and Substance Use: Dual Diagnosis, 1:1 2-9

Sobell, L.C. Toneatto, T. & Sobell, M.B. (1994). Behavioural assessment and treatment planning for alcohol, tobacco, and other drug problems: Current status with an emphasis on clinical applications. Behaviour Therapy, 25, 33-0.

Miller, W.R. & Rollnick, ,S. (2002). Motivational Interviewing: Preparing people for change (2nd Ed.)

New York: Guilford Press.Saunders, B., & Herrington, J. (1995). Exploring options: Motivational counselling and addiction behaviour. Perth: William Montgomery, Pty., Ltd.

Sciacca, K. 1997. Removing barriers: dual diagnosis and motivational interviewing.

Professional Counsellor 12(1): 41-6.

Resources & Bibliography