This TIP, Enhancing Motivation for Change in Substance Abuse Treatment, embraces a fundamentally different way to conceptualize motivation. In this approach, motivation is viewed as a dynamic and changeable state rather than a static trait. This TIP shows how clinicians can influence this change process by developing a therapeutic relationship, one that respects and builds on the client's autonomy and, at the same time, makes the treatment counselor a participant in the change process. The TIP also describes different motivational interventions that can be used at all stages of change, from precontemplation and preparation to action and maintenance. The goal of this TIP is to make readers aware of the research, results, and promise of motivational interventions in the hope that they will be used more widely in clinical practice and treatment programs across the United States.

Contents

• What Is a TIP?
• Editorial Advisory Board
• Consensus Panel
• Foreword
• Executive Summary and Recommendations
• Chapter 1-- Conceptualizing Motivation And Change
  • A New Look at Motivation
  • Changing Perspectives on Addiction and Treatment
  • Changes in the Addictions Field
  • A Transtheoretical Model Of the Stages of Change
  • To Whom DoesThis TIP Apply?
  • Summary
• Chapter 2—Motivation and Intervention
  • Elements of Effective Motivational Interventions
  • Motivational Intervention And the Stages of Change
  • Special Applications of Motivational Interventions
  • Brief Interventions
• Chapter 3—Motivational Interviewing as a Counseling Style
  • Ambivalence
  • Five Principles of Motivational Interviewing
  • Five Opening Strategies For Early Sessions
  • Effectiveness of Motivational Interviewing
  • Motivational Interviewing and Managed Care
• Chapter 4—From Precontemplation to Contemplation: Building Readiness
  • Raising the Topic
  • Gentle Strategies To Use With the Precontemplator
  • Assessment and Feedback Process
  • Intervene Through Significant Others
  • Motivational Enhancement and Coerced Clients: Special Considerations
• Chapter 5—From Contemplation to Preparation: Increasing Commitment
  • Changing Extrinsic to Intrinsic Motivation
  • Tipping the Decisional Balance
  • Emphasizing Personal Choice and Responsibility
  • The Importance of Self-Efficacy
• Chapter 6—From Preparation to Action: Getting Started
  • Recognizing Readiness To Move Into Action
  • Negotiating a Plan for Change
  • Initiating the Plan
• Chapter 7—From Action to Maintenance: Stabilizing Change
  • Engaging and Retaining Clients in Treatment
  • Planning for Stabilization
  • Developing and Using Reinforcers
• Chapter 8—Measuring Components of Client Motivation
  • Self-Efficacy
  • Readiness To Change
  • Decisional Balancing
  • Motivation for Using Substances
  • Goals and Values
• Chapter 9—Integrating Motivational Approaches Into Treatment Programs
  • The Treatment Continuum and Stepped Care
  • Applications of Motivational Approaches In Specific Treatment Settings
• Chapter 10—Directions for Future Research
  • Conclusion
• Appendix A -- Bibliography
• Appendix B—Screening and Assessment Instruments
• Appendix C—Ordering Information for Assessment Instruments
• Appendix D—Resource Panel
• Appendix E --Field Reviewers

The opinions expressed herein are the views of the Consensus Panel members and do not reflect the official position of CSAT, SAMHSA, or the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT, SAMHSA, or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized client care and treatment decisions.