So a Youth Enters the Door - Now What?

Approaches at Victoria Youth Clinic

Maia Love

Reprinted from "First Responders" issue of Visions Journal, 2006, 3 (2), pp. 29, 36

Teenaged youth who use drugs are more at risk for unprotected sex, violence between people, injuries, overdose and death.1 Intervention methods to aid youth in recovering from addiction are thus in demand.

Many youth in Victoria live on the street and use drugs as part of their daily lifestyle. Their access to health care is poor, because their age disqualifies them from several services. For example, there are only five youth detox beds to service all of Vancouver Island, and beds for youth over 19 are not available to stimulant users. This is a concern, since stimulants are the most common kind of drug requiring detoxification for youth.

Several services do exist, however; I volunteered with a drop-in service over the last year as part of a project for the Cool Aid Community Health Centre. I observed doctors at the Victoria Youth Clinic and was struck by their approach once the youth makes first contact. They combine the Five Stages of Change model and motivational interviewing to build understanding between the care provider and patient, and to assess and treat a patient at the same time. When applying some of these skills as a medical student, I was again impressed by the clarity and trust with which young patients and I could talk about the addiction issues in their lives.

Five Stages of Change model

Prochaska and DiClemente found that people who recover from addiction move through five stages of change.2 These five stages of change are:

  • Precontemplation: a person denies having an addiction problem

  • Contemplation: a person considers that he or she may have an addiction problem

  • Preparation: the person starts to cut down on addictive behaviour

  • Action: the person actively abstains from the addictive substance

  • Maintenance: a state of abstinence is actively maintained

The Five Stages of Change model is a powerful tool, because once a stage of change is recognized, certain methods can be used to help a person change. These methods are specific for each different stage. For example, educating a client about the risks of his or her addiction using statistics and scientific facts is useful in beginning stages, but is counterproductive in later stages, where action rather than information gathering is needed.

Motivational interviewing

Motivational interviewing is a technique developed by Rollnick and Miller, and is based on the stages of change.3 The technique of motivational interviewing has two important aspects: the use of empathy, and a focus on client strengths, rather than weaknesses. The term empathy means that one person can understand another person’s feelings or problems. To promote empathy, a counsellor tries to understand an addiction from the client’s point of view. Together, the client and counsellor look at the needs that are met by the addiction, and the conflicts that are created by the addiction. The counsellor then invites the client to use his or her personal values to decide how to resolve these conflicts. A client is asked:

  • How much does he or she want to change?

  • How much does he or she believe in a personal ability to change?

  • What strengths does he or she inherently possess that can support the process of change?

By talking with the client about their strengths, the counsellor reinforces that client’s confidence in his or her ability to change. Personal strengths are often overlooked in older approaches to addictions counselling.

Evidence-based support for motivational intervention

Combining motivational interviewing and the Five Stages of Change model can be referred to as “motivational intervention.” Motivational intervention has been proven to help teenage youth reduce substance use in several research studies:

  • Youth reduced their ongoing use of alcohol, cannabis and cigarettes.4Greater decreases were seen in heavier users, high-risk youth and those with less motivation to change.4,5

  • Youth with risky drinking behaviour became more open to reducing their drinking, and moved more quickly through the action stage.6

  • Five studies finding that youth reduced substance use in response to the intervention also shared two aspects: they used one-on-one sessions and feedback to determine how the youth’s substance use compared to the norm. The feedback consists of comparing the addictive behaviour of the client to age-relevant statistics and to normal use of the substance.7

Also, 29 studies on motivational intervention were looked at carefully. In 73% of the studies, people were found to have made dramatic, positive changes in their health. The studies that involved youth with substance abuse problems were included in this 73%.8

Motivational intervention is gaining a large body of supportive research, especially when used for brief interventions with teenaged youth. It is exciting to see these techniques being used in the clinical setting, because they support the independence that needs to develop in adolescence.

 
About the author
Maia is a medical student in the Island Medical Program in Victoria. She worked with Victoria’s Cool Aid Community Health Centre as part of the Doctor, Patient and Society course at UBC, and has also volunteered in the Downtown Eastside in Vancouver
Acknowledgements:

For their help and support in editing this article, many thanks to Dr. Mary Kay Nixon, course director of the Island Medical Program’s Doctor, Patient and Society course from which this article stems, and to Dr. John Anderson, a tutor at the Island Medical Program. Also, thank you to Dr. Chris Fraser, the community supervisor for the Doctor, Patient and Society project, and to the doctors at the Youth Clinic for their guidance.

 

Footnotes:
  1. Burke, P.J., O’Sullivan, J. & Vaughan, B.L. (2005). Adolescent substance use: Brief interventions by emergency care providers. Pediatric Emergency Care, 21(11), 770-776.

  2. Prochaska, J.O. & DiClimente, C.C. (1986). Toward a comprehensive model of change. In W.R. Miller & N. Heather (Eds.). Addictive Behaviors: Processes of Change (pp. 3-27). New York: Plenum.

  3. Miller, W.R. & Rollnick, S. (1991). Motivational interviewing. New York: Guilford Press.

  4. McCambridge, J. & Strang, J. (2004). The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: Results from a multi-site cluster randomized trial. Addiction, 99(1), 39-52.

  5. Tevyaw, T.O. & Monti, P.M. (2004). Motivational enhancement and other brief interventions for adolescent substance use: Foundations, applications and evaluations. Addiction, 99(Suppl. 2), 63-75.

  6. Leontieva, L., Horn, K., Hague, A. et al. (2005). Readiness to change problematic drinking assessed in the emergency department as a predictor of change. Journal of Critical Care, 20(3), 251-256.

  7. Grenard, J.L., Ames, S.L., Pentz, M.A. et al. (2006). Motivational interviewing with adolescents and young adults for drug-related problems. International Journal of Adolescent Medicine and Health, 18(1), 53-67.

  8. Dunn, C., Deroo, L. & Rivara, F.P. (2001). The use of brief interventions adapted from motivational interviewing across behavioral domains: A systematic review. Addiction, 96, 1725-42.

 

 

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