A catalyst to addiction recovery is not pain, but, the discovery of hope. A far standing conclusion that has been propagated in society is that an addict has to “hit bottom” to want to get well and stop using drugs. Nothing could be further from the truth as addicts tend to go through what they feel are their lowest points over and over again without being able to break the cycle on their own no matter how much heart they put into trying.
Another mistaken and foregone conclusion is that the addict must be highly motivated and committed to the treatment as a prerequisite to enrollment. Motivation is now viewed from a totally different perspective. According to the Center for Substance Abuse Treatment, “Motivation can be understood not as something that one has but rather as something one does. It involves recognizing a problem, searching for a way to change, and then beginning and sticking with that change strategy.”
As more research, resources, and technology are invested into the epidemic addiction phenomenon across every walk of life regardless of race, creed, and age, treatment theories and practices have changed. There is now irrefutable evidence that drug addiction is a disease and one that is treatable in the manners that other chronic conditions such as asthma or diabetes may be.
Working with the patient in a collaborative partnership to promote positive changes versus the historically, confrontational, all or nothing, and argumentative atmospheres of past treatment practices proves to be more effective for these individuals. The message from SAMHSA is that; “Recovery emerges from hope. The belief that recovery is real provides the essential and motivating message of a better future—that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.”
While ambivalence is often the central problem to seeking treatment, it can manifest into lack of motivations to change. Addicts like the way that drugs make them feel and whether or not they are prepared to deal with any barriers that would prevent them from seeking, obtaining, or using drugs, the alternative is to procrastinate about making any healthy lifestyle changes.
Being amenable to clinical advice by accepting the label of “drug addict” does not deem them motivated and no amount of judgmental feedback will make any significant differences in their ability to move forward. Ambivalence about substance abuse is normal, but, can be resolved by working with the client toward essential changes. Instead of focusing on weaknesses or “character deficiencies”, ambivalence can be overcome by positively focusing on strengths and goals to increase recovery motivations.
The Nature of Motivation
We now know that motivations to change will waver repeatedly throughout the course of any addiction treatment regardless of how well or poorly motivated the person is in the beginning. Initial motivations to stop using drugs and recover from the consequences is fleeting at best without ongoing management for negative connotations of addiction.
Once clarity of mind returns and the real efforts to change must begin, the “gung-ho” attitude that a person feels right after detox is generally short lived and the most crucial time period begins when motivations can waver the most. The Center for Substance Abuse Treatment describes the nature of motivation as multidimensional encompassing:
- Internal urges and desires felt by the client
- External pressures and goals that influence the client
- Perceptions about risks and benefits of behaviors to the self
- Cognitive appraisals of the situation
There are many issues that empower the ambivalence to change and prolong recovery contemplations when they are deeply rooted in the core inner self of a person, but, even the most ambivalent addict has a chance to succeed given the right set of service components with a focus on positivity.
Why Enhancing Motivations in Addiction Treatment is Important
When people are faced with the important decision of whether or not to participate in an addiction treatment program, they almost always find themselves frustrated, confused, intimidated, lacking confidence or inadequately equipped in some way to comply with what they imagine will be the treatment demands. According the Institute of Medicine (US), “Most forms of drug treatment, if implemented according to best clinical practices, are rigorous. These programs impose environmental schedules and controls and require a substantial amount of emotional work and behavioral change on the part of the client.”
Motivations can be undermined or influenced by the counselor’s style and therapeutic alliances, peer support groups, and the motivational treatment approaches provided in an addiction treatment program. Because motivation is of central importance to any recovery from addiction, a higher priority has been placed on enhancing and maintaining client motivations as essential to greater treatment participations, retentions, and positive outcomes.
Benefits of Motivational Enhancement Techniques
When addiction treatment is in line with what is most concerning to the individual and in the best of their self interest, motivational enhancement techniques instill motivation by helping clients become ready, willing, and able to change what needs to be changed in order to successfully recover. Being able involves having the right resources, support, and self efficacy to change and being willing is having the desire to change, but, many are willing and able, yet still not ready, the final step which involves deciding to change.
Keeping the client responsible for their treatment progression, some of the most promising treatment approaches use motivational enhancement techniques such as Motivational Interviewing as a counseling style and Contingency Management as a behavioral intervention to promote positive behaviors and enhance recovery motivations. The benefits of these techniques include:
- Inspiring motivation to change
- Preparing clients to enter treatment
- Engaging and retaining clients in treatment
- Increasing participation and involvement
- Improving treatment outcomes
- Encouraging a rapid return to treatment if symptoms recur