Stages of Change
Fourcast programs were developed using a Stages of Change paradigm designed to understand behavioural change. Our programs can assist any person whether they are identified as being ready for change or not.
Our approach is grounded in the understanding that change happens in stages. Each stage represents a valid and meaningful point for someone to enter treatment. Service users are supported based on where they are in the process.
People with addictions may have more difficulty in making behavioural changes related to substance use or problem gambling. Reasons for this include physical tolerance, behavioural patterns that are well ingrained, and/or personal and environmental cues and triggers.
The Stages of Change paradigm asserts that all persons will travel through the five stages in similar ways.
- Precontemplation – People in this stage do not intend to make changes at this time and are not contemplating altering their behaviour. It is thought they may be aware that they need to change, but they are not prepared to “pay the price”.
- Contemplation – People in this stage think that they may have a problem, but do not know what they want to do about it, or whether they want to do anything about it. They may say they will quit “sooner” or “later”. The contemplator expresses ambivalence about change in that they identify both the pros and cons of change.
- Preparation – People in this stage have begun to make some changes, or have set a target date for change and have a strategy or potential strategy in mind.
- Action – The action stage sees a person actively doing something to help themselves change a habit or behaviour.
- Maintenance – In this stage, change has been achieved and now must be maintained long term.
- Relapse – In the relapse stage, a person slips into old behaviours and ceases to practice their changed behaviours.
Motivational Interviewing
Motivational Interviewing (MI) is especially effective in substance use work because it meets service users exactly where they are in their readiness for change. MI helps reduce resistance, strengthen intrinsic motivation, and support service users in exploring their ambivalence without pressure or judgment. Through empathy, reflective listening, and collaborative goal-setting, MI empowers service users to identify their own reasons for change, build confidence in their ability to succeed, and take small, achievable steps toward their recovery goals.
Motivational Interviewing offers a variety of counselling strategies that the counsellor can use. It can be used to counsel people in different stages of change and is believed to be:
- Service user-centered
- Non-directive
- Empathetic
- Respectful of both the service user’s strengths and their own knowledge about what is best for them
- Not interested in labels such as “addict” or “alcoholic”
- Not interested in confrontation as a style of interviewing
- Mindful of the service user’s choice and preference
Harm Reduction
At Fourcast, we adhere to accepted moderation guidelines for responsible use of alcohol and gambling. Harm reduction strategies are implemented whenever and wherever possible.
For some clients, a harm reduction treatment plan that includes the moderate use of substances or occasional gambling may be appropriate. This is determined by many factors including:
- Age
- Medical status
- Cognitive competence
- Psychiatric status
- Legal status
- Service user preference re: moderation or abstinence
- Previous treatment experiences
- Level of dependence
During the assessment phase, information is gathered about the nature, extent and severity of substance use or problem gambling. In treatment planning, this information is compiled with information about other life areas, adverse consequences of substance use and gambling, and personal and social consequences. A treatment plan is developed with the service user and their preferences are explored and compared with the best clinical advice and practice.
Our harm reduction strategy embraces the following principles:
- A service user whose preference is abstinence is always supported in this goal and would never be encouraged to use substances in any circumstance. People who do not use substances are not encouraged to start.
- A service user who chooses to continue using one substance and abstain from other substances will be supported by Fourcast.
- A service user who experiments with moderation and decides on abstinence as a more appropriate goal is always supported in this revision of their treatment goals.
- Service users who continue to use substances but are working toward abstinence or moderation goals will also be supported.
- Service users who encounter significant risk while adopting moderation goals will be encouraged to revise their treatment goals.
- Service users are instructed to never use substances if driving or operating machinery.
At Fourcast, we do not believe in directing the service user against their will or preferences. Instead, we work with the service user in making the decisions that are best for them. Sometimes a medical or psychiatric condition makes moderate substance use very risky, and recommendations and education are provided to the service user. The service user makes the final decision about their treatment plan.
Sometimes moderation is not appropriate because of limited cognitive functioning. Moderation strategies often involve goal setting exercises, homework assignments and self-monitoring.