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Approach to Treatment

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 follows the assertion that there are five stages of change. Each stage is considered a legitimate place in the decision making process for any person to begin treatment.

Persons 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

Fourcast counsellors are trained in Motivational Interviewing techniques. We believe that each individual is equipped to manage their concerns. Our goal is to support our clients by empowering them to make their own choices in an open, non-judgmental atmosphere. Our focus is on positive change and we have adopted a style of interaction with clients that embraces this principle.

This method is proven to reduce resistance and foster engagement between the counsellor and client. Confrontation is the goal, but is not the style of interaction. Research indicates that confrontation in counselling will increase resistance in the client.

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:

  • Client-centred
  • Non-directive
  • Empathetic
  • Respectful of both the client’s strengths and the client’s 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 client 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
  • Client 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, personal and social consequences, and test scores indicating the level of dependence. A treatment plan is developed with the client and their preferences are explored and compared with the best clinical advice and practice.

Our harm reduction strategy embraces the following principals:

  • A client 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 client who chooses to continue using one substance and abstain from other substances will be supported by Fourcast.
  • A client who experiments with moderation and decides on abstinence as a more appropriate goal is always supported in this revision of their treatment goals.
  • Clients who continue to use substances, but are working toward abstinence or moderation goals will also be supported. A contract is terminated if the client is not making any efforts at reduction of use or use continues to escalate.
  • Clients who encounter significant risk while adopting moderation goals will be encouraged to revise their treatment goals.
  • Clients are instructed to never use substances if driving or operating machinery.

At Fourcast, we do not believe in directing the client against their will or preferences. Instead, we work with the client in making the decisions that are best for them. Sometimes a medical or psychiatric condition makes moderate substance use very risky and advice is given to the client about why this might not be a good choice, however, the client is able to make the final decision.

Sometimes moderation is not appropriate because of limited cognitive functioning. Moderation strategies often involve goal setting exercises, homework assignments and self-monitoring.

If a client has a legal status that includes an abstinence clause, then moderation is not appropriate, until after the legal status has changed (i.e. probation is complete).