Motivational Groups for Community Substance Abuse Programs
Motivational Groups for Community Substance Abuse Programs
Karen S. Ingersoll, Christopher C. Wagner, and Sandra Gharib
Mid-Atlantic Addiction Technology Transfer Center
Unifying Science, Education and Services to Transform Lives
Second Printing, 2002
Motivational Groups for Community Substance Abuse Programs
Karen S. Ingersoll, Christopher C. Wagner, and Sandra Gharib*
Virginia Commonwealth University Mid-Atlantic Addiction Technology Transfer Center
and *Richmond Behavioral Health Authority and Henrico Area Mental Health and Retardation Services
Mid-Atlantic Addiction Technology Transfer Center Box 980469
Richmond, VA 23298-0469 (804) 828-9910
fax (804) 828-4377 mid-attc@
Author email addresses: kareningersoll@ ccwagner@vcu.edu
This publication was prepared by the Addiction Technology Transfer Centers (ATTC) under the cooperative agreement from the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse Mental Health Services Administration (SAMHSA). Susanne R. Rohrer, CSAT, served as the Government Project Officer. This volume is in the public domain and may be reproduced or copies without permission from CSAT or the individuals who compiled the information. However, the source materials and authors must be appropriately cited.
The opinions expressed herein are the views of the authors and do not necessarily reflect the official position of CSAT or any other part of the U.S. Department of Health and Human Services (DHHS).
Produced under a grant funded by the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services Center for Substance Abuse Treatment. 5600 Fishers Lane Rockwall II, Suite 621 Rockville, MD 20857 301-443-5052
The contents are solely the responsibility of the authors and do not necessarily represent the official views of the agency. Grant No. 1 UD 1TI13415
8 2000, 2002: Mid-Atlantic ATTC and the authors
Contents
Acknowledgments .......................................................................................................................................................i
Preface ....................................................................................................................................................................... ii
Overview of the Guide ..............................................................................................................................................iv
Part 1: Background and Theory..................................................................................................................................1 Motivation .....................................................................................................................................................1 Motivational Elements of Models of Treatment and Recovery.....................................................................2 The Transtheoretical Model of Change .........................................................................................................6 Assumptions behind Motivational Approaches...........................................................................................12 Making a Choice to Use A Motivational Approach ....................................................................................20
Part 2: Practicing Motivational Counseling .............................................................................................................25 Motivational Principles ...............................................................................................................................25 Motivational Skills and Techniques ............................................................................................................26 FRAMES Skills and Techniques.................................................................................................................32 Techniques that Reduce Resistance.............................................................................................................40 Strategies .....................................................................................................................................................44 Conceptualizing the Phases of Motivational Interventions .........................................................................44 Learning Motivational Counseling..............................................................................................................45 Motivational Services in Community Agencies..........................................................................................46
Part 3: Groups...........................................................................................................................................................51 The Group Therapy Modality......................................................................................................................51 Psycho-educational Groups .........................................................................................................................51 Psychotherapeutic Groups ...........................................................................................................................52 Motivational Groups....................................................................................................................................52 Integrating Group and Individual Treatment...............................................................................................53 Suggested Formats for Motivational Groups ..............................................................................................54 Designing a Motivational Group .................................................................................................................55 Providing Structure for the Group...............................................................................................................56
Model 1: Core Motivational Group.............................................................................................................60 Topic 1: Introduction to Group and Exploration of Lifestyles......................................................62 Topic 2: The Stages of Change .....................................................................................................66 Topic 3: Raising Awareness: The Good Things and Not-So-Good Things ..................................69 Topic 4: Looking Forward ............................................................................................................72 Topic 5: Decisional Balance: Pros and Cons of Changing and Staying the Same ........................75 Topic 6: Exploring Values ............................................................................................................77 Topic 7: Supporting Self-Efficacy: Change Success Stories.........................................................79 Topic 8: Supporting Self-Efficacy: Exploring Strengths ..............................................................81 Topic 9: Planning for Change .......................................................................................................83 Topic 10: Exploring Importance, Confidence, and Desire for Change ..........................................87
Model 2: Single Session Motivational Group .............................................................................................91
Part 4: Implementing Motivational Services ............................................................................................................95 Technology Transfer Principles ..................................................................................................................95 Comments on Implementation ....................................................................................................................97 Assessing Agency Readiness ......................................................................................................................99 Increasing Agency Readiness......................................................................................................................99 Working with Polarized Staff....................................................................................................................100 A Sample Model of Integrated Services....................................................................................................100 Adding Motivational Services to your Continuum of Care: Some Lessons from the Substance Abuse Treatment Field ................................................................................................102 Special Populations ...................................................................................................................................105 Motivational Issues of Selected Special Populations ................................................................................107 Summary ...................................................................................................................................................109
Part 5: References and Resources...........................................................................................................................111 References ................................................................................................................................................111
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