Module 5: FASD Prevention
Selective Prevention Strategies
The following are the stages of readiness for change and their definitions.5
Precontemplation
The person is not considering change. He or she does not see the need
and may be surprised to find that others think a problem exists.
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Contemplation
The person is ambivalent. Part of the person wants to change and part
does not. The characteristic response of the contemplator is "Yes, but..."
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Preparation
The person feels ready to change. He or she may express feelings such as
"Something's got to change. I can't go on like this." If determination
does not lead to action, the individual may temporarily return to the
precontemplation stage.
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Action
The person has begun doing something about his or her behavior.
This is usually when treatment starts.
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Maintenance
This is the hardest part of change. The challenge is to maintain the
gains and avoid relapse.
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Relapse
More than 90 percent of problem drinkers or drug users will drink or
abuse drugs again after treatment. They need to recover from the relapse
as quickly as possible and reenter the change process. Relapse is not
formally considered a stage. It is included because many individuals
relapse and repeat stages.
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Motivational interviewing is a way to help people recognize their problems and
increase their motivation to change. It is especially useful in resolving
ambivalence. It is a supportive, respectful approach that is persuasive but
not coercive. One useful model for understanding motivation is FRAMES.6
FRAMES stands for six key elements that are effective in assisting persons
with at-risk or problem drinking to change their drinking behavior:
- Feedback: Provide useful feedback based on screening.
- Responsibility: Emphasize personal responsibility and freedom to choose.
- Advice: Give specific advice about how to change drinking patterns.
- Menu: Provide the person with options.
- Empathy: Show an understanding of the person's situation and be supportive.
- Self-efficacy: Convey the message that the person is capable of change.
Motivational interviewing strategies can help people stay focused and avoid
getting sidetracked. It is important to reinforce statements that indicate a
willingness to consider change. Resistance may indicate a different stage of
change than previously thought. The goal is to understand where the person
is and guide the process accordingly. Motivational interviewing has been
shown to be effective with pregnant women and women of childbearing age.2
However, it has not been tested at length with these groups.
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