Using Motivational Intervention in Addiction Treatment
This week’s presentation is on motivational interventions in substance use disorder treatment. Thank you to our presenting partner Vaughn Gilmore with the Menninger Clinic.
There’s a lot here to cover and we’re certainly not going to cover everything but but sort of to start out with really an idea of why are we talking about motivation, particularly in a substance use disorder population? We know that motivation is really how people change, and we know that motivation can be changed or can change over time. We can target motivation with really brief interventions. So depending on the setting you’re in, this can be done sort of briefly. It’s an evidence based sort of way to work with people. It focuses on the relationship, which is incredibly important when we’re talking about engagement with a client. We’re able to use motivation to access existing strengths, and there’s really an emphasis on self determination, which is really important. So to start off with, I wanted to just kind of do a little check in with people.
So, of course, if we’re talking about change, we’re going to talk about the trans theoretical model, which really this is the stages of change that focuses on decision making and intentional change. We know that people do not change their behaviors quickly and then it really sort of is a continuous and often cyclical process. We know that sort of there are behavioral theories that actually can be applied to those different stages of change. And that’s really what we’re going to talk a little bit about today is how do we assess for stage of change and then how do we intervene based on that assessment? And we just have tons and tons of research showing that the stages of change is really helped people move to healthy behaviors. For a lot of different things. I’m going to guess that most everybody is familiar with the stages of change model that really an individual starts at pre contemplation where they’re not really thinking about making any types of changes, they’re not concerned moves to contemplation where they’re thinking, you know, maybe this is not working, but I don’t know what I would do about it to preparation where they’re really thinking about making a change in the next six months to action where they’re actively making changes.
Now this, this model has relapse as a stage. I know not everybody agrees with that. So when people think about relapse as a like an event that can occur but does not have to occur, there also is sort of some people to think about a decision that might happen between contemplation and preparation. But the idea here with the stages of change is that really we can enter an exit. We may sort of move through these differently. We may be back and forth between them before we really finally commit to change, but that ultimately people go through multiple processes before they truly are able to maintain behavioral change. All right. Perfect, so I am going to share another poll with you guys, I want you to think about your clients when they first come in to your treatment setting or come in to start working with you. And what stage do you think they usually are in at the very beginning of treatment? And this may vary depending on people’s settings as well. So we got a lot of contemplation. A little bit of preparation. Some pre contemplation. So while people are answering this, I’ll tell you a little bit about what we see in our setting. We’re a psychiatric co-occurring disorder inpatient hospital. And so most of our our clients that are coming in are in pre contemplation to contemplation in terms of their substance use. Now, one of the things we know about stages of change is people can be in multiple stages to four different behaviors or different substances, so they may be coming into treatment, preparation or action.
Like I would really like to stop feeling depressed. I’d like to stop feeling bad, but but truly in pre contemplation about their substance use that might be contributing or exacerbating those psychiatric symptoms so people can be in multiple stages and actually with different substances as well. Ok, so it looks like definitely contemplation is the winner here, and that really lines up with a lot of what we see with our clients and actually in a lot of our research as well. So based on this, really one of the things we want to do at the beginning of treatment is assess readiness for change. You know, clients need motivational support that’s appropriate to their stage of change, so we have to figure out where they are. We actually know that inappropriate interventions could cause more treatment resistance. So if we’re not responding the right way, actually, that can sort of hurt the outcomes. And we really, as clinicians need to accept where they are and don’t get too far ahead. So if we are talking about relapse prevention and like going to meetings and getting a sponsor and they’re still in pre contemplation, we’ve really missed the appropriate intervention. And so we want to apply the correct counseling strategy for each stage of readiness. I’ll give you a little example here, right, so new client comes in and our counselor here is like, tell me about your alcohol use and why you want to stop drinking.
Right? You’ve come to meet with me. You’ve come to treatment, you’re doing an intake or an assessment, you know, and our client over here is thinking like, I’m not even sure I should be here. You know, I don’t even know if my drinking is a problem. So we really even at assessment, even at intake, want to think about how we’re wording questions and how we’re asking. We might ask, like, tell me what brings you in today and what changes you’re interested in making. But we really don’t want to jump to the conclusion that somebody is ready to stop just because they came to meet with us. They’re they’re likely still fairly ambivalent, as we saw in that the people’s clients are really in contemplation when they first come in. Just another example, if you do group like we do here, we have our really well-meaning counselor and group like today we’ll be focusing on relapse prevention strategies. This is something we love to do in group. We love to teach people about how to make sure they don’t relapse. The that’s not a bad thing, but the problem is our client here is like, I’m not an addict. I can cut back on my own. He’s sitting there in the group thinking he’s not even ready to make a change, right? He’s not even thinking about how to prevent a relapse because he’s not even sure he wants to stop.
Versus maybe a client that should be in this group stopping on my own has not worked. I really hope this helps, right? She’s there. She’s in preparation and action. She has been trying to figure out how to make a change, but has not been able to do it. So she’s really the appropriate client for this type of intervention. So how do we assess readiness to change? You can do it just through your clinical interview. There are some standard assessment measures out there. One that I’ll just mention is called the Eureka. This is the change assessment scale that can be used in clinical settings really to measure stage of change. This is a free available scale, with scoring instructions available to help identify what stage of change somebody is in pre contemplation, contemplation, action or maintenance. And this can be used throughout treatment or at admission or at intake to determine somebody’s motivation to change and can help guide treatment approaches, especially if you’re looking to standardize things. And then I again, I hope, but but don’t want to assume that everybody is somewhat familiar with the readiness ruler. This is just a sort of through interview way to assess readiness to change, and this can be done two ways. A readiness ruler can be used with the concrete printout. I’ve seen it and lots of different ways it ought to be done verbally. And so what this looks like is just asking the client, how important is this change to you right now? You know how important? How motivated are you to make this change? And we’re going to ask them on a scale of zero to 10 and based on their answer, our response, our response will be based on their answer.
So if somebody is at a five, oh wow, you’re out of five, so it is somewhat important to you to make this change. Tell me about that. Why a five or we could even say, Wow, OK, so it is a five, why not a one or two? You are thinking about that. This might be somewhat important. We don’t want to ask the opposite, right? Because we want to be asking change talk. We don’t want to ask the opposite of like, well, why isn’t it a 10? Because at all that’s going to do is get somebody to talk about the reasons they don’t want to change. And then similarly, we can use a confidence question how confident are you about making this change on a scale of zero to 10? And then what do we need to do? Ok. You’re at a five. You’re somewhat confident. What do we need to do to get you to an eight or nine so that you are feeling more confident? If you think back to our group example and the female client in the group sort of saying like, I want to stop, but I haven’t been able, so we may be targeting confidence, not only importance with that client.
Here are Menninger, we also do some research outcomes, and we use a different skill called the Socrates. And so I want to just tell you guys a little bit about that skill because I’m going to share some slides and data that we have gathered from that. And so this sort of assessment of readiness looks at three categories recognition basically like how much does somebody recognize the problems that their substance use and addiction has caused ambivalence. Like really, how how certain are they that they want to make a change and then taking steps? What are they already doing to sort of move towards positive change? And right here, what you can see is this is some admission data that we have collected for about three hundred patients coming in for our adult inpatient programs in the blue. You’ll see just the range of scores. So that’s not the data itself. That’s just the range that we’ve got sort of low, medium and high in terms of where somebody might be. And here in kind of that yellow or orange color, you can actually see where clients scored when they came into treatment. You know, I’ll talk about taking steps first there in that sort of low, medium range on the taking steps, meaning, OK, I am taking the step of coming to treatment, right? So there’s some action action in their behavior versus recognition.
Recognition is in the low range here for like acknowledging and noticing the problems their substance use has caused. And then same with ambivalence. It’s really in the low range. Here, this is actually just to show you a trend line for for each of the different things, the taking steps, the readiness and the ambivalence. So here you can see the taking steps score over time. And this is from admission to discharge for sort of a cohort of patients that have come through that we’ve administered this measure to. And what we can see is although it’s gradual, there is significant improvement in terms of taking steps during the course of treatment. Same thing with recognition from admission to discharge, that recognition does go through the course of treatment for the group as a whole. And maybe most interestingly, is ambivalence and how ambivalence just really fluctuates over time in the course of treatment. And again, this is grouping all of the patients together. We really I think this tells the story that that people are going to be ambivalent about changing their substance use throughout treatment, and that’s not necessarily a bad thing. So what are the clinical implications of all of this information? First, that we really want to assess stage of change over the course of treatment, so we want to think about it at admission and then we want to sort of notice those changes throughout treatment and assess it in an ongoing way. Thinking about as somebody moves into pre contemplation, as somebody moves into preparation and action, are we identifying barriers to recovery and engagement that clinically we are intervening to develop and reinforce that motivation for change, that we’re working with clients towards self-identified goals and that we might reevaluate those goals and change plan as needed? You know, I think one of the most exciting things for me to see as a clinician is when somebody comes in and pre contemplation and they really leave treatment in preparation, like what a when they had no intention of making any changes.
And over the course of treatment, we were able to develop some discrepancy, do some values clarification and really get them to a place where they were saying on their own, I do need to change my substance use. I would like to abstain now and then we’re going to change our plan and our interventions based on that. And then we also want to make sure we’re helping the client with an accurate understanding of the problems and risks with their substance use, even if they’re not ready to stop completely. How are we reducing sort of hazardous use? How are we planning for safety really through harm reduction if they are going to remain in that pre contemplation stage? Ok, so we’ve got another. Another little quiz here to see if people are paying attention and actually at their computers. So really, what is resistance? Is this sort of just difficult clients are resistant is this they’re just being independent? Is this really on us a mismatch or really an indicator of poor prognosis? So we’ll let everybody take a minute to vote on this answer.
I was going to pop in just really quick because I’m getting a ton of response in the chat that people are having some issues with the some of the poll, just a few people are grabbing issues. That’s OK. We know you’re trying. Don’t stress it. You don’t need to let us know I’m working. So you’re welcome to drop it in the chat if you want to. But if you’re having issues, that’s OK. Sometimes we have technical difficulties. Yeah, if the poll is not working, you know you can try. There are two different ways to participate the website or the text message. If it’s not working totally fine, just follow along with us. It’s all anonymous, the polls. And so there’s no like nobody’s keeping track. If you if you did it or not, it’s more for us to just sort of track or learning together. Ok, perfect. So there is a correct answer on this one. The correct answer is that resistance is really a mismatch between the client stage of change and the therapist strategies. So we’re not we’re not talking about are they in pre contemplation or not? We’re talking about when they’re really resistant, then we really need to change what we are doing. So that’s really when we are getting that resistance.
That’s a mismatch between how we’re trying to intervene and really where they are and need to change strategies. So it’s really kind of a way for us to know that maybe our our intervention needs to be different. So it’s it is the third answer a function of mismatch. Someone did just ask, where can I find that Eureka chart? Yeah, if you just Google Eureka, you will. It will pop right up multiple versions and scoring. If you have trouble finding one that works, you can send me an email and I’ll I’ll send you a link. Thank you. Ok, so before we move on, I just want to review another visual of the trans theoretical model of the stages of change that people really kind of enter a pre-contemplation. I like this one because it’s showing how cyclical it is that really it’s a progression upwards. And even if people have like a relapse or recurrence of use somewhere in there, that this process continues, that that it’s sort of ongoing. It’s it’s it’s quite a long process with with clients. Usually the example I like to give when we talk about the stages of change because we we do psychoeducation on the stages of change and actually provide education, how do people change and then ask them to weigh in on like where they see themselves in this process? But we talk about it with the analogy of like a physical exercise program, right? So if if you’re sort of initially and pre contemplation like it’s working fine, I don’t need to do anything in contemplation.
You know, I would really like to, you know, lose some weight or put together an exercise program sometime in the future. In preparation, we might start making plans for that. Doing some research in action, we’ve actually signed up for that gym membership and we’re going. And I think a lot of our clients, we use this analogy because a lot of our clients think once I get to action and I’m going to the gym like, that’s it. I don’t need to be, you know, worried about it anymore. But really, then we’re thinking about maintenance like, OK, I have to keep going. I can’t let it go. I have to continue. I might cut back the number of meetings or the number of times I’m working out at the gym, but I’m still going. I’m still maintaining my recovery in an ongoing way. This is a really wordy slide that I’m not going to talk through, but I want to share it as an example again, for some of those sort of people that said, like, I’m a beginner or a novice here, if you want more concrete information about matching interventions to stage of change, there’s a ton of resources out there that literally like have charts that do just that. I’ll have some on some of my other slides that we’re going to go over. But for example, in Sam says Tip thirty four, they literally have a chart doing that.
That’s where this comes from. But this is like just a lot to kind of try to read through on the screen. So instead, I want to share kind of really, as we’ve now talked about, what the stages of change are, what the primary task is based on that stage of change and then what that looks like in terms of actual clinical intervention. So we know the pre contemplation person is saying, I don’t see a problem. And so our task is really raising awareness. And what that looks like is first and foremost, just like all of our clinical interventions focusing on rapport, building trust. Once we’ve done that, we may be able to express some concern about maybe their safety. But we also really want to make sure we’re validating that they’re not ready. They’re not ready to make a change. That’s OK. I’m here to talk with you about what changes you do want to make and you have that right. So we really want to clarify their self-determination. We we can maybe create opportunity to evaluate behavior and lots of self exploration. Let’s understand what what the function of this substance use is. How is it helping you? And then we might also be able to, in terms of giving feedback, provide some examples that links their problems with their substance use. I’ve also got on here just a brief intervention. If you have a have one intervention with somebody based on your setting and somebody is in pre contemplation, a brief intervention that you can deliver is just psychoeducation on the health risks.
Things like that, risks for addiction. That type of brief intervention can be used when somebody is in pre contemplation. Our contemplation person, I know I want to change, I’m just not ready yet, right there. They’re just ambivalent. So the primary task here is resolving that ambivalence. Really, that’s the idea. And we do that a lot of different ways in a clinical setting. Raising awareness, developing discrepancy. I’ll I’ll talk a little bit more when we get into some MI techniques about developing discrepancy, building confidence in somebody’s ability to actually make change, creating a lot of opportunity to explore feelings of ambivalence and their personal values. So this may be a lot of like readiness, ruler conversations. You know, what are the pros and cons of changing and the that can be done through like a decisional balance exercise that can just be done like in a one on one counseling session where we’re talking about why they might not want to change and why they might want to change and the weight of those. We can also do values clarification here to help resolve ambivalence where we’re talking about really what is most important and how has their substance use or other addictive behavior sort of conflicted with those values. And really sort of the brief intervention here is to increase awareness of the consequences of a future use and the benefits of not stop of not stopping the need to stop that right.
In preparation, this person is saying, I am ready, I’m ready to make change a priority, right? I’m ready to make a change. I haven’t made one yet, but I’m ready to. So here we might be building confidence and then actually figuring out how to change. That’s our primary task. So the clinical interventions here might be really reinforcing and encouraging change talk to strengthen that commitment. They’re ready to do it, but they haven’t done it. So we really want to reinforce that change talk. We can work with them on barriers and obstacles to that change. We can start looking at resources and social supports. Great. You would like to stop using. Let’s talk about how people do that. Let’s come up with some resources. Maybe you’re ready to try out some meetings. We also can really do a lot of skills development at this. This is really where what we love to do as addiction professionals. Lots and lots of like behavioral straight change strategies, you know, relapse prevention, skills development and really focus on small initial steps if you’ve got just opportunity for a brief intervention. This is where you might do sort of some of your aspirate stuff and some referrals for treatment where you are are giving them some options and then helping them make a plan to follow through on those.
In the action stage, the person is really focused on their their new habits, their new behaviors. So we’re helping them implement those change strategies. That’s our task and then reducing relapse risks. So this might, in a clinical intervention, look like making an action plan, reinforcing their motivation to change again. We never want to stop doing that. Giving more support and guidance, we can again focus on actual behavioral change, like focusing on restructuring cues and social support, looking for sort of opportunities to build self-confidence as they deal with obstacles. We also want to not not forget that like that, even though they’re in an action stage like they may be having some sort of feelings of loss about, like about what they’ve given up. And so we want to reinforce like long term benefits and validate how they’re feeling. And then in a brief intervention, just focusing on really how to reduce those relapse risks to know what they are and reduce them short term. And in our final stage here that we want to sort of match interventions with its maintenance, so this person is successfully sustaining, so this is not likely to be in like a residential setting, but we would think and think about how to keep reinforcing their commitment. So this might continue to be like motivation, reinforcement and then skills reinforcement and in a in a brief brief intervention, really looking at sort of their actions and long term plans.
Ok, so we’ve talked a lot about stages of change and the theoretical model. I do want to spend a little time now talking about some actual motivational interviewing interventions and techniques. But but we’ll just also remind people that it’s it takes lots of training and actually like supervision to sort of really make sure you’re doing am I and an adherent way? So this is kind of a very brief overview. So what is motivational interviewing? This is a collaborative, person centered form where we are guiding to elicit and strengthen motivation. It’s really an approach in terms of working with people to help them assess their intrinsic motivation. That’s sort of in line with their values and their goals, a way of working with people, and that this can be used with other clinical interventions to sort of have some of this spirit of my. So I will talk a little bit about like sort of the philosophy or the the spirit. And then there also are strategic techniques. It’s definitely an evidence based treatment with lots of different ways you can use it. And ultimately, the goal and motivational interviewing is to produce internally motivated change and help that individual use their own resources to to make those change. So at the core of me is, is the spirit. This is sort of a philosophical approach that provides a foundation to the techniques. So all of us can sort of embrace the spirit of me, even if we’re not trained in all of the techniques.
The spirit is really this idea of partnership of of equals. So we’ve talked about that and sort of like so far, like really partnering with what are the client’s goals? Acceptance of their perspective. Again, they have the right to self-determination. And if they are not ready to stop or only want to stop certain substances, it’s just sort of accepting where they are like, we are not the expert on their life. Compassion for them as an individual, like really seeing them as a person or an individual, and then evoking their own motivation to change. So a lot of the techniques like reinforcing change, talk, et cetera, are really trying to pull from their sort of own internal motivation. And, you know, tons and tons of research on really how this is applicable in substance use disorders and actually lots and lots of other settings as well. So it’s actually been adapted to all kinds of things in terms of weight loss, medication adherence, lots and lots of different providers sort of use some of these my tools for for other problem behaviors, not just for substance use. So as a provider like what what is our goal, our goal with motivational interviewing is to resolve ambivalence, which we saw. Typically, people have lots of ambivalence about making a change, definitely to avoid strengthening resistance. So going back to that sort of like poll that we had then asked about, like, you know, what really does resistance indicate that maybe we’re not intervening correctly? And so we want to just make sure even if somebody isn’t ready to change in the way that we want them to do that, we’re not making like we’re not entrenching them more in their resistance to elicit those self motivational statements, like what is it that they want, what’s in line with their values and their long term goals? We want to, as a clinician, enhance their motivation in their commitment to making change.
And then hopefully we’re going to help them progress through the stages of change and that we really at the end of at least again, for us in our setting where people are here for several weeks at the end, we’re looking back to see like really that over their course of treatment, how have they moved through the stages of change? And even if they’ve moved from pre contemplation to contemplation, we have been impactful. So motivational interviewing has sort of some basic assumptions when engaging with a client. One is the idea that motivation is really a temporary state, right? So it is something that we can change. It can be targeted. That resistance is really a cue that we need to change what we’re doing. Ambivalence is a good thing that we should really be allies with our client and that’s how we get to that sort of intrinsic recovery and change. I am going to maybe, Krystle, if it’s OK, skip through a few of these because I know we’re sort of running towards the end of our time and I have a couple sort of specific techniques I want to make sure we cover.
Perfect. Ok, so we have another poll because I do want to make sure sort of we’re on the same page here when we argue with a client and try to convince them that they need to change, what happens? How do they respond? It’s like, Oh, OK, thank you, I’ll accept your need for change, arguing against the change, asking for advice or moving to the next stage of change. We. Awesome, I see lots of votes coming in. So the correct answer here is that when we try to really convince somebody or argue that they really just need to make a change, you just need to stop. What this really ends up doing is causing the client to argue against the change. So when we use the term, like rolling with resistance, when we’re talking about the spirit of MI, we really if we’re practicing MI, we are not arguing what they need to do differently, right? We may be able to give feedback about I notice that your alcohol use is really contributing to your marital problems. Right. We can give feedback and examples. That does not mean we when we tell them what they need to do to change, it actually just leads to them arguing against the change. And the problem with that is they’re actually then entrenching more in their resistance.
They’re using sustained talk, which we do not want and we don’t want them to to sort of talk themselves into not changing. We want them to talk themselves into changing. Ok, perfect. And this really is shown in some of these dangerous assumptions. I’ll just speak about a few of these one that that really change comes through a tough approach. It really doesn’t. The research shows us that like a confrontational approach is not what gets people to change. Now, I’m not saying you can’t give your clients feedback, you can’t be boundary with them. You certainly can give them difficult feedback. But when we do it through sort of just a really tough approach and telling them what they have to do, the only way to get sober is to go to meetings and get a sponsor, right? That sort of really that assumption that there’s only one way really harms our clients and is not the spirit of me. The other one I’ll talk about here is this expert, right? Like, I’m the expert. I’ve seen it all. I know that you’re an alcoholic and you need to stop drinking, and that’s the only way you’re going to solve your problems. Like when we come in as the expert, that’s really not this, am I? The client is the expert in their own life. Ok. I think this is our last poll about ambivalence. So how does sort of the MI framework feel about ambivalence? Is this normal and useful, a roadblock to change pathological or irrelevant? Ok, see, lots of votes for normal and useful.
Perfect. Yes, I mean, I think I’ve already mentioned this, so hopefully people will sort of take this away today that it’s totally reasonable and totally normal for our clients to be ambivalent about making a big change. Most of us, when we’re making a change, feel ambivalent about it. There are pros and cons both ways. And so a lot of our job as the clinician and really the way to resolve that ambivalence is to give voice to it. So to let somebody talk about like, what are their reservations about making change? What are the cons about making change? And then also what are the pros? So it’s that collaborative conversation where we’re talking about about their ambivalence and even labeling it as normal. That really can help me move people through ambivalence. I want to share so developing discrepancy in terms of moving people from like pre contemplation and contemplation into preparation really is what we call developing discrepancy. This is maybe kind of a helpful technique where we are helping them sort of determine the actual costs versus the perceived benefits of their substance use or behavior. Looking at the differences and their goals and their values and their actual behavior, like what’s happening versus what they want to happen. And so this is sort of how we do that self evaluation and insight.
And there’s a couple of ways to do. This is definitely can be done through like feedback through like assessments through a decisional balance, a value clarification and also like a a change plan can sometimes be useful here. The decisional balance is really where we help somebody, this has multiple names, sometimes like a pros and cons, but this is an activity we do pretty regularly, not only one on one, but in a group setting. It’s an incredibly useful group tool to really give somebody an opportunity to talk about what are the benefits of and whatever behavior or substance they get to fill that in and to list all of those out. Like, what are the pros like? Why do they like using it makes them feel good. It’s a way to socialize. It provides relief from their symptoms. Maybe it’s fun to really let them talk about that and to validate like, yeah, it does have a lot of benefits. That’s why why you’ve been doing it and then to move into talking about consequences. So how is it harming you? What? What consequences have you experienced or do you anticipate experiencing if you don’t make a change? And to talk through those and one of the reasons I love doing this activity in a group setting is they hear everybody else’s consequences as well. And it’s like, Oh yeah, oh me too. The same, even with the benefits.
And then we move into the benefits of changing. So what? Why would it be helpful to stop drinking? What benefits would you experience? And again, they sort of start thinking through the future? And then again, it can feel kind of strange to really create space to talk about the consequences of changing. But this is how this is where people’s ambivalence comes from. Change does include consequences. It might leave them feeling worse ultimate initially, but not ultimately, right, making some of these changes in terms of their substance use. So they’re left with some of those consequences. They’ve got to navigate social situations. They may feel more anxious when they first stop using talking about all those consequences again as a way to kind of help them resolve some of that ambivalence. And then the final thing I will say and have about five four minutes for questions is if you like a lot of these tools and you’re looking for some practical strategies, I’ll just give a shout out here to smart recovery. This is their change plan worksheet, but they’ve it really. They use a lot of motivational interventions in their recovery program. And we use we have multiple smart recovery meetings a week, and our clients repeatedly talk about how useful it is because of the practical nature, not only of the modules that focus on like managing cravings, but also that it targets motivation. It is a recovery pathway that literally targets motivation to change.
Ok. Thanks, Krystle. Here are a few questions we were able to answer after the presentation. Ok? It says a lot of this is treating a disease as a choice. A lot of work has been done over the past. Couple think that’s supposed to say here showing the SG is a disease, not a choice. Oh yeah. I mean, I fully believe that addiction is a brain disease, a chronic disease. So we’re not saying that addiction is a choice, but recovery is a choice, right? And being ready to stop. So that’s where, like once somebody has said, yes, I do want to make a change, that’s where then we come in with all those other interventions to sort of surround them with support and tools and strategies to make that change. But this is more about targeting somebody to get even if they’re active in their addiction, to get them ready to make the change and sort of the decision that they want to stop like we can’t force them to to stop. But that’s the key word. I think right there is them making the decision that they’re ready to stop, like, can they just choose to do it on their own? No. Like, we believe it’s an actual illness and all of that, but they do have to make the decision that they want to to do some things to stop. They want to that they’ll do whatever it takes. And that is a lot of change and a lot of choices have to be made to do that.
So there’s where the choice is. Well, and thank you for sharing today. Wow. Great information. Tons of great information. And that’s what everybody is saying. Just, I mean, just lots and lots and lots of really good feedback here. I’m making sure I haven’t missed any questions popping up in there. The only other comment I saw in there, like somebody sort of said, like people vacillate between stages, and I think that’s totally true as well. And that’s where like, I mean, you can meet with somebody one day and then again the next day, and they may they may right be vacillating between the stages. And so if we’re getting resistance, like revisiting where they are today. Yeah. I love the the thing that you showed, the circle, the spiral going up and how that changes that that’s so cool because that’s exactly what we see happening in the facility all the time. There’s there’s a constant in the life, even the short time they’re with us. You see that. I agree. I think that’s one of the coolest things to see is people really progress right when they come in and pre contemplation. I’m not changing. I don’t have a problem and they leave like I have a problem and I’m ready that I have to come.
Yeah, absolutely. Yeah. That’s how it is with our pain clients. They always they’re very averse to the word addict to begin with. We we always stress dependence and a few weeks then they’re saying, Wow, I am an addict. And so it’s just how that is perceived and how they in their head start thinking differently. And of course, that happens through a lot of what you talked about today. I really hope that we’ll be able to partner with you guys again because you just have some really valuable information to bring to our attendees. So thank you so much. Thank you all very much. Thank you, Vaughan.