Harm Reduction & How It Can. Part III

Transcription

1 Harm Reduction & How It Can Compliment Motivational Interviewing: Part III Robert J. Chapman, PhD Drexel University, Philadelphia 1

2 About the Presenter Robert J. Chapman, PhD Clinical i l Associate Professor, Behavioral Health Counseling, College of Nursing & Health Professions, Drexel University PA Regional State/Territory Coordinator for The Network Addressing Collegiate Alcohol & Other Drug Issues Contact information: Phone: rchapman@drexel.edu Web page: p 2

3 Review of Motivational Interviewing O.A.R.S. Open-ended Questions Affirmations Reflective listening 3 Summary

4 Key Concepts in MI Stages of Change Theory Expect Ambivalence Develop Discrepancies Avoid Arguments Understanding Resistance Signals practitioner moving to fast or premature intervention 4

5 About Harm Reduction (HR) HR is a process not a result A process whereby students t reflect on their behavior This reflection permits a review of the cost-benefit ratio 5

6 Smoking Related Tips ID change/quit date Carry cigarettes or lighter, but not both Mark cigarettes to be extinguished 6

7 More Smoking-Related Tips Help students understand d both types of cigarettes they smoke Focus on the process rather than the change 7

8 Eating-Related Tips The power of counting calories The power of converting calories to activity it Attending to the eating process - # of times food chewed before swallowing 8

9 General Tips Relativity experiment hot, cold, & ambient temp bowls of H2O Likelihood of change decisional balance exercise 9

10 More General Tips Using technology to deliver the message Program cell to deliver a predetermined HR message Text buddying 10

11 In Summary of all three webinars the big ball of wax if you will 11

12 AOD Challenges in Higher Ed Age specific developmental challenges 12

13 So How Do We Know What To Do? Question what we believe is understood d or basic information known by all 13

14 Factors Influencing Our Work 14

15 Factors Influencing Our Work Student selected drinking goals more powerful than goals articulated by others 1 Factors that maintain heavy collegiate drinking different than those maintaining heavy drinking by older adults Beadnell, B., Baker, S., Gordon, J., Roffman, R., & Carver, J. (1995). Risk reduction counseling groups with men who have sex with men and women who have sex with men. In J.R. Gordon (Chair), Sexual Health: A look at reducing sexual risk across a variety of populations. Panel conducted at the Harm Reduction Conference, Seattle.

16 More Factors Influencing Our Work... Recognize: Risk reduction, without abstinence, is a valid goal aka a.k.a. HR Remember: Goals should be realistic & achievable Recognize: Risk reduction can continue as students practice and improve, i.e., moderate use over time Employ less intensive interventions before proceeding to more involved interventions 16

17 Explaining What Works 17

18 Questions that Shape Prevention Efforts Is the reduction of alcohol related risk a preferable objective to banning behavior? What are we trying to accomplish - influence personal choices or control student t behavior? 18

19 More Questions How do we perceive the students we serve, as potential ti addicts or potential ti responsible decision makers? Do we choose to focus on the problem or the solution? 19

20 So What Has Moved Us Forward? 20

21 Borrowing From Clinical Models In particular, Prochaska s Transtheoretical Theory of Change Stages of Change Pre-contemplation Contemplation Preparation Action Maintenance 21

22 Other Clinical Models Miller s Motivational Interviewing/Motivational Enhancement Therapy Two key concepts: A. Readiness for change Prochaska s model B. Expect students to be ambivalent about the prospect p of changing g 22

23 Principles of M. I. A. Express empathy B. Develop discrepancy C. Avoid arguments 23

24 Principles of M.I. continued D. roll with resistance E. support selfefficacy 24

25 Strategies in M.I. A. explore a typical day B. explore positives as well as negatives of use 25

26 Strategies in M.I. Strategies in M.I. provide accurate information explore client concerns 26

27 So What Have We Learned? 27

28 Review Novice students are acculturated in a high- risk environment Students know what they learn and learn what they are taught Students beliefs shaped by modeled behavior Students reinforced with attention and recognition 28

29 Review Collegiate environment initially devoid of negative feedback First 6 weeks few grades, little awareness of cause -and-effect Notice How student perceptions are formed Regarding the perception of risk when drinking (high or low), it is relative 29

30 Review Maturing out results from: poor grades, hangovers, embarrassment boredom with same old same old - loss of excitement negative experiences, e.g., fights, harassment, unwanted sexual advances 30

31 Review Borrow from what works in clinical models Recognize that different communities are at different stages of preparedness for change 31

32 Robert s Rules 32

33 Robert s Rules #1 Nothing always happens it is very easy to become discouraged if not demoralized by what seems to be the never ending stream of AOD related issues, problems, and concerns 33

34 Robert s Rule #2 Before you can catch any fish, you ve got to cut a hole in the ice there is a lot of hard work that must be done with little apparent tangible result before change starts to become evident Its parallel, there is no silver bullet pursue an objective of reducing the frequency and/or the number and/or the severity of AOD related problems 34

35 Robert s Rule #3 Walk the walk; don t just talk the talk Do campus practices model campus objectives? Alcohol industry sponsored events? Open bar at institution sponsored events, e.g., board of trustee meetings? Staff and faculty held to same standards as students, e.g., drinking on campus? 35

36 Robert s Rule #4 Whether you storm in the front door or sneak in the back, it s just as warm by the fire. how we manage to further our efforts on campus is probably less important than what we do to further our efforts. To paraphrase Teddy Roosevelt, You do the best that you can with what you have when called on to do it. 36

37 and in conclusion, remember 37 Aim high, and know intervention always works, 100% of the time.