In treating substance abuse disorders, there are several theories that are considerably applicable in order to enhance the prospects of recovery. Of the many theories mentioned throughout coursework and recognized by the American Psychological Association, the transtheoretical model of change is mentioned, along with motivational enhancement therapy (Miller & Rollnick, 2012). These models are more commonly known as the stages of change, and motivational interviewing, as named by the techniques applied to employ the overall hope of behavioral change (Prochaska et al., 2007). Both theories present qualities that distinguish one from the other, but often they are comparable in management of treatment and motivational features. The following synopsis will distinguish these comparable techniques and exhibit the contrasting qualities to enhance one’s understanding of how the theories are extremely applicable when combined, but are not to be mistaken for one another.

The transtheoretical model of change was developed by Prochaska and DiClemente, as evolved by examining smokers who quit on their own versus smokers that required further treatment, in an effort to develop an understanding of the motivators that fueled the success for those who quit on their own (Prochaska et al., 2007). It was determined that one quit when they were mentally capable and prepared to do so, thus developing a model that purposely highlights thought processes and behaviors related to thought processes that occur in a cyclical manner. Stages of change is a model that is applied in six stages: precontemplation, contemplation, preparation, action, maintenance, and termination (Migneault et al., 2005). In precontemplation, the individual is not prepared to take action and is not in acceptance that the behavior needs to be changed (Prochaska et al., 2007). The behavior is considered unproblematic, such as an employed substance abuse patient that does not see their use of illicit substances as problematic because they are able to function on it, or abuse substances to sleep (Migneault et al., 2005). The emphasis in this stage is on the cons of changing the behavior, rather than the positives that can be achieved (Prochaska et al., 2007). The second stage is contemplation, in which the individual sees the behavior as problematic and is willing to implement change over the next six-month increment (Migneault et al., 2005). The patient is able to consider the pros and cons in a more practical manner, with emphasis placed on both; however, still not changing the behavior or feeling hesitant to do so. The next stage would be preparation, in which the patient is taking action over the next thirty days, and small steps are implemented (Migneault et al., 2005). Action stage of change is the fourth stage, in which the patient is actively changing the behavior and replacing with new, healthy behaviors. The next stage is maintenance in which the client has sustained the changed behavior for at least six months, and is working to maintain the behavior change and prevent relapse (Migneault et al., 2005). The final stage is termination, in which people have no desire to return to unhealthy behaviors, there are no more cravings or thoughts of relapse (Prochaska et al., 2007). This stage of change is often hard to reach, and many stay in maintenance stage of change, especially in settings such as medication management treatment (Migneault et al., 2005).

Motivational interviewing was developed by Miller and Rollnick to treat alcohol addiction by collaborating with a particular defined “spirit” (Miller & Rollnick, 2012). This is an approach that was designed to help individuals in finding motivation to make positive behavior change. This is a client-centered approach that is effective for those that are not entirely sure of changing their problematic behavior, such as substance use (Miller & Rollnick, 2012). The approach can only be executed if the individual wants the change, however it is the counselor’s task to identify motivators for change that a client can use to make the recovery process easier, or help them when they feel they are unable to continue the process of change (Miller & Rollnick, 2012). An example of a motivator would be a person that has lost custody of his or her children due to use of illicit substances (Jarvis-Chamberlain & Painter, 2014). This often presents as a barrier, that can be detrimental to one’s mental health but when framed in a manner such as motivational interviewing, can be utilized as an advantage to the counselor in identifying motivators for change. This process has four principles that are required of counselors who use this approach: express empathy, develop discrepancy, roll with resistance, and support self-efficacy (Jarvis-Chamberlain & Painter, 2014). To support these principles, the counselor is required to utilize four basic techniques to support their approach. The first technique is utilizing open-ended questions to gather information and develop a sense of motivators throughout treatment (Miller & Rollnick, 2012). The next technique is affirmations, or highlighting the person’s strengths to build confidence in ability to implement change. The third technique is reflective listening, in which expressing empathy is applied as the counselor is attempting to gain insight on the client’s concerns and have the client reflect on their feelings further (Jarvis-Chamberlain & Painter, 2014). The fourth basic technique is summaries, in which It is a type of reflection for the therapist to exemplify that they have been listening and fully understand the client’s concerns, with some extended techniques such as collecting, linking, and transitioning. Motivational interviewing also includes four processes, including engaging, focusing, evoking, and planning (Miller & Rollnick, 2012). Each of these processes can overlap with one another, and are subject to the counselor’s discretion rather than having concisely outlined constraints (Miller & Rollnick, 2012). The client should be able to understand the therapist to the fullest extent, the key to effectiveness for this technique is building confidence to enhance autonomy.

In substance abuse treatment, these approaches are often utilized together in an effort to apply a proven model in treatment planning such as stages of change, while coaxing the content out of the client by applying motivational interviewing techniques (Jarvis-Chamberlain & Painter, 2014). At first glance, there are several similarities between the two approaches that allow for one to apply both in treatment without distinguishing one as absolutely more effective than the other (Miller & Rollnick, 2012). One of the more prominent differences between the approaches is the momentum when the approach begins. In motivational interviewing, it is absolutely necessary for the client to recognize the behavior as problematic, and want to change the behavior (Jarvis-Chamberlain & Painter, 2014). In terms of stages of change, this is known as the second stage of change, contemplation. This contributes to the idea that one can seek information on change without being completely invested in changing the behavior, such as being in precontemplation stage of change (Migneault et al., 2005). This is in congruence to the idea that the stages of change model is concrete, one must surpass each stage of change before moving on to the next and cannot be in two stages of change at the same time (Migneault et al., 2005). Motivational interviewing focuses on four processes that are not separate as they overlap, and there is not a definite end or beginning to any of the outlined processes (Jarvis-Chamberlain & Painter, 2014). It is also notable that the processes are not to be seen as steps throughout treatment as in stages of change, as “planning” is not the last step of treatment for motivational interviewing, but is the last applied agent of change to achieve desired results (Migneault et al., 2005).

Each model is reliant on goal-setting and the follow-through of each goal, though the models offer different approaches to development of goals and applications of setting goals. An overlooked concept of recovery is the idea of “progress not perfection”, and while both models fit this mold, it is apparent that the overall goal of recovery is to not relapse. One of the burdens of recovery is that relapse is common, and overcoming this as an obstacle is especially difficult when not in active treatment. A notable element is the idea of relapse in each of these treatment approaches, and understanding how relapse or other obstacles are processed in each approach. Stages of change is a cyclical model, and one can enter at any stage of change at any given time, assuming the behavior or thought process of the individual fits the specific stage of change. In relapse, one does not typically regress to precontemplation stage of change is often returned to contemplation or preparation stage. This allows for the individual to remain somewhat autonomous, and hold themselves accountable in developing coping mechanisms to reinforce replacing negative behaviors with healthy behaviors. This promotes the idea of autonomy, and is congruent with the approach that is presented in motivational interviewing. However, there is an extreme emphasis on the techniques applied by the counselor in motivational interviewing. The counselor is required to apply several principles and techniques that heavily weigh on the success of the client’s recovery. The techniques and principles are crucial in execution, and usually define how well the client recovers from their condition. Though it is derived from a person-centered approach, it is apparent in studying the various components of the approach that it is entirely not autonomous as stages of change presents to be. This speaks to the role of the human services provider in this approach, as the therapist is required to have a more hands-on approach, and the empathetic understanding as well as the application of reflection require more support from the provider than the stages of change model requires.

 Additionally, there are several goals that need to be applied to enhance the therapeutic devices with goal setting, which is similar to behavioral therapy. The process of setting goals in stages of change is related more to the processes rather than allowing for the goals to not be categorized. Stages of change includes specific inclusions, such as finding supportive relationships within the identified support system and identifying specific environmental triggers that can encourage the outlined problematic behaviors associated with use. This is included for each individual receiving treatment, suggesting correlations between environmental factors or support systems and success of recovery, or achievement of desired results. Motivational interviewing is reliant on open-ended questions, and gathering information to set goals that are specific, measurable, action-oriented, realistic, and time-bound (Miller & Rollnick, 2012). Inherently, these are the qualities of the goals rather than focusing on specific areas of life such as employment, environment, and support system (Jarvis-Chamberlain & Painter, 2014). However, this allows for one to understand a common shortcoming of the stages of change model in which the model overlooks social context such as socioeconomic status and other stressors that can weigh into success (Migneault et al., 2005). While the counselor is required to promote change by educating the client and consistently applying strategies to help make and maintain change, it is apparent that these strategies are somewhat loose, and do not present the concise and developed technique motivational interviewing offers.

            In comparing these two theories, it is difficult to do so because the necessary evil is that often these approaches are paired together to create successful outcomes in treatment. For example, one will use the motivational interviewing as talking pieces but in development of treatment planning, stages of change is more concise and easily conveyed (Migneault et al., 2005). Additionally, the stages in motivational interviewing account for the planning of change, however stages of change accounts for each process of change, including termination, and relapse when required. Both models account for goal-setting and strive to focus on goals that are attainable given the client’s current state of being and behaviors that hinder recovery. It is apparent that each model presents with disadvantages, a commonality in all therapeutic approaches and models when applied in certain situations (Jarvis-Chamberlain & Painter, 2014). The overall consensus is that there is not a universally proven treatment model that is successful for every person in any situation (Jarvis-Chamberlain & Painter, 2014). It is apparent that each theory has advantages to support treatment regardless of present obstacles.

References

Jarvis-Chamberlain, A., & Painter, K. (2014). Effectiveness of motivational enhancement therapy in treating comorbid anxiety and substance use. PsycEXTRA Dataset. https://doi.org/10.1037/e560702014-001

Migneault, J. P., Adams, T. B., & Read, J. P. (2005). Application of the Transtheoretical Model to substance abuse: historical development and future directions. Drug and alcohol review, 24(5), 437-448.

Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.). NY: Guilford Press

Prochaska, J. O., Norcross, J. C., & DiClimente, C. C. (2007). Changing for good: A

revolutionary six-stage recovery program for overcoming bad habits and moving your life positively forward. NY: William Morrow