Pre-Contemplation


Slide1

The person has not started to think that there could be any problems associated with their behaviour and may not be experiencing any. Everyone else may be frustrated and unable to see how the user doesn’t see what is going on? Classic things he might say as a response to the ‘you know that’s bad for you.’
  • ‘The only problem I have with coke is that I can’t get a big enough line’
  • ‘I wouldn’t have to spend so much time in the pub if you didn’t keep nagging me.’
  • ‘The second I stop enjoying it I will stop.’
One of the most common prevention methods is to try to shock people into being good by working on fear. ‘Just show them what it does to their bodies and then if they keep on doing it it’s their own fault.’ It seems common sense but it just doesn’t always work.
Nearly everyone who smokes will have attended the funeral of a friend or a member of their family whose life was curtailed by tobacco. That’s not enough to bring about lasting change – people may stop for a bit but the chances are that they will be back on the whatever after a short period. Also, stress someone out about their drug using and they will need to manage their stress, the easiest way to do this is to use again. Messages based on fear can reinforce the usage.
Trying to force people like Fred to move on before they are ready can be very dangerous. Consider the well known case of Curt Cobain – it appears that in the week before he died that “Cobain was confronted by his family and friends, including members of his band, in which he was told that he had no choice but to attend an abstinence-based rehabilitation centre in Los Angeles (US).
Cobain asked if someone could ‘meet him half-way’, instead of insisting on his participation in a programme that required total abstinence. Perhaps, if harm-reduction were presented as an alternative to total abstinence, there would have been an effective means for Cobain to learn how to cope with alternative behaviours to his continuing use of heroin as a self-medication for his chronic stomach pains” *

Targeted Information

Targeted information seems to be more successful where everything is very specific. The doctor shows some results and explains what they mean – it’s not a case of vague dangers but immediate impact to my health – the impact is clearly and simply explained in terms that cannot be avoided. However, if this is done in a way that excludes hope then it is easy to conclude that the damage is already done so what possible harm in a wee bit more.

Brief Interventions.

Most people who drink alcohol have very little idea about how much they drink. One of the simplest ways of reducing drinking is to help people work out how big their glasses are and the number of units are in each glass. We run a program on Brief Interventions to help front line workers integrate these skills into triage and assessment processes. This course has been used extensively in Primary Care contexts including Accident and Emergency.

Motivational Interviewing

A major set of talking interventions that have been shown to be useful for clients in pre-contemplation and contemplation are often known as motivational interviewing.



*Marlatt, G.A. (2004, April 21). Come as you are: Cobain, addiction and hope. Seattle Times. Retrieved March 13, 2006. From http://www.seattletimes.com. Cited in Katie Witkiewitz and G. Alan Marlatt, Overview of harm reduction treatments for alcohol problems, International Journal of Drug Policy, Volume 17, Issue 4, Harm reduction and its application to alcohol policy, July 2006, Pages 285-294.)