motivation and change

Like addiction, 'motivation' is a word often used in relation to drug and alcohol use – people are often described as either having 'motivation to change' or not, but in reality life is more complex than this, and such simplistic use of language, offers little hope of understanding (and more importantly facilitating) behaviour change.

This article explores the term 'motivation' and provides a more useful framework for understanding behaviour change. Aimed primarily at drug workers, drug users, health professionals and relatives, friends and colleagues of people with any sort of problem with drugs or alcohol, it will also be useful for anyone trying to change their drug or alcohol use, or indeed any behaviour.

Understanding both what motivates people to make changes in their lives, and the process of change itself, are essential parts of understanding problematic drug use.

The systematic understanding of the principles of motivation and change has formed an important part of the theoretical basis of effective work with drug users for over twenty years.

‘Motivation’ is a term used to describe the psychological processes that arouse, sustain and regulate our behaviour. Motivation to do something usually arises because these processes have led us to believe that things will get better (or at least not get worse) as a result of our actions.

The theory of motivation and change is therefore not specific to people using drugs and can be applied to anyone wishing to make almost any sustained changes in their lives.

The process is probably best understood by applying it to anything you have tried to change in your own life.

Not interested in change
Many people engaging in behaviours that others might think they should change are not even contemplating change. This can be because they do not think there are any problems attributable to the behaviour, or because the risks and problems outweigh the benefits they get from continuing.

Thinking about change
When people acknowledge the risks or problems caused by their behaviour they begin to weigh up the potential benefits of changing against what they will lose if they change. The process of contemplating change can take years, in other cases people arrive at a decision to change very quickly.

Getting ready to change
Following the period of contemplation, those people who feel that change is desirable and possible for them to achieve, begin preparing to change. This stage of the cycle involves setting goals and making plans. For major life changes, examining options for help and support is often important.

Action
Having clear plans and realistic goals in place is likely to be very helpful at this time. It is usually best to take action on a given day, and to prepare for it in advance - spur of the moment changes are less likely to be lasting. The behaviour to be changed may be related to habit (always smoking after a meal, always buying heroin after being paid) as well as to any physical or psychological dependence on a substance. Strategies to deal with particularly problematic situations are important, as are rewards for success and support from others.

Maintaining change
Once the changes are made people (hopefully) move into a period of maintaining the change. For most people achieving change is much easier than sustaining it. At first, staying changed requires belief, effort and support. For most people this gradually becomes easier as new behaviour patterns are established.

Relapse
Many people trying to achieve sustained change will experience relapse - this is best viewed as a normal part of the process of change: the majority of people who relapse will go back into contemplation of change wiser and more self aware than they were last time. Many experts view the cycle of change as an upward spiral rather than an endless circle as each ‘trip’ around cycle allows learning about goal setting, strategies for action, strategies for maintenance and risk factors for relapse. In turn this means that each time change is attempted, the chances of success are improved. Levels of motivation can be affected by many external and internal factors, they are therefore seldom constant, changing over time, sometimes even hour to hour and day to day.

Understanding the cycle of change allows us to intervene with drug users in ways that are helpful and useful: at whatever stage of change they may happen to be.

The process of identifying and working with people at whatever stage of change they happen to be, to achieve realistic goals, is known as motivational interviewing.

The cycle of change is used to decide where in the change process drug users are and to target interventions accordingly.

For those who do not want to stop their drug use, interventions can be targeted at the riskier component behaviours of their drug use. This helps to ensure that their drug use causes as little harm as possible until they decide to move towards more limited drug use and, eventually, to stopping.

For those that decide that they do actively want to change, motivational interviewing approaches can be used to help them decide what they want to achieve and how they want to go about it.

Motivational interviewing works on the premise that, however we might feel about their lifestyle, it is more effective to provide people with information and support. Making people feel lectured to, or judged is unlikely to promote positive change.

The process requires an understanding that people are likely to have conflicting thoughts and feelings about behaviours which offer some reward, but which they know also cause them problems. Enabling people to acknowledge and work through these ambivalent feelings is usually an important part of assisting them to change.