Minnesota Institute of Public Health

Guest Blog by Kevin Spading

People consume, smoke, and insert chemicals oftentimes not thinking about real consequences. This couldn’t be further from the truth when we study the relationship of various drugs such as stimulants, depressants, and hallucinogens on the human brain. What really happens is “out of sight….into the mind!”

My goal here is not so much to begin a discourse on brain addiction, and serotonins and dopamine, but rather to understand the stages of readiness that we need to recognize when it comes to applying the science of alcohol, tobacco, and other drug (ATOD) prevention.

Intervening on this carefree spirit is a critical piece of education that needs to gain traction. Here is a quick overview of the stages of change and how we can apply it to our ability to meet the prevention needs of our community.

The stages of change model, developed by Prochaska and DiClemente, has been conceptualized for a variety of problem behaviors. The five stages of change are precontemplation, contemplation, preparation, action, and maintenance. Precontemplation is the stage at which there is no intention to change behavior in the foreseeable future. Many individuals in this stage are unaware or under-aware of their stressors or reasons for use and the consequences of their choices. Contemplation is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a commitment to take action. Preparation is a stage that combines intention and behavioral criteria. Individuals in this stage are intending to take action in the next month and have unsuccessfully taken action in the past year. Action is the stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. Action involves the most overt behavioral changes and requires considerable commitment of time and energy. Maintenance is the stage in which people work to prevent relapse and consolidate the gains attained during action (Andreasen, 1995).

This science has application to many healthcare issues. I believe there is an application in ATOD prevention and the value of this concept solicits many, such as: counselors, prevention specialists, law enforcement, and public health educators to recognize that if we want to make sure our prevention tools are most effective, we will need to recognize the “readiness” of our schools, communities, coalitions, and city councils, in addition to individuals and families.

I often say in my presentations that addiction loves silence. Silence can be harmful if there isn’t an educated “push back” to alert individuals or families to the harms related to unhealthy choices. For example, when systems like schools or courts implement best practices, as opposed to remaining silent, they become positive agents of change that are empowered with the truth for positive and healthy choices and messages.

Here is an example. If a coalition is ripe for change and “gets” the importance of a strong mobilized coalition, and, let’s say, they have a clear handle on what the data says about the different profiles of their community; this community is capable of implementing appropriate tools that can have a level of efficacy since “all the pistons are firing”…i.e. there is support and compliance from all stakeholders and the strategy fits the need. The schools and city councils for example have compassion, focus, and dedication, and are informed about different public health issues such as the negative consequences of smoking, second hand smoke and underage drinking. This scenario would more than likely fit the “action stage” and is potentially capable of maintaining quality work for a sustained period of time.

On the other hand, let’s say a community is in the “pre-contemplation stage” where there are certain “blind-spots” that hinder their ability to understand truth from myth, and hype might drive the energy of the community. In this scenario, it is possible that there may be a strong need for community mobilization to rally the stakeholders to gain a clear sense of need and determine a clear course of action. This community would benefit from a coalition that could champion the necessary strategies to make a difference.

As a result, let’s take action and work to move out of the stages of pre-contemplation and contemplation and begin our efforts to prepare for action to maintain healthy communities that eliminate preventable suffering from the abuse and dependence of mood altering chemicals.

So, are you ready?

Sources:
Anreasen, A.R. (1995). Marketing Social Change: Changing Behavior to Promote Health, Social
Development, and the Environment. San Francisco: Jossey-Bass.