Change can challenge the professional as much as the patient

Truly client-centered, integrated care depends on understanding the complexities of client change and appreciating the difficulties patients can face when unrealistic expectations are placed on them, a renowned architect of Stages of Change theory said in a keynote address Aug. 19 at the National Conference on Addiction Disorders (NCAD).

If Carlo DiClemente, PhD's Denver audience had any doubts about that message, the skepticism probably waned after he asked attendees how they would respond in their own lives to a fictitious study showing that a couple of hours of television watching per week caused brain cancer. Respondents offered every option imaginable, outside of ceasing the dangerous activity.

“We're better at figuring out how not to change than to change,” said DiClemente, professor of psychology at the University of Maryland-Baltimore County.

DiClemente emphasized several basic ways in which addiction professionals should think about client change. First, the mechanisms for change exist in the client, not in the treatment program, he said. “We are all powerless over change.”

In addition, he urged programs to think about the “change burden” they impose on patients in a number of domains all at once, from abstinence to healthy lifestyle choices to a shift in their social network. “A lot of people we're working with have very compromised self-regulatory processes and are exhausted by all the stress,” he warned.

Proceeding to the action stage of change in early recovery could take upwards of six months, he indicated, as it takes that long for the brain to recover from an addictive lifestyle.

Integrated-care projects

DiClemente, whose numerous projects include work at the Center for Community Collaborations at the university, discussed a pair of initiatives that have demonstrated the benefits of collaborative and integrated care. The federally funded No Wrong Door Project at the university established a 15-to-20 minute integrated screening instrument that seeks to uncover key risk information in behavioral, physical and sexual health.

DiClemente pointed out that in using such screens, professionals need to allow for a client readiness stage to unfold between the identification of risk and a referral to treatment. “Sometimes clients said yes [to a referral] only because you told them they had to do it,” he said.

Another project, receiving partial funding from Pfizer, has trained professionals in how to establish effective smoking cessation groups in behavioral health treatment settings. These groups, DiClemente said, have helped to dispel long-held myths among professionals, such as the notion that a substance use treatment patient's attempt to quit smoking will impede recovery from other substance use.

DiClemente's talk was sponsored by Dominion Diagnostics and by WestBridge Community Services, the New Hampshire- and Florida-based treatment provider that is sponsoring a conference track on issues and challenges in the treatment of co-occurring addiction and mental health disorders.