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College Drinking Prevention - Changing the Culture

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Motivational Interviewing (MI)

How Does Behavior Change?

From Behavior A to Behavior B (image of person thinking)

Assumptions

  • Behavioral issues are common
  • Change often takes a long time
  • The pace of change is variable
  • Knowledge is usually not sufficient to motivate change
  • Relapse is the norm

Transtheoretical Model

This diagram shows the Transtheoretical Model as an iterative process beginning with Pre-contemplation, then Contemplation, Determination, Action, Maintenance, Relapse, back to Pre-contemplation. There is also connection from Maintenance to Termination (Exit), as well as a connection between Action and Relapse. In the process, movement can also occur from Relapse to Contemplation or Determination.

Prochaska & DiClemente: Stages of Readiness to Change

Stage Description Objectives
Pre-contemplation Not considering change image of red arrow Identify patient’s goals
image of red arrow Provide information
image of red arrow Bolster self-efficacy
Contemplation Ambivalent about change image of red arrow Develop discrepancy
between goal & behavior
image of red arrow Elicit self-motivational
statements
Determination Committed to change image of red arrow Strengthen commitment to change
image of red arrow Plan strategies for change
Action Involved in change image of red arrow Identify and manage new barriers
image of red arrow Recognize relapse or impending relapse
Maintenance Behavior change image of red arrow Assure stability of change is stable
image of red arrow Foster personal development
Relapse Undesired behaviors image of red arrow Identify relapse when it occurs
image of red arrow Reestablish self-efficacy and commitment
image of red arrow Behavioral strategies
Termination Change is very stable image of red arrow Assure stability of change

Principles of MI

1. Advice

  • Give advice only when individuals will be receptive
  • Target advice to stage of change

2. Reduce Barriers

  • Bolster self-efficacy
  • Address logistical barriers

3. Provide Choices
It’s the individual’s choice:

  • Whether to change
  • How to change

4. Decrease Desirability
Help individuals:

  • Decrease their perceptions of the desirability of the behavior
  • Identify other behaviors to replace the positive aspects of alcohol use

Reflective Listening

  • Mirrors what the patient says
  • Creates a sense of safety for the patient
  • Deepens the conversation
  • Helps patients understand themselves
  • Says:
    • I hear you
    • This is important
    • Please tell me more
    • I’m not judging you

Reflective Listening (continued)

Patient:  To tell you the truth, I really enjoy drinking.
Response:    You like drinking alcohol?
Patient:  Yes. I like the taste, and it really relaxes me.

Example 1:

“My girlfriend gets really angry when I get drunk and pass out.”
“She gets mad when you do that.”

Affirmation

  • Conveys support, respect, and encouragement
  • Helps patients reveal less positive aspects about themselves
  • “You’ve tried very hard to quit.”
    “You are very courageous to be so revealing about this.”
    “You’ve accomplished a lot in a short time.”
    “I can understand why drinking feels so good to you.”

Summarization

  • “What you’ve said is important.”
  • “I value what you say.”
  • “Here are the salient points.”
  • “Did I hear you correctly?”
  • “We covered that well. Now let's talk about ...”

Elicit Self-Motivational Statements

Problem recognition

  • “Has alcohol caused you any problems?”

Concern

  • “Do you ever worry about your alcohol use?”

Intention to change

  • “What might be some advantages of quitting or cutting down?”
  • “On a scale of 0 to 10, how important do you think it is for you to quit? Why didn’t you say (1 or 2 points lower)?”
  • “On a scale of 0 to 10, how important is it for you to change your (behavior)? ”
  • “Why didn't you say (1 or 2 points lower)?”

Optimism

  • “What difficult goals have you achieved in the past?”
  • “What might work for you if you did decide to change?”

For Ambivalence - DEARS

Develop discrepancy

  • Compare positives and negatives of behavior
  • Positives and negatives of changing in light of goals
  • Elicit self-motivational statements

Empathize

  • Ambivalence and pain of engaging in behavior that hinders goals

Avoid Arguments

  • Don’t push for change, avoid labeling

Roll with resistance

  • Change strategies in response to resistance
  • Acknowledge reluctance and ambivalence as understandable
  • Reframe statements to create new momentum
  • Engage patient/client in problem-solving

Support self-efficacy

  • Bolster responsibility and ability to succeed
  • Foster hope with menus of options

 

Historical document
Last reviewed: 9/23/2005


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