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Client’s perception of situation, reasons for use and motivation to change

To complement the more specific information that is obtained during assessment it is important to gain some insight into the client’s perceptions of their situation, their reasons for using and readiness for change. This, in conjunction with other information obtained, will also inform care planning and treatment interventions. Prochaska and DiClemente have developed a model of change, which is widely used in the substance misuse field. Information to identify which stage most closely represents the client’s position is likely to emerge during the course of the assessment. For example, a client may report that he is fed up with his wife and GP nagging him about his drinking when all he does is go down to the pub with his mates a few nights each week, and his only reason for attending this appointment is to get them off his back. This man is probably at the precontemplation, or perhaps, contemplation stage (he has, at least, presented to the service).
Someone else might tell you that as a consequence of his drinking he has lost his job, has significant debts, his marriage has broken down, and his GP has told him that he has liver damage, he has now had enough and yesterday went to an Alcoholics Anonymous meeting. This man has almost certainly reached the active change stage. Future work would proceed very differently with these two people. Understanding the client’s reasons for using and the perceived advantages and disadvantages of their use can also be important in highlighting areas for intervention. Reflecting on the disadvantages and problems associated with use can also serve to move someone on in the cycle of change.

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