Terry's case: A Youth at Risk

Prochaska-DiClemente

This model is seen as a wheel rather than linear path because most people making change cycle through stages repeatedly before building the motivation and skills for effective action and maintenance. Ambivalence is normal to the decision making process. It is about thinking and feeling, about movement, about conflict between belief and action. A person may stay in the same stage for a length of time, or move back and forth between stages. It is not necessarily a linear progression. Relapse (moving back to an earlier stage) is possible at any time. The support worker has to be ready to work with the person at whatever stage that person is at.

Harm reduction applications fit each stage. The goal or objective in the earliest stages of intervention is to encourage the person to return to your agency. What can you do to help the person stay engaged? The "Stages of Changing Behaviour" model has a great deal of relevance for harm reduction interventions. According to Edith Springer:

The model explains why abstinence oriented treatment model fails more often than it succeeds. People don't leap from a state of ignorance about their problems and no motivation to change directly into action to change. What is missing is the procedure by which individuals recognize that they have a problem and consider how to address that problem. These missing stages translate into the disease model's pejorative description of the state of "denial". Often the literature speaks of the "merry-go-round of denial" and the recommended intervention of "breaking denial" through "confrontation". This process of confronting drug users and insisting that their drug use is problematic and that they must stop is the beginning of a conflict-based relationship which drug treatment encourages and requires. A majority of people who receive such interventions run as fast and as far as they can from this uncomfortable and anti-therapeutic situation.interventions must be individualized. treating everyone the same is "naive."

(New Jersey AIDS Education and Training Center. Taking Drug Users Seriously: Harm Reduction, Participant's Manual. UMDNJ-Center for Continuing Education. Newark, NJ.) as quoted in :

Canadian AIDS Society. Under the Influence. Making the connection between HIV/AIDS & Substance Use. Canadian Public Health Association, October 1997, p. 67-68.