Chapter 9
CYCLE of
ADDICTION
& CHANGE
EMPOWERING THEM TO MAKE CHANGE, AND ALLOWING THE PEOPLE TO
SEE THE GOOD SIDE OF WHO WE ARE AS PEOPLE AND AS TLINGIT. IT IS
NOT ONLY OUR CHALLENGE, IT IS OUR RESPONSIBILITY.” CHIEF PETER
JOHNSON, TESLIN TLINGIT
9. CYCLE of ADDICTION & CHANGE
9.1 What happens during a Healing Journey?
9.2 Aggression
9.3 Defusing/Calming Techniques
9.4 Stages of Change
9.5 Healthy Behavioural Changes
9.6 Alternatives to Using
9.7 Problem Solving Past Behaviours (Decision Matrix)
“AT THE END OF THE DAY, IT IS NOT ABOUT SHAME AND BLAME, BUT
9.1 What happens during a Healing Journey?
As one enters a healing process, part of the treatment process is to provide an
education of the facts about our cultural trauma in the past, so that your client
understands the social, emotional, spiritual and sexual problems experienced by First
Nations people and communities today and where they fit in this intergenerational
trauma. Through the sharing of this knowledge about our Aboriginal heritage and
achievements, your client is able to enhance their cultural pride in oneself. This
knowledge sharing will facilitate a better understanding of their cultural self identity and
esteem.
First Nations people across Turtle Island have experienced what some have called a
“soul or spiritual wound i (Duran 2006).” This wound has caused the loss of their
values, their economies, their social norms, their sense of spirituality, and even their
language/culture. All has been lost, as a result of the immigration of newcomers to
Turtle Island, residential schools, Indian Act, and other social traumas endured for the
last 500 years. While much learning from the interaction with the European peoples
and other cultures has taken place, the fact remains that the undermining and
displacement of Aboriginal cultures have also left a tragic legacy. While many, perhaps
most, First Nations people have lost much of their own cultures-languages, songs,
ceremonies, values, spirituality, rites of passage and social norms. They have not been
fully integrated into the work force, economy or society of the national society and
culture either. The negative consequences of this situation has been a lifetime of
unemployment, poverty, isolation and a variety of social/psychological problems,
including substance abuse, addictions, family violence, high crime rates, and
extraordinarily high illness rates. The disruption of the lifestyle of our First Nations has
resulted in inadequate parental care, self care, self esteem, identity and high rates of
early death due to the illnesses and deaths associated with accidents, suicides and
interpersonal violence.
The journey to healing involves the development of a personal wellness plan and the
pursuit of a healthy lifestyle that is enhanced with a culturally-centred moral
development and self-care design of personal understanding.
A healing journey is important because it is necessary to process the losses, to move to
a place of empowerment–a process that enables one to be in control of your emotions,
to care for yourself- physically, spiritually, to think rationally, and to achieve your life
goals, to be kind and caring to your family, friends and community.
If one has suffered a great deal of emotional pain and have often felt abandoned or
abused by their parents, other family members or friends, it is important to realize that,
while one needs to embark on a healing journey to live a satisfying and honourable life,
that the journey will take a lifetime. Healing is a lifetime process that allows one to set
their own path for obtaining goals towards their own healing and for reaching their own
inner strengths and life purpose.
A healing journey is a process which helps one work on your own development and
personal healing. It empowers you to grow spiritually and emotionally, which in turn
helps you to feel well, both physically and mentally.
While a healing journey typically involves seeking and securing the help of others and
that healing also involves giving of oneself to other people in need, a healing journey is
ultimately a very personal, individually-driven process.
Part of being an individual is having a specific cultural background and honouring that
heritage is part of the pursuit of your healing journey. An important measure of the
extent to which one has healed is realized when ones healing journey involves helping
others more than in helping ourselves.
A healing process that is consistent with the approaches of many Aboriginal cultures
involves four steps: recognizing; remembering; resolving and reconnecting. Each of
these steps is important to one’s healing journey.
□ Recognition that the unresolved issues in one’s background can only be
addressed by making a lifetime commitment to embarking on a healing journey.
□ Remembering means recalling gaps and traumas in one’s past that may have
become the obstacles to one’s own personal development.
□ Resolving involves the difficult task of “working through” the emotional, mental
and spiritual wounds; and the unresolved conflicts that have blocked personal
development and recovery from substance abuse habits.
□ Reconnecting is the part of healing which guides our life purpose, when an
individual is moving beyond themselves and into being actively involved with the
world around them, contributing to the well-being of others, including family,
friends, and in their community.ii
9.2
Aggression
The following information can assist you, on how to effectively deal with aggressive
people. Aggression is defined as an act of initialing hostilities or invasion, the practice
or habit of launching attacks or hostile or destructive behavior or actions according to
the American Heritage® Dictionary of the English Language. It is not just our own
anger in aggressive situations that can get overwhelming. Another person’s blow up
can also trigger intense reactions in us, including shock, fear and even reactive rage
Aggression is a situation in which an individual becomes actively engaged in the pursuit
of a specific goal or action. Some forms of aggressive behaviour are healthy, such as
the aggressive pursuit of a career, or proactively initiating a discussion with people at a
social event. However, a behaviour of this type can move on to become negative when
it limits ones social and work opportunities, especially when accompanied by anger.
Sometimes sudden changes in behaviour can be attributed to medication. Both
prescription and non-prescription medications can cause a normally balanced person to
suddenly become both aggressive and somewhat combative. This is especially true with
medications that are used to treat different types of psychological issues. Some antiseizure medication may trigger a sudden increase in aggression.
Injuries to the brain can also lead to the development of aggression. Research says that
severe trauma to the head that causes the brain to bounce within the skull may lead to
bruising that in turn impacts the brain’s production of different types of
neurotransmitters. The result is that an individual is overcome with intense feelings of
anger and is likely to lash out at anyone within relatively close vicinity. Often, the
behaviour will fade as the brain begins to heal, especially if medication is taken to help
compensate for the imbalance of neurotransmitters.
Aggression can also occur when an individual is recovering from some type of
addiction. When some people stop smoking, they often feel agitated and may exhibit
short tempers, impatience, and other forms of aggressive behavior as the body goes
through withdrawal. When recovery from addiction is the root cause for the aggressive
tendencies, using some type of medication to calm the body while it adjusts to the new
set of circumstances will often soothe the tendency to engage in aggressive behavior
and allow the individual to begin enjoying life once more.
Emotional traumas can also lead to aggression. The death of a loved one, the loss of a
job/innocence, or the diagnosis of a life-threatening illness can often create an
emotional imbalance that is evident by bouts of aggressive behaviour. Therapy along
with medication can often help move the healing process along, and help your client
recover from the trauma. As their healing progresses, the episodes will likely occur less
frequently, while also becoming shorter and less intense.
Relational aggression is a type of aggressive behavior that uses social skills — usually
within a group — to inflict nonphysical pain on an individual or individuals. There are
several different types of relational aggression: betrayal, exclusion or solitude, gossip,
humiliation, and lies. Also known as covert aggression or covert bullying, this type of
psychological abuse is most prevalent among adolescents and teenage girls.
If someone is experiencing what seems to be an abnormal amount of aggression, they
should seek medical assistance immediately. The unusual behavior may be a sign of an
emerging health issue, or be due to factors that can be easily identified and corrected.
Seeking help sooner rather than later helps to minimize the damage that aggressive
behavior can do, especially in terms of personal relationships and job opportunities
Understanding Aggression
One of the tricky things about handling another person’s anger/rage is reacting in a way
that will not escalate their aggression. When one understands the stages of aggression,
one is able to respond appropriately.
Research shows patterns commonly found in aggressive reactions to situations. This
Aggression Curve shows how aggressive reactions progress in stages, and in each
stage there are appropriate responses.
The Aggression Curve:
1. RATIONAL BEHAVIOR. At the base of the curve is rational behaviour. This is the
stage when a reasonable discussion about the cause of the aggression can happen.
Before a reaction, a person is said to be in that ‘rational’ frame of mind. However, once
the aggressive reaction takes root, people go into a state of mind where you are not
able to reason with them. It is important then to get the person back to a rational frame
of mind.
Note: You cannot reason with a person during these times: when their aggression is taking off, at the
height of their anger/ rage and even at the point when they are cooling down! You’ll just waste a perfectly
good argument.
2. TAKE OFF. The aggressive reaction slowly builds momentum, and the point when
the aggression is gaining energy is called the ‘take off’ stage. The way aggression
builds in intensity differs from person to person. Some people start with hostile facial
reactions, which progresses to shouting, and which progresses to hitting the table.
Other people build up aggression in less obvious ways, they start with keeping quiet
and then progress to physically withdrawing themselves from other people. The
aggression continues to build energy until it reaches its peak.
Note: Aggression naturally builds energy during the take off phase. Arguing back at this point in fact, any
conversation would just be a waste of time and energy. Don’t react! Respond.
3. SLOW DOWN. This stage is the most intense for the person’s aggressive reaction. It
is a turning point; the reaction stops gaining momentum and begins a steady slow
down.
4. COOL DOWN. Once the reaction has reached its height, it will start to subside. You
can tell by observing the person’s behaviour --- often their voices go down to a level
tone, they are not moving their hands as much and they appear to breathe easier.
Unless provoked further, the person will run out of steam. However, if you start arguing
with the person or agitating those even during this stage, their reaction can take off
again.
Note: Only when the reaction has slowed down can you introduce supportive behaviour. Supportive
behaviour can be any statement that acknowledges the aggression. “I can see that this is an upsetting
experience for you.”
5. BACK TO RATIONAL BEHAVIOR. Once the person has returned to this stage, you
can begin to start talking about the problem reasonably. You may start problem solving
at this point.
Conclusion: When a person is aggressive, just let them vent! It’s the fastest way to deal with the
situation.iii
9.3
Defusing/Calming Techniques
Defusing/Calming techniques are skilled interventions designed to assist a person’s
cooling down process, reducing the possibility of getting verbally or physically hurt, and
gain control of a situation.
The following are examples of defusing/calming techniques:
1. Practise Active Listening
Most of the time, all an aggressive person needs is an opportunity to tell someone how
they feel, and have their anger acknowledged. Seeing that you are genuinely listening
to their complaint or hurt can help lessen the intensity of their angry reaction.
a. Show non-verbally that you are listening
Make sure that your posture shows openness- arms are not crossed. Establish eye
contact. Speak in a soft, non-threatening tone of voice.
b. Reflect
Re-state what you hear from the person.
“This is what I heard from you: You are mad because every time you go to treatment,
no one will answer your questions.”
You can also mirror back their body language in a certain but non-judgmental fashion.
“I can see that you’re really upset. You are holding your purse very tightly.”
c. Clarify
Help the person make sense of their garbled, confusing and/ or illogical statements.
“Could you help me? Explain to me, a bit more about what happened in the dining
room? What do you mean by ‘he bullied you’?
2. Increase Your Person Space
Aggression can escalate if a person feels that he is being silenced. Make sure your
body language is non-threatening. Create some distance between you and your client.
3. Help A Person Recover A Sense of Control
Aggressive people may feel victimized by a situation, and may need to recover even a
small sense of control. You can help do this by:
a. Give them choices
“Would you like to move to a different area, so we can talk?”
b. Seeking their permission to speak
Can I tell you, what I think about what just happened?
c. Focusing on immediate solutions
“What do you think we can do today to help solve this issue?”
4. Orient Them to the Here and Now
People temporarily loses track of their immediate surroundings at the height of getting
overwhelmed. Orienting the person to the time, their location, and whom they are with
can help defuse/calm a person. It helps a person feel less threatened, if they know
where they are and how they got there. The goal is to shift from attending to their
overwhelming feelings to recovering rationality.
5. Invite Criticism
Ask the client to voice his or her criticism of you or the situation more fully.
"Go ahead. Tell me everything that has you upset. Don't hold anything back. I want to
hear all you have to say."
6. Agee If Possible, If Not, Agree To Disagree
There are times when aggression is triggered by a very valid reason. In these cases, it
can help a client lose steam by hearing someone validate the presence of their injustice.
At the very least, agreeing that a person has a right to the opinion they have can help
defuse/calm their emotions.
7. Enlist Your Support
Emphasize your willingness to help.
“Okay. I don’t know how this thing could have happened, but you have my assurance
that I’ll be here with you until we figure it out.”
8. Set Limits
Tell the client that you are willing to listen, but you’d appreciate that they tone down their
expression of aggression.
“I’m listening right now. I’d like to talk, but without all the yelling. When you shout, it is
distracting, and if this issue is important to you, then I want to be able to concentrate
without hearing you raise your voice. Can we start again? How did I upset you? “
9. When to Back Away and What to Do Next
Not all aggressive reactions can be effectively dealt with. Here are situations when it is
more advisable to back away:
a. When you are too affected by an issue to view it objectively.
Defusing/calming aggression requires that you can take yourself out of an issue, even
temporarily, and look at it objectively. If the issue has personal meaning for you, or you
are too tired to properly intervene, then you don’t have the resources to defuse/calm the
aggression.
WHAT TO DO: Withdraw from the situation and talk to someone you trust about your
own feelings.
b. When there are warning signs for verbal and/ or physical violence.
Your priority is always your well-being and safety.
Warning signs for violence include a history of violent behaviour, severe rage for
seemingly minor reasons, possession of weapons and threats of violence.
WHAT TO DO: Get as far away from the person as you can! Call for assistance or go to
a public place.
c. When there is influence of mood-altering substances.
No defusing/calming technique can help you deal with a client who has taken alcohol
and mood-altering drugs (some anti-depressants and hallucinogens).
WHAT TO DO: Disengage from the conversation and talk to them when they’re sober!
d. When no amount of rational intervention seems to work.
There are moments when a client is hell-bent on raging, and the aggression will
escalate regardless of what intervention you use. It is possible that the strength of the
aggression is significantly more than the client’s resources to cope. This is signalled by
a tendency for the aggression to take off even after slowing down and cooling down,
despite the absence of provocation.
WHAT TO DO: Disengage from the conversation and re-schedule the talk for another
time.
e. When there are signs of serious mental health conditions.
Watch out for: that the client believes they are being ill- treated wrongly or having
paranoid delusions, hallucinations, past history of violence based on delusions. Chronic
and rigid patterns of the use of aggression as coping mechanism may point to a
personality disorder.
WHAT TO DO: Compassionate understanding is important. Disengage yourself
immediately as some psychotic symptoms are correlated with a tendency towards
violence. Refer client to an appropriate mental health professional.iv
9.4
Stages of Change
The research-based Transtheoretical Model of Change (DiClemente & Prochaska,
1998v) is the theoretical basis for many interventions that effectively promote behaviour
change. This model emphasizes the decision making of the individual and has been
applied to a wide variety of problem behaviors including alcohol and drug abuse,
smoking, and overeating. The Model of Change describes change as a process—rather
than a single event—that involves progress through a series of stages. The Model of
Change are the Stages of Change and the Processes of Change. By providing
structured guidance, counsellors can support their clients’ motivation to change and
enhance the effectiveness of their efforts.
Pre contemplation: The pre contemplation stage is a time when clients who do have a
substance problem are not convinced that they have a problem or that substance abuse
is the least of their problems. They are not willing to consider change or have lost
confidence in their ability to change.
Pre contemplation: Who, me? I don’t have a problem. Maybe you have a problem with me, but
I’m fine just the way I am.
Here are some motivational strategies for the precontemplation stage.
 Encourage their client to think about and discuss their problem behaviours.
 Establish with their client a relationship of mutual trust.
 Raise doubts or concerns in your client about his problem behavior patterns:
 Explore the meaning of the events that brought your client to treatment or the
results of previous treatment episodes.
 Ask for your client’s perceptions of their problem behaviors.
 Provide personalized feedback on your assessment findings related to their
problem behaviors.
 Explore the costs and benefits of continuing their problem behaviors. Offer
factual information on the risks of continuing their problem behaviours.
 Help a significant other intervene.
 Examine discrepancies between your client’s and others’ perceptions of their
problem behaviors.
 Express concern and support
Contemplation: At this stage, the client with the substance abuse problem is actively
considering the possibility of change. People in this stage are evaluating options but
they are not ready to take action.
Contemplation: Hmmm, I wonder if things are getting a little out of hand. Should I make a
change, or leave things as they are? What are the pros and cons of changing? I need some
more information before I can decide.
Motivational Strategies for the Contemplation Stagevi
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Assist their client to evaluate their choices regarding change options
Identify ambivalence toward change as normal.
Support their client in tipping the decisional balance toward motivation to change:
Invite your client to examine his own needs and desire to change rather than
react
to external pressure to change.
Guide your client in exploring the costs and benefits of change.
Examine your client’s personal values in relation to change.
Emphasize your client’s freedom of choice and ability to change.
Ask your client’s perceptions of his ability to change.
Encourage the client to express statements of intent and commitment to change.
Ask your client’s expectations regarding treatment
Preparation: In the preparation stage, the client makes a commitment, as well as,
prepares initial plans to take immediate action.
Preparation: Well, this is it. I’m really going to do something about it. I’ll start small and see if I
can really stick with it. Wish me luck!
Motivational Strategies for the Preparation Stage
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Help their client prepare a plan for change
Guide your client to clarify their goals for change.
Explore your client’s options for change or treatment. Ask for your client’s
strategies that have been successful for them or for their acquaintances.
Negotiate a treatment plan and a change plan.
Explore the barriers to change (e.g., a lack of child care, a lack of transportation,
financial problems) and support your client in addressing these barriers.
Encourage your client to enlist the support of family and friends.
With permission, offer information and advice.
Action: Once your client begins to take action to remedy their problem, they are
considered to be in the action stage of change. In action, your client is either abstinent
or managing to significantly reduce his or her substance use and is not getting high
when using. At this stage, your client is also adopting strategies to prevent a relapse
and a return to the problem behaviour.
Action: I’ve made a plan and I am following through with it. I’ve already made some small
changes that will help get me to my goal.
Motivation Strategies for the Action Stage
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Affirm their client’s successful behavior changes and support their client in
addressing barriers to change.
Continue to engage your client in their wellness.
Encourage small steps toward change.
Assist your client in identifying relapse triggers and developing a plan for
managing those triggers.
Reinforce positive changes.
Continue to identify family and other social supports.
Continue to offer information and advice, with permission, as your client is
ready.
Maintenance: The maintenance stage of change is one in which your client stabilizes
the changes he or she has made and integrates them into his or her lifestyle.
Maintenance: I did it! I’ve been doing great for over six months now. This is the new me, and I
like it. I don’t even think about my old behaviour that much anymore.
Motivation Strategies for the Maintenance Stage
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Reinforce their client’s commitment to change and support their client in
managing triggers to use, creating a coping plan for relapse prevention, and
processing any change successes and challenges.
Affirm your client’s ability to change.
Acknowledge positive changes.
Assist your client in practicing coping strategies to avoid a return to problem
behaviors.
Assist your client in processing relapses and developing a plan to avoid
relapses.
Monitor and review your client’s progress toward long-term goals.
Termination: In this stage, your client is stable, has support systems, self help
techniques and coping well with their life.
Termination: Who, me? I don’t have that problem anymore. I did have a problem in the past,
but it’s been years now since I changed all that. vii
9.5
Healthy Behavioural Changes
This is an opportunity to help your client learn new, healthy behaviours to substitute
for their previous activities that have centred on their use of alcohol and other drug
use. Your client can use the change process to avoid engaging in activities that are
linked with alcohol and drugs use. By replacing tempting activities with healthy,
substance-free ones, your client will be using the change process to evaluate the
short and long term negative and positive effects of their substance abuse. The
positive consequences of avoiding substance use will reinforce your client’s efforts
to participate in healthy substance-free activities in the future.
Stress the importance of learning new, enjoyable behaviours that can be substituted
for the old way of living. Tell your client that people often complain of boredom after
they quit using because so much of their time was spent involving alcohol or drugs.
Facilitate a discussion identifying specific times during their day (or week) when this
boredom sets in. For some, this might be in the evening, or every Friday night–
times when they used to be occupied by their substance use activities.
Use the following examples to assist your client through the process of finding
Healthy Behavioural Changes.
9.6 Alternatives to Using
Have your client brainstorm different alcohol and drug-free activities they can enjoy,
include what they are doing currently as well as in their past for enjoyment, discuss.
Write these suggestions down as they respond. Suggestions might include something
they used to do without using or could be spending time with friends, watching a sport,
and listening to music. Is there something new they want to try? Discuss this
emphasising that for some clients these actions could tempt them to use again, while for
others, this can be a strong reinforcement that they no longer depend on substance
abuse to fill their time.
Alternatives Activities to Using:
Biking
Drawing
Woodworking/metal projects
volunteering at....
Paint by numbers
floral arranging
Reading
Puzzles
Writing letters/poetry/book
Swimming
Baseball
Hockey
Running
Photography
Learning a musical instrument
Juggling
Getting a pet
Cooking
Cleaning
Going to school
Working on a vehicle
travelling
Designing clothes
sewing/quilting
Beading
making crafts
Tree planting
gardening
Singing
meditating
Fishing
hiking
Coffee/tea clatching
computer training
Dancing
drumming
Walking
visiting/call a friend, neighbour
Cutting wood
hunting
Trapping
sober party
Pottery/tool making
snowshoeing
Identify Potential Roadblocks
Have your client think about things that might “get in their way” of these activities.
Choose a few suggestions from the list to demonstrate examples of potential
roadblocks. Potential problems may include someone who wants to play sports but
may have a lack of equipment. Write these examples on the list next to their
respective activities. Have your client write and discuss potential problems or
distractions for the activities they have written on their list.
Problem-Solve the Roadblocks
It can often be helpful to try and solve potential problems or difficulties before they
actually arise. Using the examples you have written on the list, have your client
discuss things that can get in their way and the ways to overcome these barriers;
write these down. Assist your client in implementing these new lifestyle changes by
connecting them with the resource(s) that they require.
Problem-Solve the Roadblocks
SPIRITUAL
EMOTIONAL
PHYSICAL
MENTAL
See Appendix P for a blank copy of this exercise.
9.7 Problem Solving Past Behaviours (Decision Matrix)
To assist your clients in understanding how to problem solve their past behaviours a
decision matrix has been developed. When clients complete a decision matrix, they are
actually exploring their "reaction" between an internal experience (a thought or feeling)
and a behavioural/emotional response. In the past when they encountered a situation,
they responded with acting out behaviour. After participating in a wellness program, it is
assumed that they no longer see their old response connection the way they use to.
When your client explores the way they use to react connection of their old behaviour
and the response of their new, adaptive behaviour; they will make the connection that
they have changed.
Also, all experiences have a cost and a benefit. That is, all experiences have positive
attributes and negative attributes. In their past, their acting out behaviours had things
that they did not like (costs--like waking up with a hangover) and things they did like
(benefits--like getting high). It is the hope that they do not see these costs and benefits
in the same way as they did in the past. As a result, they should have a new set of
costs and benefits for their past behaviour. Their new behaviour also has costs and
benefits that may or may not be related to the old costs and benefits. What resources
did they use in the past and what are their new resources needs to be determined.
Problem Solving Past Behaviours
On the attached form fill in the appropriate boxes:
Describe potential
Problem:____________________________________________________________
___________________________________________________________________
___________________________________________________________________
Old Behaviour in the
past
View of past
behavior today
Benefit
1. feeling accepted
by others
2. relieve craving
3.feel
relaxed/high/creative/
better/socially
comfortable
4.forget/get to sleep
1. not same person
Cost
1. loss of job
Resources
1. stealing
2. loss of family
3. poor health
2. lying
3. alcohol/drugs
4. no home
1. old friends gone
4. used friends
1. family present
2.lost time/life
2. new skills
3. sick
3. dental work
required
4. no cultural
activities
1. making new
connections without their
substance
2.need to upgrade
skills lost
2. new healthy
relationships
3. finances
4.loss of self identity
New response to
avoid past
behaviour
1.Creator loves all
individuals
2. I know who I am
and where I am
going
3.eating healthy and
exercising
4. I am a kind and
caring person.
3. physical pain
and suffering from
poor diet
4. loss of family
4. connected to
traditional healer
1. connected to
traditional healer
2. spirit name
and clan
3. knows
importance of
healthy eating
4. parenting
skills training
See appendix Q for a blank copy of the decision matrix.
i
Adapted from Prevention and Management of Aggressive Behaviours training
ii
Information source: Aboriginal Healing Foundation Annual Report 2002 located at:
http://www.ahf.ca/downloads/annual-report-2002.pdf
In the Words of our Ancestors- chapter 1 Sharing our Gifts, pg14.
v
Prochaska, J.O. DiClemente, C.C., & Norcross, J.C. (1998). Stages of Change:
Prescriptive Guidelines for Behavioral Medicine and Psychotherapy. In G.P. Koocher,
J.C. Norcross, & S.S. Hill III (Eds.), Psychologists’ Desk Reference. New York, Oxford:
Oxford University Press.
Prochaska, J.O. Johnson, S, & Lee, P. (1998). The Transtheoretical Model of Behavior
Change. In S.A. Shumaker, E.B. Schron, J.K. Okene, & W.L. McBee (Eds.), The
Handbook of Health Behavior Change (Second Edition). New York: Springer Publishing
Company
vi
Adapted from
http://www.motivationalinterview.org/Documents/LearnersManualforMotivationalIntervie
wing.pdf
vii
Prochaska, J. and DiClemente, C. (1983) Stages and processes of self-change in
smoking: toward an integrative model of change. Journal of Consulting and Clinical
Psychology, 5, 390–395.
Prochaska, J. and Velicer, W. (1997a) Introduction: the transtheoretical model.
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Prochaska, J. and Velicer, W. (1997b) The transtheoretical model of health behaviour
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Prochaska, J., DiClemente, C., Velicer, W. and Rossi, J. (1993) Standardised,
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