A new model of attitude to change:

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1 A new model of attitude to change: the MASCOT (Melbourne Attitudes to Substance use, Change and Openness to Treatment scale) Matthew Berry

2 Challenge Working with motivation central to AOD treatment Current models not adequate to guide clinical work

3 Stages of Change Precontemplation Maintenance Contemplation Action Preparation

4 Challenges Stages of Change Model describes the person s behaviour with regards to change, but. it doesn t indicate underlying processes and therefore indicate areas of clinical need. These stages are not homogenous.

5 Which stage? come off it mate cannabis is natural and it s not doing anyone any harm. It s only illegal cos they can t figure out a way to tax it! I don t drink any more than the other guys at work we work in a high stress industry it s normal what s the point in trying to change? I ve done more than 20 detoxes and rehabs, done methadone and bup, nothing works for me I don t have a problem I m only here because my corrections officer said I have to be.

I don t drink any more than the other guys at work we work in a high stress industry it s normal what s the point

6 Challenges of SoC e.g at least four types of Precontemplator 1.True Precontemplators happy users come off it mate cannabis is natural and it s not doing anyone any harm. It s only illegal cos they can t figure out a way to tax it!

7 Challenges of SoC 2. Rationalising Precontemplators Repressors I don t drink any more than the other guys at work we work in a high stress industry it s normal 3. Resigned Precontemplators what s the point in trying to change? I ve done more than 20 detoxes and rehabs, done methadone and bup, nothing works for me

other guys at work we work in a high stress industry it s normal 3.

8 there s more 4. Rebellious Precontemplators Deniers (usually reveal to be one of the other types ) I don t have a problem I m only here because my corrections officer said I have to be.

9 Not just precontemplators Also into action I definitely want to get my heroin use under control. Now that I m no longer stressed at work I reckon I can return to weekend use only. I know I can t drink anymore the doc said that I ll bleed to death. I won t have time for aftercare, but I m gonna keep busy as that usually helps.

Now that I m no longer stressed at work I reckon I can return to weekend use only.

10 Three Attitudinal Components of Motivation

11 3 Motivational Hurdles Apparent behavioural motivation seems to come from three factors: 1. Accurate appraisal of problematic behaviour 2. Openness to change 3. Willingness to make changes/engage in treatment

12 1 st : Accurate Appraisal First hurdle is to be able to accept/admit: 1. the extent of their problematic behaviour 1. their level of control, both when they are using, and when they are abstinent

13 Accurate appraisal I don t drink any more than the other guys at work we work in a high stress industry it s normal what s the point in trying to change? I ve done more than 20 detoxes and rehabs, done methadone and bup, nothing works for me

14 2 nd : Openness to change Accepting the problem is only the first hurdle to overcome Clients may also need to open their mind to the possibility of life without substances

15 Openness to change I know I ve got a serious problem, but it s all I know life would be crap without any drug use I ve had clean time up before and, although it was tough at first, it was awesome

16 3 rd Willing to do what it takes Desire to change alone is not always sufficient Willingness needed to follow advice around: making certain lifestyle changes, and for some, to engage in treatment/support Not everyone needs treatment look at past outcomes

making certain lifestyle changes, and for some, to engage in

17 Willingness to do what it takes I know I can t drink anymore the doc said that I ll bleed to death. I won t have time for aftercare, but I m gonna keep busy as that usually helps. I m gonna do my counselling and give those meetings a try. I m also trying out a new medication that the doc says may help

I won t have time for aftercare, but I m gonna keep busy as that usually

18 Examples come off it mate cannabis is natural and it s not doing anyone any harm. It s only illegal cos they can t figure out a way to tax it! Low Acceptance of substance use Low Openness to change Low Willingness to treatment

19 Examples what s the point in trying to change? I ve done more than 20 detoxes and rehabs, done methadone and bup, nothing works for me High Acceptance of substance use Low Openness to change Low Willingness to treatment

20 Examples I definitely want to get my heroin use under control. Now that I m no longer stressed at work I reckon I can return to weekend use only. Low Acceptance of substance use High Openness to change Low Willingness to treatment

21 Examples I know I can t drink anymore the doc said that I ll bleed to death. I won t have time for aftercare, but I m gonna keep busy as that usually helps. High Acceptance of substance use High Openness to change Low Willingness to treatment

22 Measurement of Motivation and the MASCOT

23 Outcomes Importance of measuring motivation: Rapid aid for treatment planning Help to demonstrate improved motivation as a treatment outcome Not concerned with motivation as a predictor of treatment outcome But current tools are very limited.

24 Purpose of a toole Rapid Assessment Help demonstrate treatment outcomes

25 Limitations of current tools #1 Not suitable as pre post e.g. It is urgent that you find help immediately for your drug use TCU CEST: Desire for Help scale

26 Limitations of current tools #2 Problematic in a residential setting. e.g. My drug use is causing a lot of harm or I have already started making some changes in my use of drugs SOCRATES: Problem Recognition and Taking Steps scales

27 Limitations of current tools #4 Assessment tools based on Stages of Change may not be useful for demonstrating service level outcomes

28 MASCOT Melbourne Attitude to Substance use, Change, & Openness to Treatment Constructs underlying motivation to engage in AOD treatment Three scales of attitude (not behaviour) Measure pre post treatment outcomes Relevant across different treatment settings

29 Development process Phase 1 COMPLETE Review of literature (e.g. Hiller et al. 2002; Rosen, 2004; Ekendahl, 2007; Kennedy & Gregoire, 2009 etc.) and current tools, (e.g. SOCRATES, URICA, STOCHQ, CEST) Identification of three factors Development of pilot tool (three 11 item scales) Consultation with AOD clinicians to check face validity

30 Question examples Attitudes towards Substance Use Using drugs/alcohol has made my life worse Attitudes towards Change I can t enjoy life without drugs and/or alcohol Attitudes towards Treatment In treatment I need to do all of the activities my counsellor recommends

31 Development process Phase 2 COMPLETE Trial of tool in Community AOD Forensic Residential AOD Factor analysis for separation of scales and items Reduction to three 6 item scales

32 Development Process Phase 2 Results Sample N = 341 Principal Components Analysis with Direct Oblimin rotation supported 3 factor structure explaining 54% total variance

33 Development process Phase 2 results Reliability analysis Attitudes towards substance use: 11 items a=.80 / 6 items a=.87 Attitudes towards change: 11 items a=.72 / 6 items a=.81 Attitudes towards treatment: 11 items a=.84 / 6 items a=.80

34 Development process (next!) Phase 3 Testing as a pre post tool Forensic, residential, and non resi settings Looking for agencies to get involved!

35 Development process Phase 4 Larger scale normative data across: Residential vscommunity Voluntary vs forensic/mandated AOD vs non AOD setting Primary drug, age, gender etc

36 Phase 5 Development process Release of the MASCOT as a public (free) license tool Publication of study results

37 Thank you More information Matthew Berry and Melanie Kiehne For more info please Jacinta

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