Individual Behaviour Change - Alcohol Misuse - Essay Example

Introduction The field of health promotion and education pursues to educate communities by equipping them with essential skills for sustaining health. First, the paper explores the factors that health promoters should take into account when aiding clients accomplish alcohol cessation. Second, the paper highlights applications of the TTM to the problem behaviour of alcohol abuse. Part A Factors to put into consideration in Helping a Client Cease Negative Drinking Behaviours The factors impacting on behaviour can be categorized as modifying factors, cognitive-perceptual factors, as well as variables impacting on the probability of action (Galloway 2003, p.249). Situational factors may also impact on the behaviour given that it relates to the client’s immediate environment. Family, workplace colleagues, and friends play a critical role in shaping health-related behaviours as they avail social support to the client seeking alcohol cessation (Baban and Craciun, 2007, p.45). Interpersonal factors relate to the social realm and centres on the individual at a personal level, coupled with the expectations that others have in him or her. For instance, an esteemed clinician that counsels a client to quit smoking or negative drinking habits cessation can avail the drive for the client to quit (Johnson et al. 2008, p.1188). Interpersonal factors also relate to factors that predispose individuals to relapse such as frustration and anger, social pressure, and internal temptation. In helping the client abandon negative drinking behaviours, the healthcare personnel should pay close attention to demographic factors encompassing age, gender, racial/ethnic, and educational background. For instance, as the client’s income rise, there is an enhanced probability that the client will be able to pursue and sustain preventative services. This factor relates to the concept of self actualization whereby, if all the core necessities are met, then the client can aspire to higher levels of self-actualization. In most cases, health behaviours differs widely in line with demographic factors, whereby younger, highly affluent, well educated individuals under low levels of stress, and with well established social support, usually manifest typically better health habits. In most cases, the success of intervention behaviours for persons with negative drinking behaviours deteriorates in young adulthood, but improves as the client matures (Hingson, Heeren and Winter 2006, p.739). Furthermore, cognitive-perceptual factors present the principal motivating mechanisms for the acquisition and sustenance of health promoting behaviours (Kleber et al. 2007, p.5). The cognitive-perceptual elements encompass elements such as the client’s perception on: significance of health and the need for to safeguard of health, definition of health, health status, and self-efficacy. Based on cognitive-perceptual factors, diverse forms of programs can be crafted as per the client’s internal versus external locus of control (Stevenson and Sommers 2006, p.28). Lastly, health habits are closely tied to personal goals and values and may be reinforced or dampened by personal goals. Usually, a focus on personal goals essentially yields to self-affirmation and leads to adoption of better health habits. Furthermore, self affirmation also possesses the capability to undermine defensive reactions that crop up to counter health threats. Individuals who are inclined to perceive good health as a personal goal are highly likely to practice effective health habits compared to an individual, who resign their health to chance factors. Risk factors to Negative Drinking Behaviours Genetic factors Research indicates that alcohol dependence, as well as other forms of substance addictions, may be linked to genetic variations within diverse chromosomal regions. Some of the inherited traits may point out a potential, but unproven connection with alcoholism (Anton et al. 2006, p.2003). For instance, inherited traits such as serotonin (neurotransmitter) is associated with behaviours such as relaxation, eating, and sleep with high levels of serotonin being linked to an enhanced level of alcohol tolerance. Social and Cultural pressures The persistence of negative drinking behaviours may be linked to socio-cultural pressures. The media, for instance, frequently depict the pleasures of drinking through advertising and programming. This may be a core cause of the deep entrenchment of negative drinking behaviours. Workplace programs to safeguard against, or reduce alcohol related problems among employees also bear considerable potential given that close associates may have the chance to spotlight the development of alcohol problem at its early stages. Race and Ethnicity Overall, there is no considerable disparity in the incidence of alcoholic prevalence between the various ethnic identities. Although, the cultural or biological causes of such disparities in risks are unknown, certain sections of the population group may manifest a genetic susceptibility or invulnerability based on the manner in which they metabolize alcohol. Psychiatric and behavioural disorders Individual manifesting psychiatric disorders such as severe depression or anxiety are associated with an enhanced risk of alcoholism, smoking, as well as other forms of addiction. Studies have also demonstrated a connection between behavioural disorders and absence of impulse control in which alcohol is strongly connected to impulsive, novelty-seeking, and excitable behaviour. Part B: The Use of Transtheoretical Model in Helping the Client Overcome Negative Drinking Behaviours The trans-theoretical model of change (TTM) represents the basis for developing successful interventions to facilitate health behaviour change and embodies an integrative model of behaviour change (Wright, Prochaska and Velicer 1997, p.38). The model spotlights environmental-level interventions, which pursue to minimize the availability of alcohol, as well as opportunities to drink such as minimizing community tolerance to drinking (Wright, Prochaska and Velicer 1997, p.38). Aspects of the role of counsellor 1. Assessment of the extent of the problem 2. Assessment of mental health issues to determine if there is an underlying mental health problem 3. Highlight the triggers, which may incorporate situations, thought and feelings that stimulates the client’s drinking. 4. Lifestyle changes directed at aiding the client implement appropriate lifestyle changes, such as paying close attention to those that they interact or socialize with and who may draw them into drinking. 5. Self-soothing activities, which encapsulates aiding the client spotlight distractions that help him/her, cope with the cravings. 6. Suggest treatment options by making referrals to residential treatment programmes where appropriate. 7. Availing support and motivating those willing to change Stages of Behavioural Change 1st Stage: Pre-contemplation This represents the stage in which the client with negative drinking behaviours is not intending to take action to remedy the alcohol abuse problem within the foreseeable future (usually estimated to be the next six months) (ODonnell 2002, p.189). The client may not see the problem and may perceive that those highlighting the drinking problem are exaggerating. There are diverse reasons explaining why the client may be in this stage: reluctance (inertia to consider change), rebellion (drinking is a heavy investment to lose), rationalization (client may think drinking is not a problem), and resignation (the client may have lost hope of the potential for change and appear overwhelmed by the problem). The counsellor should heighten the client’s perception of risks and problems with his or her present behaviour. 2nd Stage: Contemplation At this stage, the client is more knowledgeable of the benefits of changing behaviour but may also be deeply conscious of the costs of doing so. This necessitates a balance between the strengths and weaknesses of altering behaviour given that an imbalance can generate intense ambivalence that keeps individuals fixated in this stage for lengthy periods (Diclemente 2006, p.65). The treatment professional should assist the client in making risk-reward analysis whereby the client considers the cons and pros of drinking, and the reasons for previous failures. 3rd Stage: Determination: commitment to action This represents the stage at which the client is resolute in adopting action within the future (in the coming month). The counsellor should aid the client to determine the most appropriate course of action to take in pursuing change and establish a plan (Diclemente 2006, p.65). The considerations of the pros and cons of drinking by the client, coupled with risk-reward analysis eventually tip the balance in favour of effecting change. It is essential to make a reasonable plan given that commitment to change devoid of suitable and applicable skill and activities can only herald an uneven and shaky action plan. It is essential to aid the client acknowledge the problems and pitfalls and establish concrete solutions that are likely to form part of the ongoing treatment plan. 4th Stage: Action: Implementing the plan Action stage represents the stage in which the individual makes certain overt adjustments within their lifestyle in the preceding six months (Wright, Prochaska and Velicer 1997, p.39). The client should be facilitated to put his or her plan into action, utilize skills for problem solving. This stage characteristically encompasses making a public commitment to ditch drinking so as to drive the external confirmation of the plan. As such, the client should join counselling or some form of outpatient treatment, start attending AA if he or she has not done so. Similarly, the client should tell his/her close associates of the decision to stop drinking. Making public the intentions and commitment will aid the client to gain support that he or she requires to recover from alcoholism, and generates external monitors. 5th Stage: Maintenance, relapse, recycling Maintenance represents the stage at which the client is working consciously to safeguard against relapse, but the client need not employ change processes as repeatedly as do people in action (Prochaska and Velicer1997, p.38). The action stage usually takes close to six months to complete and necessitates building a fresh pattern of behaviour over time. The counsellor should aid the client to highlight and utilize strategies to safeguard against relapse, and resolve the associated problems. The real test lies in sustaining the change for extended periods. In this stage, the client should be able to maintain an alcohol-free life as the threat to relapse to old patterns fades away and becomes less frequent. Given that alcoholism is a chronic disease, the potential for relapse still remains and the client should guard against relapsing. 6th Stage: Termination The ultimate objective of the change process is termination. At this stage, the client not expected to find a temptation or threat in alcohol given that he/she has full confidence and ability to cope devoid of fear of relapse. Determining when change occurs: The Constructs Conventional theories of change encompass only a solitary univariate product of success, frequently discrete (Baye 2006, p.161). These constructs encompass the pros and cons derived from the decisional balance scale, temptation or self-efficacy, and the target behaviour. Decisional Balance The Decisional Balance mirrors the individuals’ comparative weighing of the pros and cons of changing behaviour. The four groupings of cons detail instrumental costs to self and others and disapproval from self and others. A predictable equilibrium relates to how the pros and cons connect to the stages of change, whereby in pre-contemplation stage, the pros of alcohol abuse are highly likely to offset the cons of alcohol abuse (Fava, Velicer and Prochaska1995, p.189). Self Efficacy This construct reflects the situation confidence that the client can mange with high-risk circumstances devoid of relapsing. The Situation Temptation Measure mirrors the intensity of urges to engage in certain behaviour amidst intricate situations (Rotgers and Davis 2006, p.100). The situational self-efficacy measure mirrors the confidence of the client not to involve in negative drinking behaviour across a succession of circumstances. How the Desired change occurs Processes of change avail a critical guide for intervention programs given that the processes represent independent variables that the client should apply, or engage in, when moving from stage to stage. This represents the covert and overt activities that client utilize to progress via the stages (Schuckit 2009, p.405). Processes of change: Experiential 1. Consciousness raising (enhancing awareness) Some of the interventions that can enhance awareness encompass feedback, education, media campaigns, and interpretation. In the initial stage of confronting the alcohol problem, the client will most likely manifest ambivalence towards wanting to seize control of the negative behaviour, and may desire to cut back or stop, but the enticement to persist with the behaviour may also be too strong, especially where individuals are either psychologically or physically reliant on alcohol intake. 2. Dramatic relief (emotional arousal) This relates to how the client reacts emotionally to warnings on alcohol abuse. There are several techniques that be employed to move the client emotionally including the use of personal testimonies, media campaigns, psychodrama, and role playing. 3. Environmental reevaluation (social reappraisal) This is recognition by the client that alcohol abuse can be harmful to the environment (interpersonal relationships). Environmental reevaluation joins both affective and cognitive appraisals centring on how the presence, or absence of a personal habit impacts on one’s social environmental such as the impact of alcohol abuse on others. One of the underpinning issues that manifest in the majority of individuals with an alcohol problem is low self-esteem. This may be caused by the family background where the client’s psychological and developmental needs were not sufficiently met as a child. As such, the role of the counsellor centres on establishing whether low self-esteem contributes to the persistence of negative drinking behaviour. 4. Social liberation (environmental opportunities) This highlights appreciation on the part of the client that the society is changing in ways that render it easier for the non-alcohol. This demands an increase within the social opportunities or alternatives, especially for individuals who may be comparatively dispossessed or oppressed (Bandura 1977, p.191). Advocacy and empowerment procedures can generate the necessary policies for health promotion. 5. Self reevaluation (self appraisal) This represents recognition that alcohol dependency makes him/her disappointed in himself or herself. Self evaluation utilizes both cognitive and affective appraisals of the client’s self image with or devoid of presence of a certain unhealthy habit. Processes of change: Behavioural 6. Stimulus control (re-engineering) The client should remove things from his or her environment that remind him/her or entice him/her to taking alcohol. Stimulus control essentially eradicates cues for unhealthy habits and introduces prompts from uptake of healthier alternatives. Avoidance, self-help groups, and environmental-re-engineering can avail stimuli that reinforce change and minimize risks for relapse (Johnson et al. 2008, p.1188). Restructuring the environment Indeed, in the majority of alcohol abuse cases, most clients struggle with their alcohol problems for long periods attempting to keep it under control, before they come to the realization that they cannot achieve this on their own. This stems from the fact that when one is up against addiction, will power, alone is an inadequate resource, a can only take the client so far. This necessitates restructuring the client’s environment so as it support alcohol cessation can be regarded as the key to his or her recovery. As such, is advisable for the client to join support groups such as AA so as to surmount the overwhelming negative drinking behaviour that might be worsened by denial and low self-esteem. 7. Helping relationship (supporting) The client should recognize that he/she has someone who is willing to listen when he/she need to converse about alcohol abuse. Helping relationships mainly merge caring, trust, acceptance, and openness as support for the healthy behaviour change. Rapport building, counselling, and therapeutic alliance can avail social support. 8. Counter conditioning (substituting) This is recognition that undertaking other things is an effective substitute for alcohol abuse. Cuter conditioning demands the learning of fresh and healthier behaviours that can replace the problem behaviours. These may entail relaxation to dissipate stress and assertion to counteract peer pressure. 9. Reinforcement management (rewarding) The client should reward himself or herself when he/she does not take alcohol. This avails consequences for adopting steps within a certain direction. Although, reinforcement can encompass the utilization of punishment, self-changers depend mainly on rewards. Reinforcements may encompass contingency contracts, positive self-statements, and group recognition, overt and covert reinforcements that enhance the possibility that healthier response will be forthcoming. 10. Self liberation (committing) The client should make commitments not to abuse alcohol. Self-liberation embraces the belief that one can alter behaviour and recommit to act in ways that align with that belief. This may entail resolutions, public testimonies, and numerous, instead of solitary choices, that heighten self-liberation (will power). In the event that the client is ready to deal with their negative drinking behaviour, one of the things that the helper must assist the client is to start trusting in himself or herself. Part of this process also entails learning trust individuals who are attempting to provide support. For the client, thus may start with the gradual development of belief, grounded in the support and encouragement rendered by the counsellor, and subsequently can cope with life devoid of resorting to drugs or alcohol. Strengths and weaknesses of Transtheoretical Model The model appreciates that behaviour change is non-linear, dynamic progression. Furthermore, the model is generalizable and avails a connection between stages and processes of change, which informs the targeted interventions. One of the benefits of the TTM details that it bears general implications for a number of areas of intervention development and implementation. TTM model stipulates that individuals normally find themselves within diverse stages and interventions have to be adapted so as to satisfy their needs (Cayley 2009, p.370). Since TTM based interventions are structured to accommodate the requisites of a certain group, this ensures that the dropouts rates are kept to the minimum. The other strength of TTM details that the model avails sensitive measures of progress. Moreover, the TTM eases the examination of mediation mechanisms owing to its stage-like structure. Indeed, the stage-like configuration fosters the process of analysis of changeover patterns from one stage to the other and informs the interventions that are successful for which stage (Leddy 2006, p.209). Challenges may arise amid the application of this model, especially when dealing with intricate behaviours such as bullying. Critics to the model highlight that human functioning as flexible to be grouped into discrete stages. TTM is also criticized for being primarily self-help and for overly highlighting the decision-making capabilities of the individual. Conclusion The Transtheoretical Model encompasses a succession of intermediate/outcome measures that has been effectively employed to diverse health behaviour change interventions such as smoking and alcohol cessation, exercise, addictive behaviours, and dietary change. Transtheoretical Model is an appropriate model to the outlined case of alcohol abuse and bear significant implications to the entire population. One of the strength of this model detail that it manifest enhanced retention rates, which is contrast to conventional models that register high dropout rates. This is made possible by the fact that the interventions are individualized to their needs, and fewer individuals find unsuitable demand characteristics. References List Anton, R. .F, et al. (2006). Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial, JAMA 295(17), pp.2003-17. Baban, A. & Craciun, C. (2007). 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