Introduction

Once assessment is completed, the crucial question of how to help a particular individual with their drug problem has to be answered. For some, the immediate response is pharmacological (see Chapter 7), although this is usually only a short-term measure and can only be one component of the total treatment response. But many who seek help have a drug problem with little or no physical dependence and for them there is no drug-specific treatment. For all drug abusers, therefore, it is essential to work out a long-term plan aimed at bringing about change in them and their lifestyle, so that they do not need to take drugs and can cope without them, even if they continue to be freely available.

A person's level of motivation for change is an important factor in determining the likely success of any intervention (and measurement of this will form part of the assessment interview). Of course, not every person presenting with a drug problem will be fully motivated to benefit from treatment, and a person's motivation for change will fluctuate depending on many factors. Most people have a degree of ambivalence, and a number of reasons for and against giving up or changing a habit, and the salience given to each of these can fluctuate even in a short time period. It may be helpful to think of motivation for change as a circle which the drug abuser may go round many times before achieving long-lasting change. The circle of motivation starts with the person not contemplating achange in their behaviour, either because of denial that a problem exists or because of a belief that the problem is unchangeable (‘precontemplative’ stage).