It is important to note that addiction is a major problem, which manifests itself not only as a physiological dependence but also as a psychological struggle to recognize the underlying causes and negative harms. The given case analysis will be centered around Peggy, who has alcohol abuse, which is hindering her life, impacting her family, and making her feel guilty and trapped. The analysis of the case reveals that Peggy is at her preparation stage of the transtheoretical model, and the most applicable treatment option is motivational interviewing.
The case provides a number of indicating factors about Peggy being ready to initiate change in order to eliminate the problem of alcohol abuse from her life. It is stated that “the Transtheoretical Model of Change (TTM) is divided into six distinct stages: pre-contemplation, contemplation, preparation, action, maintenance/adaptation, and evaluation/termination” (Csiernik, 2021, p. 311). The case states that she “knew something needed to change,” and she “was insightful enough to recognize that her chosen method of coping was also fueling the problem she was attempting to cope with.” In other words, she fully recognizes that there is a problem that is hindering her life and wellbeing as well as impacting her family in a negative manner. The provided examples from the case only mean she is either in the contemplation stage or preparation stage. It is stated that “in the second stage of the model, service users become aware that they are stuck in a situation and must decide whether they wish to change or remain where they are” (Csiernik, 2021, p. 313). The case claims that “Peggy shared that she was done feeling this way,” which means that she is both aware of her problem and decided to change. Therefore, she is not in her contemplation stage but rather the following one.
The client is in her early preparation stage because she already recognized the presence of a major addiction issue and made a decision to fight the problem. It is stated that “the third stage, preparation, which is also known as the determination stage, is when service users consider changing their drug-using behavior and anticipate what this future action will entail” (Csiernik, 2021, p. 315). In other words, a person in the described stage is aware of the problematic area, is determined to initiate change, and wants to learn about the ways to recover. Peggy knows that her family is being negatively impacted by her drinking problem, where the highest risk factor is her daughter, who is exhibiting similar behavioral patterns as her mother during the latter’s adolescence. In addition, Peggy is worried about engaging in risky and dangerous behaviors due to her alcoholism, such as driving a car while being intoxicated. In addition, the client states that she “is done feeling this way,” which clearly communicates a firm decision, which only lacks an action plan. Therefore, Peggy has only entered the preparation stage but needs guidance on how she should approach the problem.
The most effective and appropriate treatment approach for Peggy is motivational interviewing or MI. Firstly, it is important to provide a basis on why MI can be used for alcohol addiction. Research conducted among military personnel found that MI “shows promise for decreasing drinking and alcohol dependence among this high-risk sample of non-treatment-seeking soldiers and may complement existing AUD services already provided by the Army” (Walker et al., 2017, p. 99). In other words, alcohol use disorder services were improved by MI, and since the subjects involved individuals with the most resistant types of personalities and preferences, the selected approach could be even more potent for someone, such as Peggy.
Literature focused on MI clearly shows that MI’s effects are both longitudinal and multidimensional. Another study demonstrates that “MI is a promising mode of intervention in treating and preventing substance abuse,” and it can even be effective in telephone and internet formats (Jiang et al., 2017, p. 216). Thus, one can conclude that since the phone and online means of communication are more limited compared to face-to-face counseling, in-person MI will be even more effective for Peggy. When it comes to primary care setting and long-term effect of MI, it is stated that motivational interviewing “intervention delivered in PC reduced negative consequences from alcohol and marijuana use 1 year later” (D’Amico et al., 2018, p. 775). Therefore, Peggy will not relapse in her alcohol addiction at least within a year, which is a significant period of time.
Although Peggy made a direct decision to end her addiction, she has no clear-cut plan for her to execute. The case states: “Peggy reported feeling uncertain about what she could or should do to improve her situation.” In other words, she lacks knowledge, expertise, and a plan of action, which means that her first need is a structured strategy. The second need is emotional, which can only be satisfied with moves in the right direction and progression along the way. Many examples are presented about Peggy’s emotional state, such as feeling scared, hopeless, lost, or overwhelmed. Her readiness level is uncertain, but it looks promising since the perceived risks are too high. She is motivated to change since the addiction endangers her children, especially her daughter, and affects her relationship with the husband.
The counseling option of MI should follow all key components and attributes of motivational interviewing. It is stated that “there are four distinct components to motivational interviewing that are collectively known as PACE: partnership, acceptance, compassion, and evocation” (Csiernik, 2021, p. 320). The emphasis needs to be put on compassion and acceptance since she is emotionally overwhelmed and trapped. The four attributes of motivational interviewing include expressing empathy, developing discrepancies, rolling with resistance, and supporting self-efficacy (Csiernik, 2021). In the case of Peggy, a counselor needs to focus on empathy expression and self-efficacy support because her struggles and barriers are mostly internal rather than external. For example, the case states: “she also reported feeling scared that she did not have the ability to make the changes that might be required for her and her family.” In other words, there is a clear emotional “cocktail” of fear, guilt, shame, hopelessness, and uncertainty about her action plan in regards to combatting the addiction.
In conclusion, Peggy is in the preparation stage of the transtheoretical model of change because she is aware of her issue and no longer ambivalent about what she wants, which means she made a decision to end her addiction. However, she lacks an action plan and structural strategy, which is indicated by her emotions of fear, guilt, shame, hopelessness, and uncertainty. The most appropriate and effective treatment measure is motivational interviewing because the evidence supports its effectiveness against alcohol addiction. The counseling option should focus on compassion and acceptance components with an emphasis on empathy expression and self-efficacy support attributes.
Csiernik, R. (2021). Substance use and misuse: Everything matters (3rd ed.). Canadian Scholars.
D’Amico, E. J., Parast, L., Shadel, W. G., Meredith, L. S., Seelam, R., & Stein, B. D. (2018). Brief motivational interviewing intervention to reduce alcohol and marijuana use for at-risk adolescents in primary care. Journal of Consulting and Clinical Psychology, 86(9), 775–786.
Jiang, S., Wu, L., & Gao, X. (2017). Beyond face-to-face individual counseling: A systematic review on alternative modes of motivational interviewing in substance abuse treatment and prevention. Addictive Behaviors, 73, 216–235.
Walker, D. D., Walton, T. O., Neighbors, C., Kaysen, D., Mbilinyi, L., Darnell, J., Rodriguez, L., & Roffman, R. A. (2017). Randomized trial of motivational interviewing plus feedback for soldiers with untreated alcohol abuse. Journal of Consulting and Clinical Psychology, 85(2), 99–110.