Using Stages of Change "Tool" to Promote
Following the Low Risk Drinking Guidelines

Beginning the client intervention:

Part of my job as a health professional is to prevent needless illness and injury in my clients. Following a healthy lifestyle including reduc tion of alcohol intake helps reduce risks for many chronic diseases, injury and negative social behaviors. Are you a ‘low risk’ drinker?  Low Risk Drinking is a term used to describe an approach that encourages healthy adults to make informed decisions about their alcohol consumption in order to minimize risk.

Goal:

To encourage reduction in alcohol consumption to a level that is considered to lower risk for individuals.  See the Low Risk Drinking Guidelines. www.lrdg.net

ASK about the client’s use of alcohol:

Suggestions:  Explore the following questions with your client:

• Have you or your family and friends ever felt that you should cut down on your drinking?
• Have you ever felt bad or guilty about your drinking?
• On a typical day, how many drinks do you have?
• On average, how many days a week do you drink alcohol?
• Turn to In a Nutshell for more advice on the health and social effects of alcohol.

* Discussing LRDG’s as part of a BCI may not be appropriate with the alcohol dependant person who most likely requires more intensive treatment with abstinence as a treatment goal.  See Quick Reference for details on how to assess the differences between the problem drinker and the alcohol dependant drinker according to CAMH (Centre for Addictions and Mental Health). Referral to treatment may be indicated at this point. See treatment/referral options in the Relapse section of this document. See below for the risk continuum as it relates to alcohol consumption.  The BCI approach is only intended for those who are exceeding the LRDGs but who do not demonstrate signs of alcohol dependence.*

ASK the following staging question: Are you thinking of changing your drinking behavior NO YES

If YES, ADVISE the client about the health benefits of the Low Risk Drinking Guidelines:
Suggestions:         

• Are you aware of the Low Risk Drinking Guidelines? See link for further details www.lrdg.net
• Are you aware of the negative health and social effects of excess alcohol consumption?

See link In a Nutshell for moreadvice on the health and social effects of alcohol.

 * The Low Risk Drinking Guidelines were developed to provide people with a lower risk alcohol consumption guideline if they are of the legal drinking age and do not have any of the following:  liver disease or mental illness; taking medications such as sedatives; sleeping pills or pain killers; family history of cancer or other risk factors for cancer; pregnant, trying to get pregnant or breastfeeding; operation of a motorized vehicle such as a car, truck, motorcycle, boat, snowmobile, all-terrain vehicle, bicycle or farm equipment; responsible for the safety of others at work or home and reasons either medically or legally that prohibits use of alcohol. *

Click on the appropriate stage below for examples of what the health professional might say to clients that are exceeding the LRDGs.  These are suggestions to stimulate your thinking about what you want to say to that particular client.

Client is not intending to change drinking behavior in the foreseeable future.

Goal for Client Intervention:

• Encourage understanding of how drinking increases risks to health and safety.

 Intervention Options:

Ask: Ask the client to think critically about their drinking behavior.

• What are the positive and negative experiences that are associated with your drinking?
• What factors influence your decision to drink or not to drink?

Advise: Increase awareness of particular risks associated with drinking.

• Your risk for adverse health and social outcomes is reduced when you follow the LRDGs.

Assist:

• Encourage critical thinking about current drinking behavior
  How would you know if your drinking was a problem for you?

• Support belief that following the LRDGs will improve health.
  Every little bit counts!

• Foster belief that people can change behavior.
  One small step in the right direction usually leads to another.

• Provide resources if willing.
  This information is new for many people.
  Have a look and see how your drinking behavior compares with the LRDG recommendations.

Resource Options:  

• Low Risk Drinking Guidelines www.lrdg.net
• Centre for Addiction and Mental Health www.camh.net
• Simcoe Muskoka District Health Unit www.smdhu.org

Future Intervention:

Ask:

Have you thought about reducing your alcohol consumption?

NO		Still PRECONTEMPLATION
YES		CONTEMPLATION

Click on Contemplation (or whatever stage they are at) below for examples of what the health professional might say to clients.  These are suggestions to stimulate your thinking about what you want to say to that particular client.

Client is intending to follow the LRDGs within the next 6 months.

Goals for Client Intervention:

• Encourage the examination of pros and cons of reducing alcohol consumption to fit within the LRDGs.
• Promote confidence in their ability to follow the LRDGs.

Intervention Options:

Ask:  Ask about the pros and cons of reducing alcohol consumption.

Advise: Emphasize the benefits of following the LRDGs.

Assist:

• Encourage talking about their reasons for reducing their alcohol consumption.
  How do you think reducing your drinking will benefit you?

• Encourage talking about their concerns about the process of reducing their alcohol consumption.
  Have you thought about how you will reduce your alcohol consumption?

• Encourage examining some concerns and barriers to reducing alcohol consumption.What problems do you think you’ll run into?

• Gently offer possible solutions that have worked for others.
  Some people have tried __________ to get around that.

• Foster a positive belief in their ability to do it.
  I have every confidence that you will be able to……

• Provide information.
  This resource gives good reasons to follow the LRDGs

Resource Options:  

• Low Risk Drinking Guidelines www.lrdg.net
• Centre for Addiction and Mental Health www.camh.net
• Simcoe Muskoka District Health Unit www.smdhu.org

Future Intervention:

Ask:

Have you thought more about following the LRDGs?

NO		Still CONTEMPLATION
YES		PREPARATION

Click on Preparation (or whatever stage they are at) below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Goal for Client Intervention:

• Encourage the replacement of the client’s typical drinking patterns with those in keeping with the LRDGs.

Intervention Options:

Advise: Focus on meaningful benefits.
Your risk of________________ will improve if you can plan the first and next steps to  decreasing the amount of alcohol that you consume in a day/week.

Assist:

• Assist to verbalize a plan with a starting point to decrease alcohol consumption
  Tell me what your plan is to reduce the amount of alcohol you consume in a day/week. 

• Encourage the inclusion of family or peer support.
  Who is going to do this with you or encourage you to continue with it?

• Discuss what has worked and not worked in the past.
  What worked and what didn’t work when you tried to reduce your alcohol consumption in the past?

• Encourage avoiding, changing or removing cues that get in the way of decreasing your alcohol consumption
  What do you see as your biggest barrier?  i.e., stress, loneliness, social events, friends, environment etc.
  How do you plan to get around it?

• Explain that relapse is part of the process and a learning experience.
  Some people experience some set backs.  It is what they learn from them and trying again with a better plan that moves them forward.

Resource Options:  

• Low Risk Drinking Guidelines www.lrdg.net
• Centre for Addiction and Mental Health www.camh.net
• Simcoe Muskoka District Health Unit www.smdhu.org

Future Intervention:

Ask:
The last time we spoke you were making a plan to reduce drinking.  Have you been able to follow your plan?

NO		Still PREPARATION
YES		ACTION

Click on Action (or whatever stage they are at) below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Client has followed the LRDGs in the past 6 months.

Goal for Client Intervention:

• Assist to set and meet daily goals.

Intervention Options:

Ask: Ask the client about a relapse prevention plan, triggers and successes.

Advise:

• Compliment decision and accomplishment of following the LRDGs.
  Great!
  Following the LRDGs was a good decision for you.
  How are you following the LRDGs?  i.e., substituting water or non alcoholic drinks in between alcoholic drinks, consuming drinks more slowly, 1 per hour. etc

• Emphasize benefits.
  Your risk for ___________ will be lower.
  Don’t you feel better?

Assist:

• Encourage rewarding self.
  What have you done to reward yourself?
  Have you had fun with friends or family or been to a new place?

• Encourage identification of what is working and existing barriers.
  What parts of your plan are working well?  What is not working well?
  How could you plan to get around it?

• Promote self-confidence.
  You are making good progress.
  You should be pleased with yourself.

Resource Options:  

• Low Risk Drinking Guidelines www.lrdg.net
• Centre for Addiction and Mental Health www.camh.net
• Simcoe Muskoka District Health Unit www.smdhu.org

Future Intervention:

Ask:

Are you able to consistently follow the LRDGs?

NO		Still ACTION
YES		MAINTENANCE

Click on Maintenance (or whatever stage they are at) below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Precontemplation

Contemplation

Preparation

Action

Maintenance

Relapse

Client has been following the LRDGs from 6 months to 5 years.

Goal for Client Intervention:

• Assist to continue following the LRDGs as part of their lifestyle.

Intervention Options:

Ask:  Ask the client about planning for the future.
          How are you managing? What are your plans to maintain this change in drinking
          behavior?

Advise:

• Recognize accomplishment and benefits. Being able to drink within the LRDGs is contributing to your health and well-being.
  Good for you!

Assist:

• Encourage ongoing awareness of triggers and pitfalls.
  New people and new situations may bring new temptations.  Be aware of these pitfalls and adapt your plan if required.

• Emphasize importance of continuing to reward self.
  Make sure you remember to reward yourself for continuing.  You deserve it

Resource Options:  

• Low Risk Drinking Guidelines www.lrdg.net
• Centre for Addiction and Mental Health www.camh.net
• Simcoe Muskoka District Health Unit www.smdhu.org

Future Intervention or Now:

Ask:
Do you have any concerns that you may drink > than the LRDGs recommend?

NO		Still MAINTENANCE Is there another lifestyle topic you are concerned about, healthy eating, healthy weights, smoking, sun safety, etc.?
YES		Ask about concerns and assist.

If the client is in Maintenance, ask if they are ready to think about another lifestyle change to further reduce risks for chronic diseases.

Precontemplation

Contemplation

Preparation

Action

Maintenance

Relapse

Client has stated that they have started binge drinking again :

• Assist to see relapse as a normal part of the process of change.

Goal for Client Intervention:

• Assist to see relapse as a normal part of the process of change.
• Referral to treatment may be necessary, see options below.

Intervention Options:

Ask: Ask the client the reason(s) for change in drinking behavior.

Advise: or

• Normalize relapse as part of the process of change.
  Some people experience some setbacks.

• Emphasize the benefits that were gained.
  Your ______________________ was improved while you were following the LRDGs
  or
  Your risk for __________ reduced while you were following the LRDGs.
  Most people find they gain knowledge about themselves that helps in their next attempt.

Assist:

• Identify and discuss reasons for relapse and counter strategies for the next try. What did you like about yourself when you were following the LRDGs?
  Do you know what happened to cause a change in your drinking behavior?
  What could you try next time to get around that?

*The BCI approach may not be completely effective with the alcohol dependent drinker.  More intensive treatment with abstinence may be the goal. See below for referral options.*    

Referral Options:

Referral to Simcoe Outreach Services in Simcoe County http://www.mhcva.on.ca/sosmain.htm.

Referral to Addictions Outreach Service in Muskoka (website not available at this time) 1 (800) 668-5192

Referral or encourage the client to refer themselves to RVH Addiction Services-    Withdrawal Management (705) 728-4226 (They service all of Simcoe/Muskoka)

Check the Quick Reference to determine the client’s stage of change. Click on the appropriate stage below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.