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APHA Scientific Session and Event Listing

George M. DuWors, MSW, LCSW, BCD, Private Practice, 1712 Pacific Ave., Suite 204, Everett, WA 98201, 425-339-4119, gduwors1@verizon.net

Motivational Interviewing has rapidly become established as a state-of-the-art modality in the treatment of addictions. It has become inseparable from the “Trans-theoretical Model of Change.” However, virtually all of the research has focused on moving clients from the “Pre-contemplation” and “Contemplation “ stages to “Preparation” and “Action.” There has been little discussion and/or research focused on the “Maintenance” stage, as such. This paper will begin to close that gap by exploring the virtually universal thinking at moments of physical relapse. “MI” requires “development of discrepancy” to motivate for change. “Wishful thinking” and “Expletive thinking,” found at moments of (choosing to) relapse, are rich in generic discrepancy. “Wishful thinking” reveals a chemical-free mind controlled by illusion, apparently resulting from failure of memory and unacknowledged craving. “Expletive thinking” reveals a child-like refusal/inability to accept reality. “Wishful thinking” leads to the task of maintaining memory and motivation. “Expletive thinking” implies the task of learning to tolerate frustration, practicing and maintaining “acceptance.” Both imply maintenance work well beyond the initial change work: remembering the realities of addiction and accepting the realities of life, while maintaining the willingness to do both. “Bad Cop” interventions develop the above discrepancies while “Good Cop” helps the person to tolerate the process, to see discrepancy as challenge rather than attack.

Learning Objectives:

• 1. Elicit and understand two types of client thinking at moments of addictive relapse.
• 2. Recognize and elicit four motivational discrepancies inherent in each type of thinking.
• 3. Identify two primary tasks to prevent recurrence of each type of thinking.

Keywords: Alcoholism, Drug Abuse Treatment

Presenting author's disclosure statement:

Not Answered