Theory and Frameworks

Evidence-based practice uses the best available research to support theories and inform treatment strategies and interventions, providing a framework for consistent, quality practice. Building on strong, well-researched evidence improves client outcomes and contributes to continuous improvement and ‘best practice’. Good practice is also informed by professional expertise and client and stakeholder feedback.

Evidence-based practice (EBP) is of paramount importance in the field of Alcohol and Other Drug (AOD) services due to the unique challenges and complexities associated with substance use disorders. Here's an extended explanation elaborating on why EBP is crucial for AOD services, along with examples:

1. Enhanced Effectiveness and Efficiency: AOD services cater to individuals facing a range of issues, from substance dependency to co-occurring mental health disorders. By relying on evidence-based interventions, practitioners can optimize treatment strategies to address these complex needs effectively. This approach not only improves client outcomes but also maximizes the efficient use of resources within AOD programs.
2. Reduced Risk of Harm: Substance use disorders can have severe physical, psychological, and social consequences for individuals and communities. Evidence-based interventions are grounded in research that identifies approaches with the lowest risk of harm and the highest likelihood of positive outcomes. This reduces the likelihood of inadvertently exacerbating clients' conditions or causing unintended negative consequences.
3. Informed Decision-Making: EBP empowers practitioners to make informed decisions about treatment and intervention options. By staying abreast of the latest research findings, practitioners can select approaches backed by solid evidence of efficacy and safety. This ensures that interventions are aligned with best practices and tailored to the individual needs and circumstances of clients.
4. Adaptability and Innovation: The landscape of AOD treatment is constantly evolving, with new research findings and innovative approaches emerging regularly. Practitioners who engage in evidence-based practice are better equipped to integrate new knowledge and innovations into their work. This adaptability allows AOD services to remain responsive to changing client needs and emerging trends in substance use and addiction.
5. Professional Accountability and Ethical Practice: Evidence-based practice promotes accountability and ethical conduct among practitioners by requiring them to base their interventions on reliable research evidence. This ensures that practitioners uphold the highest standards of care and adhere to ethical principles such as beneficence, non-maleficence, and respect for autonomy. By prioritizing the well-being of clients and adhering to evidence-based guidelines, practitioners demonstrate their commitment to ethical practice.

Examples of Evidence-Based Practices in AOD Services:

• Medication-Assisted Treatment (MAT): MAT combines medications (e.g., methadone, buprenorphine) with behavioral therapies to treat opioid use disorder. Numerous studies have demonstrated the effectiveness of MAT in reducing opioid use, preventing overdoses, and improving retention in treatment.
• Cognitive-Behavioral Therapy (CBT): CBT is a widely used therapeutic approach for addressing substance use disorders. Research has consistently shown that CBT helps individuals develop coping skills, identify and challenge maladaptive thoughts and behaviors, and prevent relapse.
• Brief Intervention: Brief interventions involve targeted conversations aimed at increasing awareness of substance use and motivating individuals to make positive changes. Research supports the effectiveness of brief interventions, particularly in primary care settings, for reducing risky substance use and promoting healthier behaviors.

In alcohol and other drugs (AOD) services, the aim is to support clients to change negative behaviours, including drug and/or alcohol use. To be part of this, you will need to understand factors that contribute to negative patterns of behaviour, such as substance abuse; and theories about how and why behaviour changes.

The theories on behaviour that are most relevant to health care and influencing or changing health-related behaviours are:

• The health belief model
• The transtheoretical model and stages of change
• The social-cognitive theory
• The social-ecological model

The Health Belief Model

The health belief model focuses on how beliefs about health risks and the effectiveness of acting to prevent illness can influence a person’s behaviour or change their behaviour. This theory helps us to understand how and why people respond to health prevention programs such as screening for cancers, vaccinations, falls prevention programs, and lifestyle change programs to prevent conditions such as heart disease.

The Transtheoretical Model and Stages of Change

The transtheoretical model for understanding behaviour change focuses on the change process as a series of stages through which the person moves until they are ‘ready’ and motivated to change their behaviour. These stages are:

• Precontemplation (no need to change, no interest in changing)
• Contemplation (thinking about changing)
• Preparation (planning to change)
• Action (adopting new behaviours and habits)
• Maintenance (practising and maintaining the new behaviours and habits)
• Relapse (returning to negative behaviours and habits).

This theory is helpful in developing support strategies to assist a person to change negative health behaviours, such as alcohol and/or drug use, because it recognises that, unless the person is ready and motivated to change, interventions are not likely to succeed.

Watch

Watch this video to learn about the stages of behavioural change.

The context is encouraging healthy exercise, but the same principles apply within an AOD context.

The Social-Cognitive Theory

The social-cognitive approach to understanding how we learn and change behaviours and habits is based on Albert Bandura’s social learning theory, which explains human behaviour as the result of interaction between personal characteristics and the social environment.

Observing the behaviour of people around us is a significant factor in shaping our own behaviour. We tend to imitate the behaviour of people who are significant to us (role models) and we also learn through the responses of others to our behaviour. Negative responses will reduce the likelihood of the behaviour reoccurring, and positive responses will increase its likelihood. Through observation and reinforcement, we learn to behave in ways that are ‘socially acceptable’ to the people around us.

Watch

Watch this video illustrating the power of social and emotional factors in influencing health-related behaviour.

The Social-Ecological Model

This social-ecological model recognises the role of multiple social, community, environmental and political factors that contribute to health problems; and that these factors must be addressed in changing negative health-related behaviours. It is an integrated approach aimed at changing physical and social environments and cultural factors instead of focusing on changing only the individual’s behaviour.

Working with individuals includes working at individual, interpersonal, community and societal levels. For example, social acceptance of the excessive use of alcohol within a community, endorsed by societal and cultural norms, must be addressed if the individual’s drinking behaviour is to change. A community development approach is useful in addressing AOD issues where they exist at a community level, for example, with First Nations communities in Australia.

Watch

Watch this video for an overview of approaches to changing health-related behaviours.

A person’s ‘readiness’ to make changes and their willingness to participate in treatments or interventions are key factors in determining the person’s success in recovering from addiction. The transtheoretical model provides a framework for understanding where a client is in terms of being ready for intervention and motivated to change habits and behaviours.

Other key factors affecting readiness to seek help and change behaviours are the stigma still associated with using alcohol and drugs and the loss of face involved in admitting you have a problem and are seeking help. These obstacles make it difficult for people (especially those with prominent social positions) to seek assistance.

Motivation is an internal process that initiates and guides goal-oriented behaviour and prompts us to act. Helping the person to identify factors that motivate them to change is an important aspect of supporting recovery from substance abuse and addiction. Motivation explains why we do something, so understanding motivation and how it works is essential for supporting behavioural change.

The components of motivation are:

• Activation, or factors that make us decide to do or to change something
• Persistence, or factors that keep us going
• Intensity, or strength and energy used.

Extrinsic Motivators

Extrinsic motivators are external factors that reinforce a behaviour—tangible rewards such as food, comfort or money. For example, to encourage or motivate your children to do their chores, you might use a star chart and award a gold star each time they complete a task. The gold star is an external motivator.

Intrinsic Motivators

Intrinsic motivators are internal factors, such as feelings of achievement, pride and self-esteem. Receiving a gold star might trigger feelings of pleasure or satisfaction, which are internal motivators that are linked to an external motivator.

In order to be effective, the motivating factor must meet a need or want that the person has.

Intrinsic motivators are generally more powerful and long-lasting than external motivators. Ideally, the person should experience something positive from engaging in the behaviour itself if the change is to become permanent. In other words, the behaviour itself and its positive results become the motivation.

In working with people with AOD issues and supporting them to change their negative behaviour, finding factors that work to motivate that particular person is essential. Each individual is different, and what motivates one person may not motivate another.

Listen

Listen to these Australian stories of their journey with addiction and how they overcame their addiction.

Motivational interviewing is a therapeutic approach that focuses on supporting a person’s willingness and motivation to change. It is often used in working with people with addictions but can also be used to encourage a person to change any harmful behaviour. It includes:

• Assessing the person’s readiness to change their behaviour
• Using collaboration rather than confrontation
• Encouraging self-direction and autonomy.

Motivational interviewing techniques address the needs and interests of the individual and are based on the belief that people make their own choices. This means you do not try to persuade or coerce the person to change. Instead, you support the person in identifying for themselves the benefits and barriers to change and working out their strategies for initiating and sustaining changes in their behaviour.

Motivational Interviewing

A key aspect of motivational interviewing is to shift the person’s mindset from one in which change does not seem possible to one in which change does seem both possible and desirable. Strategies in motivational interviewing include:

• Active listening
• Avoiding confrontation and ‘rolling with’ resistance
• Developing the person’s awareness of discrepancies or inconsistencies between their negative behaviour and their values and aims
• Helping the person to move through the stages of change
• Providing feedback
• Planning and strengthening the person’s commitment to change.

Cognitive behaviour therapy (CBT) approaches aim to help people change negative thought patterns that support negative or harmful behaviour patterns. CBT helps people to:

• Challenge and overcome negative thoughts and feelings associated with a situation that they find problematic
• Use more positive thought patterns to change the associated feelings and learn more positive responses and behaviours.

CBT is commonly used in mental health settings and is also appropriate for using in AOD counselling, especially when clients have complex needs and issues.

Cognitive Behaviour Therapy 

Helps to crack the vicious cycle of negative thinking and feeling. 

Watch

Watch this video to better understand how CBT works.

Detoxification is also known as ‘withdrawal’. Cutting back or stopping substance abuse can have physical and psychological effects and may need careful supervision. Physical dependence occurs when the body becomes accustomed to the presence of whatever substance the person is using so that the person needs it to feel ‘normal’ and to function.

Psychological dependence arises from the person believing that they need the substance to function and to feel normal, perhaps in specific situations such as unwinding or at a formal social occasion.

Withdrawal Symptoms

Withdrawal symptoms vary in type, duration and severity according to the type of drug, how long the person has been using it, and individual characteristics such as age and physical and mental health. Common symptoms are:

• Cravings
• Agitation
• Sleep disturbances
• Dizziness
• Nausea
• Anxiety
• Inability to concentrate
• Mood swings
• Unpleasant sensations such as itching and pain.

Symptoms can last for a few days or months, depending on the type of drug and length of use.

Unsupervised withdrawal can be dangerous and, in some cases, life-threatening.

Alcohol Withdrawal

Sudden withdrawal from extended alcohol abuse can be dangerous and result in a condition called ‘delirium tremens’ (DTs), with symptoms of:

• Profound confusion
• Autonomic hyperactivity
• Cardiovascular collapse, which can be potentially fatal.

DTs is commonly treated with benzodiazepine to control agitation and risk of seizures.