CONTENTS

About This Course

Table of Contents

1. Introduction to the Issues
2. Understanding Alcohol Abuse
3. Understanding Violence Against Women
4. Alcohol and Domestic Violence
5. Alcohol, Sexual Assault, and Rape
6. Prevention and Early Intervention
7. Screening and Assessment
8. Diagnosis and Treatment
9. Legal and Ethical Issues

Supplements
Fact Sheets
Videos
Resources

Silence Hurts
Alcohol Abuse and Violence Against Women

Module Content Objectives Introduction to Prevention Prevention Framework Alcohol Abuse Prevention and Early Intervention Strategies -- Prevention Education -- Alternative Activities -- Community-Based Strategies Aspects of Effective Prevention Programs -- Cultural Awareness Early Intervention Matching Levels of Use to Prevention and Pre-Treatment Approaches Summary of Module Module 6 Quiz References

Early Intervention

Problem identification is needed to recognize individuals with suspected substance use problems and to address the problems before they worsen. It may involve referring individuals for assessment and treatment. When assessing female clients, health care providers can help by including a routine evaluation for alcohol consumption, home violence, and related risk factors. Using self-assessment questionnaires and taking an alcohol and drug history are especially helpful. See Module7 for more information on screening. In addition, counseling women on ways to stay safe can help them avoid turning to alcohol.

Motivating Change

When a problem has been identified, early intervention is needed to prevent it from getting worse. A key issue is motivating change. Motivation is not just the responsibility of the problem drinker. Motivation is the result of an interaction between the drinker and others. A therapist can increase motivation for change through his or her interactions with the person experiencing or at risk for drinking problems.

Understanding the reasons people stop drinking can help in motivating change. Dr. Frederic Blow at the University of Michigan has been studying motivation to stop drinking. Results of his research revealed the following reasons people gave for discontinuing their drinking. The total percentage of respondents may add to more than 100 because some gave more than one reason:

Reasons To Stop Drinking

• Health, 46.5 percent
• Costs too much money, 10.5 percent
• Did not like taste/effects, 27.6 percent
• Entered Alcoholics Anonymous, 4.3 percent
• Religious objections, 13.5 percent
• Had treatment to stop, 2.7 percent
• Objections from family/friends, 5.8 percent
• Social crowd does not drink, 6.7 percent
• Other, 17.6 percent³

A printable graphic version (PDF) is available.
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Research shows that people may respond quite differently to recommendations that they alter or discontinue longstanding or previously pleasurable behaviors. Reactions depend, to a great extent, on an individual's readiness to change.⁴ For example, screening or assessment findings may confirm an individual's suspicions about the negative effect of alcohol on personal health. He or she may immediately commit to abstaining or begin tapering off. Another approach, giving brief one- or two-sentence advice, requires more knowledge and experience. (See Brief Advice.)

For some people, an assessment may be a revelation that must be processed over time before they can make any changes. Still others may be unconvinced by the findings and not see the need to change.

Most individuals experience several stages of change in addressing an alcohol or drug problem, as indicated in the diagram below.⁵ To learn more about each stage, click on the corresponding wedge presented in the diagram.

Although relapse is not formally considered a stage, it has been included because many individuals experience relapse and subsequently repeat the stages of change.

Categorizing individuals this way helps predict who is most likely to succeed in making changes. It also helps determine which interventions work best at different stages.^6-8 It has been suggested that research on brief interventions for problem drinkers should examine stages of change as a way to tailor interventions to readiness.⁹ Because people often move through these stages of change in cyclical patterns over long periods, it is important to:

• Evaluate the recent and past course of the participant's movement through the stages of change.
• Adjust treatment approaches to reflect the participant's experience in trying to change.
• Individualize treatment to the extent possible.
• Set realistic treatment goals. Sequence and shift goals as participants progress.
• Keep in mind that much of the change takes place outside the treatment setting. Treatment assists the participant through certain stages of change.
• Recognize the current stages of participants in group treatment. Members can facilitate or hinder the progress of others through role modeling and by raising appropriate or inappropriate issues