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Abstract
The neuroanatomical elements of rewarding stimulation have been identified using electrophysiological and neurochemical techniques.
The central components of the dopamine reward system are nerve cells whose cell bodies are located in the ventral tegmental area (VTA). from these cell bodies, axons reach out to various other brain regions, most prominently the nucleus accumbens (NAc), and the prefrontal cortex.
Brain reward system receives many things as a reward, (ex: substances of abuse, listening to music, praying, love, pleasant tastes, sexual images, attractive faces, money).
Brain reward system is responsible for learning environmental cues that predict reward, learning comparative values of rewards, focusing attention on cues that predict rewards, and motivating the system to act on the basis of these cues.
Motivation in psychology is the influences that account for the initiation, direction, intensity and persistence of behavior.
There are four prominent theories of human motivation:
-instinct theory: states that motivation is the result of biological, genetic programming.
-drive reduction theory: emphasizes biological factors, but it is based on the concept of homeostasis.
-arousal theory: states that people are driven to maintain a certain level of arousal in order to feel comfortable.
-incentive theory: states that people act to obtain positive incentives and avoid negative incentives.
The transtheoretical model of the stages of change was developed by Prochaska and DiClemente, and states that stages of change can be visualized as a wheel with six stages, the first is precontemplation in which substance-using persons are partly or completely unaware that a problem exists, the second is contemplation in which these individuals become aware that a problem exists, they begin think there may be reasons to change, the third is preparation in which more specific planning for change are done, the fourth is action in which they choose a strategy for change and begin to pursue it, the fifth stage is maintenance in which they work to sustain sobriety and prevent recurrence, the sixth is recurrence in which relapse occurs.
Motivational interviewing is a client-centered yet directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence.
Basic assumptions of MI are: (Ambivalence about substance use (and change) is normal- Ambivalence can be resolved by working with the client’s intrinsic motivations and values- The alliance between the clinician and the client is a collaborative - An empathic, supportive, yet directive, counseling style provides conditions under which change can occur).
The five general principles of MI are:
-Expression of empathy through reflective listening.
-Developing discrepancy between clients’ goals or values and their current behavior.
-Avoid argument and direct confrontation.
-Adjust to client resistance rather than opposing it directly.
-Support self-efficacy and optimism.
Strategies to use in MI Sessions are (Asking Open-Ended Questions- Listening reflectively- Summarizing- Affirmation- Eliciting Self-Motivational Statements).
A large number of controlled studies have demonstrated that MI is significantly more efficacious than no treatment and at least as efficacious as other viable treatments for addictive problems.
To consider change, individuals at the precontemplation stage must have their awareness raised. To resolve their ambivalence, clients in the contemplation stage require help choosing positive change over their current situation. Clients in the preparation stage need help identifying potential change strategies and choosing the most appropriate one for their circumstances. Clients in the action stage need help to carry out and comply with the change strategies. During the maintenance stage, clients may have to develop new skills for maintaining recovery and a lifestyle without substance use.
Brief interventions in treatment of addiction are referred to as ”simple advice,” ”minimal interventions,” ”brief counseling ”or” short-term counseling.” and have flexible goals, allowing the individual to choose moderation or abstinence.
The client characteristics are not good predictors of a person’s response to a brief intervention and that brief interventions may be applicable to individuals from a wide range of cultures and backgrounds.
The acronym FRAMES summarizes the Components of Brief Interventions: (Feedback- Responsibility of the clients- Advice- offering Menu of options- Empathic counseling- Self-efficacy).
A brief intervention consists of five basic steps that incorporate FRAMES:
1- Introducing the issue in the context of the client’s health.
2- Screening, evaluating, and assessing.
3- Providing feedback.
4- Talking about change and setting goals.
5- Summarizing and reaching closure.