CHAPTER 2 Mental and Behavioral Health elapse Returning to baseline levels of use No recognition of a problem No intention to quit Maintenance Sustaining abstinence Recognition of a problem No immediate plans to qui Action Making plans to quit in the near future Figure 21-5 Stages of change modeL. Modifed from Prochaska IO, DiClemente CC: Psychotherapy 19: 276-288, 1982.) between waking and smoking the first cigarette, which is universal school-based drug prevention programs delivered strongly associated with level of dependence. Motivation can by police officers is Project daRE( Drug Abuse Resistance be assessed using the contemplation ladder, which has Education). Despite its popularity, meta-analyses show tha smokers indicate their readiness to stop smoking on a scale dare produces either no effect or possibly harmful effects of 0 to 10 he contemplation ladder has its theoretical in terms of youth drug use. Conversely, school-based inter foundation in the stages of change model, which is com- ventions that teach drug refusal skills and address outcome prised of five stages and is reinitiated by a relapse(Fig. expectancies for drugs, delivered as either universal or 21-5). The contemplation ladder may also be useful for selected prevention programs, can be effective for decreasing ssessing motivation to quit among users of alcohol and substance use. other drugs. These measures could be used in combination Universal efforts to prevent suicide involve psychoeduca with a brief physician intervention (e. g, five "A"model tional programs targeted to asing awareness of the described later)to enhance motivation to quit as well as symptoms of mental health disorders, their role in suicide, guide decisions about the most appropriate approach and available resources. In gatekeeper training, for example, encourage cessation selected individuals are trained to recognize warning si While simply asking about thoughts of suicide and the of depression and suicide and to intervene with distressed presence of a plan is considered a reasonable strategy for persons. A systematic review found that gatekeeper training identifying individuals at risk of killing themselves, using the improved trainee's knowledge, skills, and attitudes toward depressive symptom index(DSI)suicidality subscale is rec- intervening and, in specific populations, produced reduc mmended. This four-item measure, with scores from 0 to tions in suicidal ideation and attempts. Research on the 12(higher scores indicate greater risk), assesses presence and efficacy of crisis centers and hotlines, both targeted preven frequency of suicidal ideation, presence of a plan, and per on programs, is inconclusive. vasiveness of the desire to kill oneself. a cutoff score of 3 is Targeted brief interventions and brief treatments for sub- ecommended to ensure that all high-risk persons are iden stance use and mental health disorders include motivational fied while minimizing false positives interviewing(MI), a brief intervention(1-4 sessions)devel oped to encourage internal motivation for change. MI has E. Psychosocial Interventions been effective for enhancing treatment retention and reduc- ing substance use and related negative consequences Brief Intervention Recently, MI has been effectively applied to the treatment of mental health disorders, either to increase motivation to ew prevention programs ally target anxiety. How ven the significant numb shared risk factors betvyser, engage in treatment or to encourage patients in treatment to ake the steps necessary to achieve therapeutic change(e. g anxiety and other mental and behavioral problems, exposure exercises)"(see Chapter 15) prevention programs aimed at other disorders will likely In addition to MI, research suggests that advice by a phy. have a broad beneficial impact for preventing anxiety. sician may be sufficient to enhance motivation to change School-based programs are effective for improving coping behavior and to enter treatment. The U.S. Public Health and social skills and thereby reducing the risk of depression Service and National Cancer Institute developed the five "A and anxiety. One of the most well-known and widely used program, a brief intervention designed to assist physicians