Program note:
The Guided Self-Change approach has been refined and extended to various populations (adults, adolescents, Spanish speakers, males and females, alcohol users, and other drug users), and settings (outpatient alcohol programs, primary care centers), and individual and group formats.
Program Goals
Guided Self-Change (GSC) treatment was a brief, cognitive-behavioral, motivational intervention was designed to address alcohol and other drug use as well as aggressive behaviors among school-age, English- and Spanish-speaking adolescents. The program employed 1) a motivational client–therapist interactional style; 2) a cognitive–behavioral approach to planning, implementing, and maintaining changes in alcohol and other drug behaviors; and 3) a harm-reduction perspective for the treatment of addictive behaviors. GSC was intended as a middle step in a stepped-care model of alcohol and other drug treatment and is meant to take place before self-change efforts and brief motivational interviewing, but after more intensive interventions such as family or residential therapeutic approaches.
Target Population
GSC targeted adolescents between the ages of 14 and 18, with at least six instances of alcohol and other drug use, who were involved in at least one act of aggressive behavior (relational or predatory violence). Relational violence included hitting or threatening to hit a family member or someone outside the family; predatory violence included the use of force or threats of force to obtain money or items from people, involvement in gang fights, attacking someone with the intent of seriously hurting or killing them, or carrying a hidden weapon (Ellickson and McGuigan 2000).
Program Theory
GSC was based on 1) motivational interviewing theory, which suggests that the motivation to engage in delinquent behavior is changeable, and thus can be a target of treatment; and 2) cognitive social-learning theory, which suggests that people are more committed to goals when they are able to set them for themselves (Bandura 1986). Also, GSC adopts aspects of relapse prevention (RP) theory (Marlett and George 1984), a social-cognitive therapeutic intervention, which suggests that both cognitive and behavioral strategies can be used to prevent or limit relapse. However, as the GSC approach assumes participants have sufficient behavioral skills and resources to achieve successful outcomes, the approach includes only the cognitive aspects of RP theory such as providing a structure or guidelines for cognitive tasks that are expected to impact behavior and providing personalized feedback in terms of where drug use fits with societal norms and the types of health risks (Sobell and Sobell 2005).
Program Components
GSC followed a one-on-one, 5-week session format. However, GSC sessions could be extended by up to two sessions by participant request. The major treatment components included 1) weekly self-monitoring of adolescent behaviors targeted for change; 2) treatment goal advice, with adolescents selecting their own goal; 3) brief readings and homework assignments exploring high-risk situations, options, and action plans; 4) motivational strategies to increase an adolescent’s commitment to change; and 4) cognitive relapse-prevention procedures.
GSC used both fundamental behavioral change principles and motivational engagement strategies. It incorporated individualized treatment targets and changed strategies and substance use goals based on clients’ experiences (Gil, Wagner, and Tubman 2004). Although GSC was similar to other cognitive–behavioral brief interventions for alcohol problems, it was also different in several ways. First, GSC explicitly allowed clients to choose their goals. Second, it routinely used self-monitoring logs as a clinical procedure, for data collection, and to provide clients with feedback in terms of changes in substance use. Third, it included a cognitive relapse-prevention component to provide a realistic perspective on recovery and management of goal violations. This component included a long-term perspective on recovery and viewing change as incremental; interrupting a slip (i.e., goal violation) as soon as possible to minimize consequences; and understanding a slip as a learning experience (i.e., what can be learned from it) and not attributing it to a personal failure. Fourth, it was flexible rather than fixed in its structure (clients could request additional sessions after basic sessions had been completed). Fifth, it included a planned aftercare telephone contact 1 month after the last treatment session. Finally, GSC used brief readings and homework assignments to improve decisional balance and problem-solving components (Sobell and Sobell 2005).