Early Intervention - A Life Changer

Updated: Dec 19, 2021

“Claire 120”

The 18 year old Prehab version

Written By Patrick Moore LPC

Amy Olseth MSN, RN introduced an older stage 4 "Claire" to followers on Linkedin last month #doyouknowclaire. Claire’s family was desperate for help. Claire was in full survival mode and trapped in a place where living is terrifying and death would be a relief. Claire is desperate for change; she cannot let go of the familiar. Fortunately for Claire, she is right in Amy’s professional wheel house and about to get her life back. There are many who do not make it, many of them are much lower risk than Claire for dependence.

This process did not happen overnight. It took years of repeated action and development. Could this process be identified and intervened on before symptoms became glaring? What would happen if we had a time machine and went back to Claire’s first week in college?

At 18 yo and in college, Claire was having a good time. Playtime in high school was finally over. Claire was well prepared to experiment with new relationships and experiences. At Claire’s college some counselors specializing in addiction prevention came in her freshman orientation class one day. What could these people have to say that I have not already heard? wondered Claire. When it was announced Claire and her class would be involved in a research experiment and the assessment after a 45 minute presentation would be anonymous Claire became a little bit interested. This might be different.

Claire soon found out that Prehab is not about drugs. It is about the affective risk response system, specifically her own risk response development.

While the speaker introduced risk response factors Claire could see in the 5 stage model she had experienced a lot already.

Claire recognized mental and physical changes she was sure everyone else experienced. It was news to her that most people have not. She had to concede she left stage 0 in the Prehab model long ago. She appreciated the concept of constructive paranoia - but had never used it. She was relieved to hear she was gifted with the ability to take risks in stage 1 using risk factors like; new/familiar, good/bad and social proof. Taking risks and either adopting or rejecting the behavior based on outcomes and returning to stage 0 to prepare for new risks was an attractive concept, but not that familiar. Claire learned most people never go above stage 1, yet it is a deadly stage where the acute deaths like automobile accidents and Alcohol poisoning happen. Most of the population bounces between 0 and 1 safely when educated about low risk hazards, constructive paranoia along with using control for processes, not outcomes. The other 25% move on to stage 2.

Claire diagnosed herself at stage 2. She had experienced more and more physical tolerance her last two years in high school. She was familiar with and enjoyed some of the mental impulsivity that developed along the way - that seemed to always lead to good times. She could see this pattern in hindsight evolved into smaller and more risky groups that she initially felt were more intimate, mature and fun. Claire could see that social proof, attributing too much to others with seemingly more experience, was an easy and powerful mistake to make.

Claire started pregaming - a stage 2 activity - over the summer. A lot of her new friends were also stage 2 and partied before the party also. She would be playing beer pong that night - they had already negotiated a designated driver, two more stage 2 clues. Claire could recognize her commitment and the work it took to maintain her previous choices to manage the appearance of high benefit and low risk experiences. She liked her new exciting life and did not want it to change. The model gave her two choices at stage 2. Go on to stage 0, or on to stage 3. She began to feel that commitment slip and she looked at stage 3.

Step three looks like addiction but it isn’t quite dependence yet. There are still choices.

Claire had to wonder if her tolerance had already peaked and how much of her impulsivity was actually preoccupation. She could see how her caution - smoke more weed - if drinking was getting out of control served a purpose, but had nothing to do with her goals. Wake and Bake was something she was considering along with a host of other ideas related to using drugs to compensate for the use of other drugs. Why shouldn’t she use a little speed or someone’s Adderall to push through the responsibilities she poorly planned for and lose a little weight along the way. Where was the downside? Forming relationships with drug paraphernalia, like naming your bong was a concept Claire considered cute. She now knew it as stage 3 behavior and several of her friends in the class were already there. Clarie looked around the classroom, her friends were doing the same thing. Claire knew stage 3 was close. Very close.

Stage 4 describes what Claire thought could never happen to her. Physical withdrawal combined with a mental obsession and a pattern of risk response factors that prevented change even as death became imminent. In fact the idea of stopping only to start again explained the deaths of several of Claire's friends, and her uncle Joe. Claire’s Jr. HS boyfriend dropped out of HS in order to get help with depression. She wondered how much this presentation might have helped him. Claire realized it was not their environment, stigma or genetic predisposition. It was a path that looked and felt autonomous but was instead unsustainable dependence unless one had massive resources. She knew one of these too.

As memories rose and fell related to the model the presentation stopped. It was time to take the anonymous assessment. The assessment was very short, quick and simple. Besides gender and age, the assessment asked three questions.

  1. What stage were you at?

  2. What stage are you at?

  3. What stage will you be at?

Claire already knew she was at stage 2, probably at the end of the summer just before going to college. Before that it was stage 1 going to 2. Though she might have a toe into stage 3, she was certain it was time to investigate the responsibility of stage 0, with very little time to spare.

Clair’s Response

  1. What stage were you at? 1

  2. What stage are you at? 2

  3. What stage will you be at? 0

Claire’s self assessment of her own risk response pattern when put together formed the variable 120. Claire was one of the invisible high risk 20% in the classroom that day that accurately calibrated their risk response system and made a choice to investigate a new way to use their gifts as evidenced by honestly recognizing high risk behavior (stage 1 to 2, maybe some 3) and what she learned and was willing to change as evidenced by consciously choosing the direction of risk from stage 2 to stage 0.

The rest of the program demonstrated how to form habits in stage 0, rather than stage 4, no matter what their assessment score was. At the end of the presentation the instructor asked the class to fill out the evaluation. Here is a real example evaluation of a 18 year old female with a 120 score.

“This helped to open my eyes and see the truth about Alcohol and drug use/abuse. Thank you for taking the time to teach me and help me become aware of the effects and future effects this usage withholds. You helped me understand me 10 times better and the risks I am at. Thank you for helping me out.”

Claire is one of 224 invisible high risk students out of 1,135 tested that were not ignored but intervened on in 2014 and 2015 at Kennesaw State University. No drama. No stigma. No judgment. The other students and their scores fell into the other objectives of Prehab. Alcohol citations and arrests dropped 79% over these two years.

Here are the measurable objectives of each random Prehab presentation.

  1. Educate the low risk (75% of the 1,135 sample).

  2. Identify and intervene on invisible high risk (20%).

  3. Introduce ambivalence into the severe risk patterns (5%).

Thanks to Amy Olseth MSA, RN for her brilliant suggestion and providing time and room in her blog and linkedin posts for a Prehab illustration. For anyone wishing to expand their influence or be a catalyst for change please consider the book, videos and other resources at www.prehabmapp.com or email pnm867@gmail.com.

Note of Gratitude:

I am sincerely grateful for the professional contribution of Patrick Moore LPC to the field of addiction intervention and treatment. I mostly work with clients at stage 3 or 4 and repeatedly get asked by loved ones "what could we have done before it got this bad". Prehab is an option for any individual wanting to evaluate their own use patterns and autonomously determine how to proceed with their relationship with risk behaviors and substances.

Amy Olseth MSN, RN, NCIP, Founder of Holistic Interventionist LLC

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