State Leadership Conference

The major killers in the United States today largely derive from behaviors such as smoking, alcohol abuse and a sedentary lifestyle, but so far the American health-care system has yet to fully integrate behavior change into treatment, said James Prochaska, PhD, at a plenary session at the 2005 State Leadership Conference. He encouraged psychologists to work to change that.

"We certainly could do a great deal to change those lifestyle/behavioral risk factors," he said.

U.S. health-care costs exceed $1.4 trillion per year, and 60 percent of that money goes to treat ailments that are, at least in part, caused by behaviors, added Prochaska, who is the director of the Cancer Prevention Research Consortium and a psychology professor at the University of Rhode Island. But unfortunately, he said, physicians make little effort to change the behaviors at fault, often because they don't think that behavior change is possible.

Consequently, most behavior-change efforts target only people who are particularly motivated to change already, Prochaska said. Some government-sponsored smoking-cessation hotlines, for example, reach less than one quarter of one percent of smokers--only the ones motivated enough to call the hotline.

In contrast, Prochaska and other psychologists have developed a model that addresses stages of change. According to the model, patients move through a series of stages of emotional readiness to change a problem behavior. The five stages are precontemplation, contemplation, preparation, action and maintenance. Physicians and psychologists who are aware of these stages can learn to properly support patients at whatever stage they're in and help them move to the next stage.

In one study applying the stages of the change model, for example, Prochaska found he could retain precontemplators--people who were not even thinking of quitting smoking before they joined his smoking cessation study--at nearly the same rate as people who began the study already motivated.

"We need to reach out to the people who aren't motivated," Prochaska said. "Of course, the $900 billion question is: Who's going to pay for it?"

William Hancur, PhD, associate director for behavioral health at Blue Cross & Blue Shield of Rhode Island, addressed that question in the second half of the plenary session.

"Behavioral health is at the bottom of the cost totem pole for insurers," he said. "The main costs are in general medicine."

Because of that, he said, it's important that psychologists and other behavioral scientists communicate with primary-care physicians. "They're willing to talk to us," he said, "if we're willing to talk to them."

Peter Erickson, PhD, president of the Rhode Island Psychological Association, moderated the session.

--L. WINERMAN