Substance Use & Misuse, 49:645–653, 2014 C 2014 Informa Healthcare USA, Inc. Copyright  ISSN: 1082-6084 print / 1532-2491 online DOI: 10.3109/10826084.2013.841245

ORIGINAL ARTICLE

Talking About Friends, Drugs, and Change: Meanings of Friendship in Substance Abusers’ Change Talk Harri Sarpavaara School of Social Sciences and Humanities, University of Tampere, Tampere, Finland own that affect the association between individual and network drinking patterns. Finney, Moos, & Mewborn (1980) found that for individuals in alcohol recovery, social support affects treatment acceptance and provide resources that affect posttreatment functioning. Walters (2000) showed that in spontaneous remission from alcohol and other drug abuse, social support and nondrug using friendships were pivotal in maintaining change. A number of studies have found that especially friendships may play an important role in substance abuse treatment outcomes. On the positive side, having more nondrinking friends (Mohr, Averna, Kenny, & Del Boca, 2001; Zywiak, Longabaugh, & Wirtz, 2002), and encouragement from friends for abstinence (Beattie & Longabaugh, 1997, 1999) predict more positive outcome. Groh, Jason, Davis, Olson, & Ferrari (2007) found that general social support from friends significantly predicted less alcohol use. On the negative side, the more drinking friends in the network, the poorer the outcomes tend to be (Havassy, Hall, & Wasserman, 1991; Mohr et al., 2001). Having even a single person in the social network who uses the same drug of abuse is predictive of poorer treatment outcomes (Havassy et al., 1991; McCrady, 2004). Mohr et al. (2001) reported that changes in both friendship quality (e.g. subjective appraisals of value or adequacy of the relationship) and structure (e.g. quantity or frequency of interactions) would predict follow-up drinking levels. Saarnio (2002) showed that greater number of contacts with problem users increased the breakdown of therapy for substance abusers. Although several studies have examined the influence of friendships on clients’ substance abuse and treatment outcome, there is a paucity of research examining clients’ talk about their experience of the meaning of friendships. The purpose of this qualitative investigation is to explore the meanings that substance-abusing clients attach to friendships during treatment sessions. In particular, clients’ talk about their friendships that are examined in the context of the motivational interviewing (MI). MI

This article explores the meanings of substanceabusing clients attach to friendships during motivational treatment sessions in Probation Service. Sessions (98) were videotaped in 12 probation service offices in Finland in 2007 to 2009. By using semiotic framework, this qualitative study examines client’s change talk utterance about friendships as a symbolic sign. The findings indicate that the friendships play an important role in the substance-abusing clients’ motivation to change and in their treatment outcome. The study suggests that the personal meanings of clients’ utterances in motivational treatment sessions could be seen as potential predictors of their future behavior. Keywords friendships, substance abuse treatment, motivation, outcome, change talk, semiotics, qualitative study

Social networks play an important role in the resolution of substance abuse problems. Prior research has repeatedly found that social networks and social support are pivotal in recovery from substance abuse (e.g. De Civita, Dobkin, & Robertson, 2000; Ellis, Bernichon, Yu, Roberts, & Herrell, 2004; Havassy, Wasserman, & Hall, 1995; Kaskutas, Bond, & Humpreys, 2002). Gordon & Zrull (1991) demonstrated that the drinking status of a problem drinker’s social network members influences the treatment outcome. Longabaugh, Wirtz, Zywiak, & O’Malley (2010) noted that alcohol-specific social support, support that is directly tied to alcohol use, is predictive of client abstinent days during and following treatment and heavy drinking days following treatment. Abbey, Smith, & Scott (1993) found strong associations between individuals’ drinking patterns and the drinking patterns of their social network members. Bullers, Cooper, & Russell (2001) reported that both influence of social networks and selection effects in which individuals form social ties with those who have drinking habits similar to their

Address correspondence to Harri Sarpavaara, School of Social Sciences and Humanities, FI-33014 University of Tampere, Finland; E-mail: [email protected]

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is a clinical style that has spread all over the world since its introduction by William R. Miller in 1983 (Miller, 1983). It is a style that has become a well-recognized brand of counseling (Lundahl, Kunz, Brownell, Tollefson, & Burke, 2010, p. 137). MI has been defined as a “clientcentered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” (Miller & Rollnick, 2002, p. 25) and as a “collaborative, person-centered form of guiding to elicit and strengthen motivation for change” (Miller & Rollnick, 2009, p. 137). The spirit of MI emphasized the client–counselor collaboration and elicitation of motivation for change from the client, not its imposition upon the client (Miller & Rollnick, 2002). MI is one of the leading evidence-based methods for helping people with substance abuse and other behavioral problems (e.g. Burke, Arkowitz, & Menchola, 2003; Hettema, Steele, & Miller, 2005; Miller & Rollnick, 2010; Project MATCH Research Group, 1998; UKATT Research team, 2005). However, the results of the studies give rise to new questions about “what works” in MI. The links between MI’s processes and outcomes are not yet fully understood (Apodaca & Longabaugh, 2009; Burke et al., 2003; Lundahl et al., 2010; Miller, 2012; Miller & Rose, 2009). Several studies have focused on client language as a predictor of MI outcome. For instance, Amrhein, Miller, Yahne, Palmer, & Fulcher (2003); Bertholet, Faouzi, Gmel, Gaume, & Daeppen (2010); Campbell, Adamson, & Carter (2010); Moyers et al. (2007); Moyers, Miller, & Hendrickson (2005) have shown that MI increases clients’ change talk, and positive change talk predicts good outcome after MI. Change talk stands for the client’s utterances that indicate the recognition of a reason, need, ability, desire, commitment, or taking a step to change (Rollnick, Miller, & Butler, 2008). The objective of this qualitative study is to expand on the current understanding of the significance of the client’s change talk during MI sessions. One hitherto unexplored aspect has been the semiotic aspect of the client’s change talk (but see Sarpavaara, 2010, 2013; Sarpavaara & Koski-J¨annes, 2013). There is reason to believe that semiotic features of client’s language and client–counselor interaction are relevant to change behavioral problems. The regulation of behavior is based on the use of signs, and to change behavior, one also needs to change the signs relevant to its regulation (Vygotsky, 1978). Using semiotics as a general theoretical framework, this article aims to provide new perspectives to the analysis of substance-abusing clients’ change talk about their friendships. By using a semiotic framework, the personal meanings attached by the clients to friendships can be examined in addition to the forms of the clients’ change talk. Three research questions guide the analyses: (a) What kind of meanings the clients attach to friendships? (b) What do friendships mean to the clients’ motivation to change? and (c) Do the clients’ change talk about friendships predict the treatment outcome?

DATA

The data for this study have been gathered during the counseling sessions of the Finnish Probation Service. The Probation Service is a part of the criminal sanctions system of Finland. It “is in charge of the enforcement of community sanctions and other activities related to sanctions served in freedom. [. . .] Community sanctions consist of the supervision of conditionally sentenced young offenders, juvenile punishment, community service, and supervision of parolees” (Criminal Sanctions Agency, 2007). In community sanction work, particular attention is paid in evaluating substance abuse problems and in increasing the use of programs for substance abusers (ibid). In 2007, a Swedish MI-based program called Beteende–Samtal–F¨or¨andring [BSF (Behavior– Interviewing–Change)] developed specifically for the needs of the Probation Service was also introduced in the Finnish Probation Service. The BSF program is a structured adaptation of MI where the employees of the Probation Service are expected to use the skills of MI to motivate clients to change as regards to offending and substance abuse. The employee acts as a counselor who helps clients to enhance intrinsic motivation to change by working in a client-centered but directive manner. The BSF program is a semi-structured five-session MI-based intervention focusing on drug use and criminal behavior. During sessions, the client is encouraged to examine different stages of change, to see the positive side of change, to elicit change talk, to explore the discrepancies between his or her values and current behavior, to map his or her social network, and to elicit the personal strengths of the client. (Farbring & Berge, 2006; Farbring & Johnson, 2008). Even though the criminal justice context due to its oppressive, directive, and autonomy limiting features is not perhaps an ideal environment for MI (Ashton, 2005), the BSF program is designed to be as open as possible for client autonomy. The clients were volunteers to this particular program and the counselors were not required to report to legal authorities of possible drug use revealed by the client. The analyses presented here are based on viewing 98 videotaped BSF sessions, and studying the transcripts of these sessions and the follow-up interviews. This database involves the first two counseling sessions of 49 client–counselor pairs. Sessions were videotaped in 12 probation service offices in Finland during 2007 to 2009. All clients who participated in this study had either an alcohol or a drug abuse problem. The clients were followed up 6 and 12 months after the sessions to discover to what extent they had been able to limit their use of alcohol and drugs. Informed, written consent was obtained from all participating clients and counselors and the approval for the study was obtained from the Finnish Criminal Sanctions Agency. In this article, I focus on the analysis of clients’ talk about their friendships and concentrate on all those 35 clients whose change talk utterances concern the influence of friendships on their substance use. The mean

MEANINGS OF FRIENDSHIPS

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age of these clients was 35 years (range = 19–62 years). Among these, 94% (33) were male.

According to Peirce, the action of signs, semiosis, is a triadic process whose components include sign, object and interpretant

METHOD

A Sign, or Representamen, is a first that stands in such a genuine triadic relation to a second, called its Object, as to be capable of determining a third, called its Interpretant, to assume the same triadic relation to its object in which it stands itself to the same object. (CP 2.2741 )

The first step in data analysis was to identify the client’s goal in regard to their use of alcohol and drugs (e.g. to quit or cut down the use of alcohol, cannabis, or other drugs). Identifying the goal was fairly easy because it was usually discussed at the beginning of the videotaped sessions. The second step was to search for sequences that are central from the point of view of this goal. The third step was to code the client’s change talk in these central sequences. As guides to coding this talk I relied on A Training Manual for Coding Client Commitment Language (Amrhein, 2007) and the Manual for the Motivational Interviewing Skill Code (MISC). Version 2.1 (Miller, Moyers, Ernst, & Amrhein, 2008). After some experimentation with the videotaped and transcribed data, I combined the core ideas of these manuals by focusing on the following categories of clients’ change talk utterances. The first one is, however, a new category that was not included in either of the reference manuals:

• Problem recognition. The client makes an utterance that shows she/he is aware or unaware of the problem or she/he considers or does not consider the problem. • Reasons. The client states a particular motive, rationale, basis, or incentive to change or not to change. • Need. The client makes an utterance that indicates a necessity, urgency, or requirement for change or nonchange. • Desire. Client’s utterance indicates wanting, wishing, and willing to change or nonchange. • Ability. Client’s utterance indicates personal perceptions of capability or incapability of change. • Commitment. Client’s utterance implies an agreement, intention, or obligation to change or not to change. • Taking steps. Client states that she/he has taken specific behavioral steps toward or away from change in the recent past. The coding of the client’s change talk sequences was carried out by first watching through the videotaped BSF session and making preliminary notes on the transcription at any utterances representing change talk. After this, I examined these utterances in more detail and labeled them with the above-mentioned categories. The fourth step was to search for all the utterances about friendships from the sequences of client’s change-related talk. By applying Charles S. Peirce’s semiotic theory of signs, I explored client’s utterance about friendships as a symbolic sign. This study is the part of the on-going “Motivating substance abusers for change—Semiotic perspectives to client–counselor interaction” research project, which was launched with an aim to apply Peirce’s theory of signs. This semiotic theory was chosen as it offers the possibility to analyze the action of signs in motivational counseling sessions from many relevant perspectives. The basic idea of the project is to map the semiotic features of MI sessions that appear to predict clients’ willingness to change their addictive behaviors.

Therefore, any sign is in a triadic relation with an object and an interpretant. The first division focuses on the sign as such. Peirce calls this division into qualisigns, sinsigns, and legisigns. The second division focuses the reference of signs to objects. Peirce calls this division into icons, indexes, and symbols. The third division focuses on the interpretation of signs or on the effects of signs on interpreters. Peirce calls this division into rhemes, dicents, and arguments (CP 2.243–2.250; Liszka, 1996; Short, 2007). The second division of signs is relevant from the viewpoint of this study because it concerns the sign’s relation to its object. Icons refer to their object by means of similarity (e.g. an image, a diagram, or a metaphor); indexes refer by means of contiguity, causality, or by some other actual connection (e.g. smoke as the sign for fire); symbols refer by means of a habit, convention, disposition, or law (e.g. words and numbers) (CP 2.247–2.249, 2.292–2.307; Liszka, 1996; Short, 2007). In this article, I concentrate on symbols by investigating the utterances about friendships as a symbolic sign. I explore the utterance about friendships as a symbol (sign), and analyze what kind of habits and conventions (objects) concerning substance use the clients attach to it. Finally, I compared the client’s utterances about friendships with the client’s follow-up data to find out whether this kind of use of signs would predict the clients’ later behavior with regard to their stated goal in treatment. The clients’ situation was queried 6 and 12 months after the BSF sessions mainly by questionnaires and telephone interviews but also by using any other information on the client that the counselors happened to have. The clients’ outcome was mainly assessed on the basis of self-reports on their frequency and quantity of alcohol and drug consumption over the past 6 and 12 months and comparing those data with their baseline data. The main criterion was a decrease of at least 30% in the consumption of the main drug of abuse without the simultaneous increase of some other psychoactive substance use. Maintaining the already reached change goal was also regarded as a successful outcome. MEANINGS OF FRIENDSHIP

All in all, there were 35 clients (out of total of 49 clients) who produced change talk utterances that concern 1

Quotations from Peirce (1965) are referenced in the standard manner of Peirce scholarship, parenthesized within the text. The first numeral in the citation is the volume number of Collected Papers of Charles Sanders Peirce (CP), and the number to the right of the point is the paragraph. Thus, 2.274 refers to paragraph 274 of volume 2.

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friendship. The situations in which the clients talked about their friendships varied from session to session. In some sessions, the counselors were first asked about the significance of the friendships; in others, the clients brought the topic to the discussion. In most cases, the client’s utterance about friendships occurs in the change talk categories Reasons and Taking steps. The client usually mentions the friendship when she/he states a particular motive, rationale, or incentive to change (eleven mentions) or not to change (eight mentions) or when she/he states that she/he has taken specific behavioral steps toward change (32 mentions). On the basis of the change talk coding and of the semiotic analysis, it seems that the clients do attach different meanings to friendship. These meanings can be divided into four headings: “friendship” as a symbolic sign stands for

• Support to change (10 clients) • Reason to change (11 clients) • Obstacle or a threat to change (19 clients) • Surmounted obstacle to change (16 clients). In what follows, I examine each of these semiotic objects and these meanings of friendship with illustrative examples from the data corpus. Then, I study their connection to the clients’ follow-up data. The extracts are translated from Finnish original data. The translations are as exact as possible but the sentence structure of the spoken language has been edited to a more comprehensible form. It should be noted that Finnish-speaking addiction clients very often use the “zero-person construction” instead of the more active first-person language when talking about themselves. In this construction, there is no stated subject or object, or agent (Halonen, 2008). An example of a change talk where friendship as a symbolic sign stands for a support to change appears in Extract 1.2 It involves a client with a goal of abstinence who has told in the session that he is aware of his drinking problem and he has already managed to cut down his drinking. A counselor makes an encouraging inference about the situation and asks how the change has been achieved. Extract 1: Client 31 Co: It is great to note that you have already changed your drinking habits. Cl: Yes, I have. I have not drunk for weeks. Co: Yeah. What have you done so that it has changed? Cl: Well, I have that one friend. When he does not ski, we spend quite much time together. Well, this winter it was snowing and he can ski. Co: Do you wait that snow would melt away? Cl: No, I do not wait for it. Co: Cl: Also this morning, we spoke with each other on the phone. He often calls me and asks if I would like to go with him to the city and things like this. Co: So, he is clearly the friend with whom you spend a lot of time. Cl: Yes, he is.

2

Co stands for the counselor, Cl for the client.

The client answers the counselor’s question by mentioning the significance of his friend’s role in the change of his drinking habits (“Well, I have that one friend”). In this case, the friend of the client seems to be an important factor with the help of which the client has succeeded in reducing his drinking and has come closer to his goal and closer to the abstinence. The client has taken steps toward change with his support, even though the friend’s skiing has somewhat reduced his chances to spend time with him. In the client’s change talk, the friend appears as a symbolic sign that refers to a support to change. The friend often contacts the client and arranges activities for him to keep him away from drinking. Even if a friend is not an active supporter, she or he may, however, be the reason why a client feels that it is necessary to change her/his substance use behavior. Extract 2 shows a case where a client with a reduced drinking goal mentions friendships as an important reason why he should change his drinking habits. Extract 2: Client 35 Co: So you want that drugs would no more spoil the things that have agreed to do. What do you mean by that? Cl: Well, for example, if you have promised something to a friend, for example, to go to the city with him tomorrow at two o’clock, or to come to help him in the lifting a bookshelf tomorrow, or something. And then, you are not able to go because you are so drunk or you have so bad a hangover. Co: Yes, well, what kinds of situations have arisen when you have had to state that (you are not able to come)? Cl: Well, of course, it doesn’t always feel very good even to me afterwards. And it surely has not felt good to those friends either because they have trusted in me. Then when you are sober you will think what the hell. Co: Yes. Your conscience is knocking. Cl: Yes, right.

In this Extract, the client’s change talk utterances show that he has a particular reason and motive to change. He regrets that he betrayed his friends’ trust. In this case, the utterances about friendships refer primarily to a moral and psychological reason to change. In many cases (19 clients) the meaning of friendship is constructed as an obstacle or a threat to change in the clients’ talk. An example of an obstacle to change-type change talk appears in Extract 3. It involves a client whose goal is to quit using amphetamine. The counselor raises the topic of the disadvantages of change. The client states that leaving the friendships would be difficult. The client’s group of friends seems to be a barrier to change because he is not ready to leave the drug-using friends. Here friendship is a particular reason not to change. In a Peircean sense, it is a symbolic sign that refers to an obstacle to change. Extract 3: Client 17 Co: If you would make this change decision and would imagine a life without drugs, so what disadvantages would there be in it?

MEANINGS OF FRIENDSHIPS

Cl: Well, relationships are one such a thing. All the drug users have to be cut out from my circle of friends. And this circle consists solely of users. Co: Mmm, okay. It would mean leaving the group of friends behind. Cl: Yes, and it has always been a little difficult.

An example of a threat to change type talk appears in Extract 4. The goal of this client is to quit his use of drugs. The client has taken steps toward the goal but he doubts his ability to reach it because there are so many things that may intervene. The counselor asks the client to explain what these things are. Extract 4: Client 27 Co: Well, could you tell me what these things are. Cl: Well, such things as the former network of friends, feelings, and everything. Co: Mmm. The former network of friends and feelings. Cl: Yes. Co: How often do you see these friends? Cl: Well, from time to time. Yet I have not allowed it to win or . . . Co: (you have not allowed) the desire (to use drugs) to win. Cl: Yes. (. . .) Co: They continue to use drugs even if they are your friends. Cl: Yes. Co: You have not yet made a final break with them. Cl: Well, perhaps one never totally gets rid of them. Co: Would you like to get? Cl: Well, I don’t know. There are, however, some good friends among them.

The client brings up the meaning of the former circle of friends. In the client’s change talk this circle appears as a symbolic sign that refers both to the steps toward change (“I have not allowed it to win . . .”) and the threat to change (“They continue to use drugs”, “never totally gets rid of them”). The circle of drug-using friends seems as a threat to reach his goal to quit using drugs. Even though friends are often found in the clients’ speech as an obstacle to change, they also appear in many cases (16 clients) as a surmounted obstacle. The overcoming of the obstacle is revealed by the fact that the client has changed his groups of friends and is no longer dealing with substance users (eight clients) or the client spends time with substance using friends but does not use drugs anymore (eight clients). Extract 5 illustrates the latter case and it is taken from a session between a counselor and a client with a reduced drinking goal. The client has told that he has already managed to considerably cut down his drinking. He has not drunk for 2 months. At the end of the session, the client gives an example of how the change manifests itself. Extract 5: Client 10 Co: For 2 months, you have been able to live such a controlled life, right? Cl: Yes, and in some cases you can tell yourself that you have gone much further. When I go to visit a particular friend’s house, he is there always with a beer bottle in his hand. But I have never asked

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for beer to myself, I prefer coffee. It has turned to a habit already. Even if the other one drinks beer, you do not have to drink it.

In Extract 5, the client’s utterances indicate that he has taken steps toward change. He can still visit his alcoholusing friends and spend time with them but he does not drink any more himself. In this case, the friend appears as a sign that refers to surmounted obstacle. MEANINGS OF FRIENDSHIP AND CLIENTS’ 12-MONTH OUTCOME

In the light of the follow-up data on 35 clients, 16 succeeded in reaching their goal by 12 months. Two clients could not be followed up. They were therefore regarded as unsuccessful. I examined the relationship between the client’s change talk about friendships and the treatment outcome to see whether it was possible to predict the outcome of the BSF sessions from these change talk utterances. For this, I first made table of the occurrence of different categories of meanings of friendship (“Support to change”, “Reason to change”, “Obstacle/threat to change”, and “Surmounted obstacle to change”) and treatment outcomes per client (Table 1). Then I cross-tabulated the categories of meanings of friendship with the “Client reached the goal” and “Client did not reach the goal” outcome categories (the criterion of success, see the Method section). Table 2 presents the results of this cross-tab analysis. As can be seen in Table 2, the client’s change talk where friendship as a symbolic sign stands for a support to change predicted good treatment outcome: in most cases (70%) where a friend appears as an active support, the client reached his or her goal. The utterances about friendship referring to a reason to change seem to promote a more uncertain goal attainment than the “support to change” utterances: more than half of the clients who produced change talk utterances about friendship as a reason to change did not reach their goal. Most often, the meaning of friendship is constructed as an obstacle or a threat to change, and in these cases, most of the clients (58%) did not reach the goal. However, if the client makes utterances that refer to friendship as surmounted obstacle to change during the sessions, it seemed to be an indication of a good treatment outcome: in most cases (63%), he or she reached the goal. There are limitations of this analysis. The results are tentative because of the relatively small sample size. On the basis of 35 clients, it is impossible to make strong causal inferences concerning the relationship between clients’ utterances during treatment sessions and clients’ treatment outcome. Even if the design of this study does not allow the strong inferences of causality to be made, the results of the cross-tab analysis suggest that in most cases, the client’s change talk about friendship as a “support to change” or a “surmounted obstacle to change” predicted a good treatment outcome and an “Obstacle or a threat to change” talk predicted a poor outcome.

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TABLE 1. Meanings of friendship and treatment outcomes Meaning of friendship

Client # (n = 35) 1 6 7 10 14 16 17 18 19 20 21 22 23 26 27 28 29 31 32 33 34 35 36 37 39 40 41 42 43 44 46 47 48 49 50

Support to change (n = 10)

Reason to change (n = 11)

x

Obstacle/threat to change (n = 19)

Surmounted obstacle to change (n = 16)

Outcome (G = good P = poor)

x x x x

x x

G G P G G G P G P P G G G G G P P G P P G G P P P P P P P P G P P G P

x

x x x x

x x x x

x

x

x x x

x

x

x

x x

x x x x x

x

x x x x x x x

x x x

x x x

x x x x x

x

x x

x x x

DISCUSSION

This study investigated the substance-abusing clients’ change talk about their friendships during MI. I have shown what kind of meanings the clients attach to friendships, and what do friendships mean to the clients’ motivation to change. In addition, the relationship between the meanings of friendship and the treatment outcome are examined. The meanings of friendship were analyzed by coding the clients’ change talk utterances and by applying Peirce’s semiotic theory of signs. I explored the utterance about friendships as a symbolic sign, and analyzed what kind of meanings, habits, and conventions concerning drug and alcohol use make the clients attach to it. Based on the results of the present study, it appears that most of the clients (71%) talked about friendships in their change talk utterances during MI sessions. They usually

mentioned this topic when they stated a particular reason to change/not to change or when they stated that they had taken steps toward change. A more exact semiotic analysis showed that the meanings of friendship were divided into TABLE 2. Treatment outcomes by meanings of friendship (%) Meaning of friendship

Outcome Client reached the goal Client did not reach the goal Total (n)

Support Reason to change to change

Obstacle/ Surmounted threat to obstacle change to change

70

45

42

63

30

55

58

37

100 (10)

100 (11)

100 (19)

100 (16)

MEANINGS OF FRIENDSHIPS

four categories, which were defined as follows: a support to change, a reason to change, an obstacle or a threat to change, and a surmounted obstacle to change. The results of the study display that the clients’ utterances about friendship as an active support to change mostly predicted a good treatment outcome. Also the clients’ utterances that refer to friendship as a surmounted obstacle to change seemed to predict a good treatment outcome. However, if the clients’ utterances refer to friendship as an unsurpassed obstacle or a threat to change, it appeared to indicate a poor outcome. So it seems that the friendships and their quality play an important role in the clients’ motivation to change and in reaching the goal. In addition to the intrinsic motivation, the active support of friends seems to be an important factor that promotes the change. This result raises a question about one of the basic premises of MI. In the theory of MI, the significance of intrinsic motivation is emphasized (Miller & Rollnick, 2002), but is it enough that we focus on enhancing intrinsic motivation? In the light of my research, the client’s strong intrinsic motivation to change is important, but the role of social factors is often at least as crucial. If in the substance abuse treatment it is too strongly emphasized that the motivation is an issue that relates to the client’s internal world, his or her goals and values, the significance of the social factors such as of friendships will receive too little attention. So, the focus on internal motivation should not be interpreted as neglect of external factors supporting the change. It should rather be interpreted as in invitation for the client to consider the meaning and value of friends and other significant others to client’s goals in life. Thus, it is suggested that social networks, especially those consisting of friends, should not be overlooked during MI. The contextual meaning of friendship is one factor among others that contribute to motivation to change and substance use treatment outcomes. My results confirm other research in the field indicating a link between social support and substance abuse treatment outcomes (e.g. Ellis et al., 2004; Hunter-Reel, McCrady, & Hildebrandt, 2009; Longabaugh et al., 2010). In addition, these results support the suggestion by Longabaugh et al. (2010) that it is important when planning substance use treatment to assess the client’s social network to estimate how it may be supportive or not in achieving treatment goals. Friends have the potential to both stimulate and hinder change. The results are also consistent with suggestions made by McCrady (2004) that counselors should harness the potential-positive contribution of the social network, including the client’s friends, in successful change. However, there is a need for more analysis of the relationships between the client’s internal motivation to change and his/her social network. For instance, it will be important aspect to analyze how social networks are related to internal motives of change. The results of this study demonstrate that by analyzing the semiotic aspect of the client’s change talk, we can find the significant features and meanings of client’s talk that potentially relate to the treatment outcome. Therefore,

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paying attention to the symbols and other Peircean signs in the analysis of the client’s change talk during treatment sessions could be recommended. In other words, I suggest that it is not only the forms of the client’s change talk that can serve as predictors of change or sustaining status quo but also the personal meanings attached to the client’s utterances. In my pervious articles, I have tried to demonstrate the same by analyzing the role of metaphors in the interaction between clients and counselors (Sarpavaara, 2010; Sarpavaara & Koski-J¨annes, 2013). The present study is a qualitative exploratory attempt to apply one part of Peirce’s theory of signs to the analysis of client’s change talk utterances during MI sessions. It is also possible that other events in those sessions were more decisive for the outcome. Thus, the results are tentative but do highlight the significance of the friendship for change. On the basis of this study, it is impossible to make strong causal claims about the relationship between clients’ talk about friendships and clients’ treatment outcome. The value of this study is not in its quantitative substantiation, but rather in bringing forth a potentially important new perspective on the focus and methods of exploring the predictors of clients’ future behavior on the basis of session interaction. Finally, I believe that these findings have important practice and research implications. They would benefit further development of the professional theories and practices of motivational interaction in probation service and other institutional contexts. Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. This work was supported by the Academy of Finland [grant numbers 118424, 25012504623, and 250125 61453]; and the Finnish Criminal Sanctions Agency [grant number 21126]. THE AUTHOR Harri Sarpavaara, Ph.D., is an Academy Research Fellow of the Academy of Finland. He is working at the School of Social Sciences and Humanities at the University of Tampere in Finland. He is also an Adjunct Professor (Docent) of sociology. His current research focuses on the semiotic analysis of interaction in MI-based consultations with substance abusers in the probation service.

GLOSSARY

Change talk: An individual’s utterances that indicate the recognition of a reason, need, ability, desire, commitment, or taking a step to change.

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