The Stages of Change and Addiction

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Sad Woman | Stages of Change | The Hills

If one looks up “overcoming addiction” or “addiction recovery” online there will certainly be a wide variety of search results returned. This is due to the vast nature of tried and true methods for addiction recovery that have been utilized for many years. Some treatment programs are offered in a residential treatment center whereas some others are utilized in outpatient and group treatment settings. As with any form of recovery or lifestyle change, what works well for one person may not work well for another so sometimes, addiction recovery is a series of small, trial and error steps until success is achieved. One addiction recovery model you may be familiar with is the “stages of change” model.

This model is also referred to as the Transtheoretical model. Stages of change is an easy to understand, easy to follow way of describing how people overcome addiction. While the stages of change can be applied to a wide variety of behaviors that someone may want to change, it is most notable for how it has been successfully applied to treating people who are trying to overcome addiction.

The stages of change model

This model was developed by analyzing how the recovery process occurs in a natural setting. Over time, it has been embraced as one of the prime treatment models for addiction over more traditional, pathological approaches which were viewed as more confrontational. The stages of change model falls into a treatment category similar to modern-day person-centered and motivational methods such as motivational interviewing.

According to this model, there are four main stages of recovery. They include pre-contemplation, contemplation, preparation, and action. In some cases, the model includes six stages which add two other stages to the above mentioned four. These include maintenance and relapse.

Visually, the stages are represented as a cycle. It is suggested that someone going through the recovery process go through these stages in sequence. This is merely a suggested because, as with any process recovery is not linear or clearly defined. During this process, people will jump between stages, move forward only to move backward and in some cases, straddle two stages at the same time. Viewing the stages in sequence merely helps to make the process easier to understand.

Stage one-Pre-contemplation

The first stage in the stages of change or transtheoretical model of addiction recovery is called pre-contemplation. This stage is very early in the process. In many cases, when people are in the pre-contemplation stage, they have not reached a point where they view (or accept) their behavior as being problematic. This mindset occurs for different reasons. For some, they have not experienced any negative consequences associated with their behavior. Others may be experiencing a state of denial about the actual negativity or severity of the consequences they have experienced. For these individuals, there was indeed a negative consequence but it “wasn’t all that bad” or “nothing really bad happened”.

People who are in the pre-contemplation stage generally aren’t too interested in hearing someone (clinician, loved one or otherwise) tell them about the potential or actual negative consequences associated with their behavior. Additionally, they have not reached the point yet where they are ready to have someone provide them advice about quitting their addiction.

People who are still in the pre-contemplation stage often view the behavior associated with their addiction as positive or pleasant. However, regardless of this viewpoint, the negative consequences do eventually influence people who are exhibiting addictive behaviors. These effects may come as a result of their addiction impacting other areas of their life or as a result of other harms or impacts associated with the behavior. Eventually, these negative impacts will push an individual into the second stage of the model, the contemplation stage.

Stage two-Contemplation

To contemplate something means you are considering it or “thinking” about it. Once someone reaches the contemplation stage of the stages of change model, they have reached the point where they begin to think about changing, quitting or cutting down on their engagement in the addiction or addictive behavior. It is valuable to note the contemplation stage is separate from the preparation or action stage when looking at the stages of change model. Someone who has reached the contemplation stage is more open to hearing or receiving information about their addiction or addictive behavior and the possible negative consequences associated with it. They may also be open to learning about the different ways to control or quit the behavior. However, this openness to suggestion and information does not mean they have reached a point where they are going to make positive steps towards quitting. It simply means they are ready to learn about how quitting may be possible when, and if they decide they are ready.

The contemplation stage may be a stopping point for those with addictions that lasts for many years. After a time, some may move forward to the next stage, preparation, or some may move backwards to the pre-contemplation stage. This is the stage where the individual with the addiction will benefit the most from non-judgmental information giving and motivation as opposed to confrontation and directed accusations regarding the consequences of their behavior. The contemplation stage comes to an end when the individual makes the decision to progress to the next stage of the model.

Stage three-Preparation

Arrival at the preparation stage means a person has moved forward from thinking about change to planning and preparing for following through with the changes they were considering during the previous stage. For those with substance addictions, this stage can be very critical and well thought out preparation can be the key to success or failure.

The idea of preparation can be rather confusing. What does one do prepare to combat addiction? How do they plan for such a thing? Some examples of things someone might do or plan during the preparation phase could include:

  • Determining the change to be made: Once the decision to change is made, the next step is to determine what kind of change. Is it time to cut down on the use of the addictive substance? Is it time to quit completely? These options need to be considered to determine the correct direction for planning and preparation.
  • How to make the change: If someone has decided to quit a substance altogether, how are they going to do that? Are they going to do so “cold turkey”? Are they going to seek assistance from a medically supervised rehabilitation program?
  • Secure the necessary resources for the plan: Continuing with the previous example-if a person has decided to quit substance use completely, the would want to start looking into treatment programs. This may require phone calls or facility visits. It may also be achieved by contacting a primary care medical provider who can guide them in the right direction.
  • Remove triggers: Triggers are reminders of an addiction or addictive behavior that are likely to cause cravings and make recovery and sobriety more challenging. Triggers for someone who is quitting substance use could include drugs or associated drug paraphernalia Getting rid of these items can be challenging on its own. This is a part of life that has been constant but closing this door is necessary for success.
  • Put support systems in place: Strong support systems will be integral to assuring success after treatment is over. Supports can include everyone (and everything) from friends and family to a support group. Some people may also consider informing their current circle of friends (and other users) of their plans and asking them to respect their decision and the process. Quitting substances can be challenging enough without negative input from those within one’s close social circle.

In addition to the items above, there may be induvial preparations that need to be made depending on someone’s personal circumstances. For instance, if their current living conditions do not foster sobriety, finding a clean and safe place to start over may be necessary. It may also be beneficial to reach out to a social worker or substance abuse counselor early on during this stage to see if they may be able to provide advice and suggestions that could make the process a little easier. Most importantly remember, the preparation stage is different for everyone and will look different depending on induvial circumstances and needs. This stage requires time, support and commitment.

Stage four-Action

The action stage is the stage in which all the contemplating, planning and preparing comes to fruition. For many who are attempting to overcome addiction, this is the stage that receives the most focus as it is the stage at which real change starts to happen. This stage can be exciting and highly stressful all at the same time however, with proper preparation the stress does not need to outweigh the excitement of seeing success.

For many who are trying to overcome substance addiction, the action stage will begin with their entrance to a detox center where trained staff are on hand to help with the early phase of detoxing from substance use. Depending on the induvial goals set during the contemplation stage and the plans made during the preparation stage, the action stage may be a complete change of lifetime, or a series of small, gradual steps towards the end goal of sobriety. Again, sobriety and the mechanism for getting there are both highly individual things.

During the action stage, it is important to develop ways to cope with stress and anxiety which are likely inevitable during the action stage process. It is crucial to develop strong coping mechanisms as it will help the transition from the action stage to the maintenance stage without the potential for experiencing the relapse stage.

Stage five-Maintenance

The most important element of this stage is continuing to make forward progress and maintain the progress that was achieved during the action stage. For those who are recovering from substance addiction, this means upholding and adhering to the decisions made during the preparation stage and the new lifestyle behaviors introduced during the action stage. This generally means staying “clean” or abstinent from drugs or alcohol to maintain the sobriety reached during the action stage.

Surprisingly, this stage is the most challenging especially after time has elapsed since initial detox and the drive of meeting early goals has lost its power. This is the stage where complacency can lead to relapse. It is easy to believe or feel as though one little “break” from routine will not have a significant impact, but this is far from true. This is why the coping strategies developed early on are so important.

Stage six-Relapse

In Therapy | Stages of Change | The HillsThis stage is not a concrete stage that everyone should go through during the stages of change. Unfortunately, it is a stage that many will unwillingly (and sometimes willingly) go through at least once during their recovery process. Although it is listed after maintenance, a relapse often occurs before maintenance is achieved. For some, it is only after several relapses and experiencing the reintroduction of negative consequences that sobriety truly occurs.

The struggle to maintain sobriety after substance abuse treatment can be challenging. Whether it is the first time someone has reached the stage where they are ready to move beyond merely considering treatment; or it is a subsequent treatment program after relapse has occurred, the challenges remain the same. It does not get easier and a strong support system is essential to achieving and maintain success.

If you are struggling with substance addiction, don’t fight alone. Achieving and maintaining sobriety is generally more successful when someone leaves rehabilitation after detoxing and recovering in a program where medical staff is on-site to help with each step of the process.

At The Hills, we have highly trained staff on-site to walk you through each element of your detox and recovery. Since each person is different your treatment will be individualized and designed specifically around your needs as that is what will be the most successful for you. If you have reached the stage where you are considering your treatment options, contact us at The Hills and ask how we can help you reach your sobriety goals.

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