Stages of Change and the Process of Addiction Recovery

This is for all of us who have in some way been impacted by addiction, either personally and/or with someone we are close with and love. That is likely all of us. May we, and those we love, find our pathways out of the darkness and into the light and beauty of who we truly are.

With warmest blessings ~ Molly

STAGES OF CHANGE

 A Process to Understand How We Approach Recovery from Addiction

 

As in any aspect of life that is difficult to approach, changing lifestyles, or habits, or beliefs or self-image can be a daunting task. Sometimes it may even seem impossible. And as in any aspect of life, of living, changing the way in which we do things takes a process. There are steps that we must take in order to make lasting changes.

To help make sense of this process, two alcoholism researchers, Carlo C. DiClemente and J. O. Prochaska, developed a model of change that they called “The Stages of Change.” This model involves six stages that take a person from the beginning - learning to identify a problem - to the end - living without that problem. The Stages of Change model helps providers to understand addiction, and helps people with addiction learn to recognize their place in the change process as a means of striving towards recovery.

The Stages of Change are:
Precontemplation
Contemplation
Determination/Preparation
Action
Maintenance and Relapse Prevention
Termination

Precontemplation

In this stage, an individual may not even recognize that she or he has a problem. People are not yet thinking about changing their behavior directly, and may believe that other people are overreacting to them and their behaviors.
 
Reasons to be in precontemplation can be broken down into four categories:
· Reluctant: May not have enough information to identify the problem.
· Rebellious: Are so habituated to their behaviors that they become hostile or resistant. They do not perceive that they have choices and options and do perceive suggestions as “being told what to do.”
· Resigned: Believe in the inability to change and thus remain stuck.
· Rationalizing: Take the time to think out their behaviors and justify their choices. The problems are someone else’s.

The Precontemplation Stage is characterized by denial and ignorance of the problem. Individuals in this stage are not even thinking about changing. Clients in this stage benefit from encouragement to rethink their behaviors; education about the risks and potential short- and long-term consequences of their behavior; and assistance in conducting self-analysis. If you suspect that you may be in this stage, ask yourself some simple questions: Have you tried to change an addictive behavior in the past and failed? Do you have any habits that your loved ones worry about? How would you know that you had a serious problem? What would have to happen for you to consider your behavior a serious problem?
 
Contemplation
 
The Contemplation Stage is characterized by ambivalence, uncertainty, and conflicted emotions. Individuals in this stage are becoming aware of the risks associated with their behavior and the potential benefits of making a change. The contemplation stage can vary widely in duration, from a couple of weeks to even years. In fact, some people never make it past this stage.

This is the openness to consider that a problem exists, and that there may be a need to change one’s behaviors in order to correct that problem. A commitment to change has not yet been made; there is not yet direct action although one may undertake to learn more about the nature of the problem.
 
Determination/Preparation
 
The person has made a decision to stop using, to make a change. Sometimes this Stage is referred to as Preparation, as the person begins planning a course of action to initiate change in her life.

The Preparation Stage is the first active stage. In this stage, the addict begins to experiment with making small changes and begins collecting information about change and recovery. For example, a problem drinker may begin trying to limit alcohol consumption and may seek information on local self-help groups; a chain smoker may try switching to a brand of cigarettes with less nicotine.

Clients in this stage benefit from writing down their goals, preparing a plan of action, and making a list of motivating statements. If you are in the Preparation Stage, it is crucial to locate healthy outside sources of information, education, and advice, and support in the form of support groups, counselors, or friends.

Action
 
The person recognizes and admits that a problem exists, and has developed a plan to make changes. He modifies his behaviors, environment, relationships, and experiences to overcome the problem. He puts the plan he made in the Determination stage into action.

In this stage, the client takes direct action toward achieving a goal. This stage shows whether the client has adequately prepared for change. Without clearly articulated goals and a specific and thorough long-term plan of action, many efforts at recovering from addiction fail.
 
Maintenance and Relapse Prevention
 
Change has been achieved - a pattern of addictive behaviors has been replaced with sobriety and strides into recovery. In Maintenance, the person recognizes the benefits of successful change, however, work must still be done as the risks remain for returning to old behaviors.
 
It has been said that “Relapse is part of recovery” and as such, the person must be on guard against triggers to relapse. If a relapse does occur, the person must re-enter a Stage such as Contemplation or Determination. In some cases, the person returns back to Precontemplation. This does not equal failure, but merely the need to re-engage the process of change from the beginning.

In this stage, recovering addicts focus on maintaining their new patterns of behavior and avoiding temptation. Those in this stage are learning to incorporate their new behaviors into their long-term identities, goals, and activities. As mentioned previously, most individuals cycle through the stages several times before achieving long-term change. Relapse, although ideally avoided, may provide excellent opportunities for clients to learn more about themselves and about addiction, making their next effort at recovery even more successful.
 
Termination
 
At some point in the Maintenance Stage, the threat of relapse truly is reduced. When triggers arise, such as personal crisis or financial hardship, the person has a support system in place and resources available to maintain sobriety in a recovery lifestyle. Substances no longer emerge as the first, second, third or tenth response to crisis.

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Articles by Emily Battaglia and also adapted from Prochaska, J.O., & DiClemente, C.C. (1984). The Transtheoretical Approach: Crossing traditional boundaries of therapy. Homewood, IL: Dow Jones-Irwin

For original articles, please go here:

http://courts.oregon.gov/Marion/docs/services/stagesofchange_000.pdf

 http://www.drugalcoholaddictionrecovery.com/stages-of-change-and-substance-abuse-treatment/