When it comes to addiction recovery, change can be a complex process. Truth be told, it is not perfectly linear and, thus, it can be messy. How nice would it be if any time we wanted to make a change we just set a goal, make the change, and then easily maintain the new behavior?
In our lifetime we will make an abundance of changes. Take a moment and reflect on the changes you have made. You may recognize some changes were easier than others, and the really tough ones probably came with a lot of moving back and forth through various setbacks, stagnation, relapse, and progress. Change is a wonderful thing, but sometimes the process can be nothing short of pure frustration and setbacks. With that being said, it could be helpful for anyone trying to make significant behavioral changes to take a moment to learn about the stages of change.
History: Transtheoretical Model of Change
In the late 1970s and early 1980s, psychologist and researchers James Prochaska and Carlo DiClemente conducted various studies on smoking cessation. Through this research, they recognized patterns as people worked on making behavioral changes (Lamorte, 2022). The model that came from their research is referred to as the Transtheoretical Model of Change, which often is simply referred to as “Stages of Change.” This model shows that people move through a predicable set of stages as they change habitual behaviors, which takes time for positive outcomes to come to fruition. They recognized that change tends to adhere to a cyclical process that follows a path of an upward spiral towards sustained changed behavior (Lamorte, 2022). For this blog, we will be applying the Stages of Change to addiction recovery. However, change is change, regardless of the target behavior, so this model can be applied to a variety of other health and behavioral goals.
Stages of Change
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse
Precontemplation
The first stage of change is called precontemplation, and at this stage a person is typically unaware that anything needs to change. Basically, if it isn’t broke, you don’t need to fix it! When it comes to addiction, others may be aware of a person’s problem behavior, but the person struggling with addiction will lack awareness of the negative impact of the addictive
behavior. So, how does insight come about in this stage? A huge contributor to cognitive dissonance is recognizing when my behavior is misaligned with my values. For example, at my core, I may value family and friends, career, freedom, spirituality, etc.; but when my attention shifts to my addictive behavior long enough, I may start to have negative consequences that impact my ability to connect to my values. Becoming aware that my behavior is causing me to lose the things that are important to me can put “a pebble in my shoe.” It’s uncomfortable. Early indicators of values and behaviors not being aligned may include reduced self-esteem, reduced sense of self-efficacy, or beginning to experience guilt and shame as we begin to have negative experiences from our addiction. Awareness is a first step in making changes, and even if the problem is not addressed right away, the awareness that something is not right begins to grow and that is what shifts us to the next stage of change.
Contemplation
At this stage of change, a person may be fully aware that their behavior is not working for them. However, this does not mean that they have any intention of changing any time soon, or that they even know how they will make a change. A person can live in this stage of change for a long time.
Do you have a time when you knew that you needed to make a change and maybe sat with that awareness without action for weeks, months, or even years? For those struggling with addiction, they may be experiencing negative consequences such as relationship challenges with friends and family, problems at work or job loss, health problems, financial problems, arrests, and so forth that raise awareness that their addictive behaviors are problematic at this stage. As the discomfort continues to increase, they may begin to shift to the next stage.
Preparation
Individuals at this stage of change may begin to research and make a plan of action for how they will change their behavior. Maybe they identify a quit date and let people know their plan or identify prime times for use and create alternative behaviors. People may identify support systems that may include personal and professional supports. Consideration for distraction strategies or alternatives is needed for times of craving. This is also an ideal time for people to consider professional supports if they have not already connected with a program, therapist, or medical provider. Considerations may be made for including medication assisted treatment (MAT). Depending on the addiction, they may need to identify resources such as detox facilities, residential programs, outpatient treatment such as individual therapy or group therapy programs like substance use intensive outpatient (SAIOP). There are also community supports such AA/NA, Celebrate Recovery, SMART Recovery, Refuge Recovery, or others.
Recovery is a lifestyle; it is so much more than just not using, and there is truly so much that goes into a solid recovery plan. This stage is crucial for effective change. There is a saying in recovery, “If you fail to plan, you plan to fail,” and that saying really captures just how important this stage is in the process of successfully achieving a recovery lifestyle.
Action
Once a plan has been made, it’s time to put it into action. At this stage individuals have entered into treatment, or they have activated their plan and are using their strategies. Once a person has been in the action stage of change consistently, without relapse for six months, the new behavior really begins to set in as the “new norm.” Around six months, a person will move into the next stage of change.
Maintenance
At this stage, the change has become more habitual and routine. This stage can last a lifetime. However, with addictive behaviors, the work is not completely done. This stage involves a strong relapse prevention plan and continued awareness of indicators of relapse. This can include planning ahead for difficult events, continuously applying and adapting recovery skills, staying connected with recovery supports, effectively taking care of oneself daily including attending to mental health, nutrition, fitness, and overall health.
Relapse
This stage of change is not always a requirement; however, it is part of the stages of change for a reason. As mentioned previously, change is not linear. This is because it is not uncommon that relapse can happen at any time, including for those in long term maintenance. Even if a person has 20 years of recovery, relapse can happen. However, there is value in relapse. When relapse occurs, it is typically a result of having missed a much-needed element in the preparation stage. It is important to note that relapse does not mean a person goes back to the precontemplation or contemplation stage, though that is possible. It simply means there is a need to go back to preparation and apply what was learned from the relapse.
Addiction is essentially a disease of the mind as use changes the way the brain functions (executive functioning changes) in ways that makes it difficult to start or stop behaviors. If you or someone you know is struggling with addiction, it may be helpful to connect with professional supports as part of strengthening the change process. If our best thinking has got us where we are today, obtaining support from a resource outside ourselves can help restore us to our most independent and best selves.
At Avance, we have a variety of behavioral health therapists who are Licensed Clinical Addiction Specialists (LCAS) to help those struggling with addiction find their way to recovery. To learn more about our behavioral health services and providers, please visit: https://www.avancecare.com/service/behavioral-health/
References:
- https://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html
- https://expertprogrammanagement.com/2022/01/stages-of-change-model/
