Addiction and the Stages of Change (Honours Project)

Addiction and the Stages of Change: An Honours Project

Making a change in life can be tricky. Making lasting change can be an even larger feat. Just ask someone who's made a new year's resolution. Often they will only make it through a few days before tossing their goal aside for next year. Recovering from an addiction can look very much the same. Many people get to the point where they are desperate to make a change, yet when they attempt to, they end up getting discouraged by setbacks and aren't able to gain momentum on their goal of giving up their addiction. Often they will end up relapsing and returning back to where they were. Does this sound familiar to you? You may be wondering, why does this keep happening, along with how does one break free from the cycle and create lasting changes in their lives in order to recover from their addictions?

This project will help to answer the above questions by giving an overview of the Transtheoretical Model of Change, a well-known explanation of the changes and setbacks that happen while one is recovering from an addiction. We will learn about the 5 different stages a person progresses through while recovering from their addictions, along with some strategies that may be helpful for people at each stage. We will also learn about relapses and how they can be an opportunity to learn and build skills.

The Transtheoretical Model was developed by researchers James Prochaska and Carlo DiClemente in the late 1970s while they were studying smokers attempting to kick the habit. One of its key features is the fact that it normalizes the change process and recognizes that people progress through the stages at their own pace, and not necessarily follow them in order. It also recognizes relapse as a normal part of recovery that can occur at any stage and that many people go through several relapses before being able to maintain long-term recovery from their addictions.

Let's take a look now at the 5 distinct stages of change along with relapse which is a strange one in the sense that it isn't officially included in the change sequence but is an integral part of it as we will learn.

https://studentmentalwellness.com/stages-of-change/

Precontemplation

What is it?
The stage that occurs before a person considers making a change. They aren't yet ready to give up their addictions and aren't considering so within the next six months or less.

What does it look like?

-In the person's mind, the addiction is not problematic in their lives and the personal benefits of their addictions outweigh any negative consequences.
-They may have the belief that they are in control of their addiction and that they can stop at any given time. They may react defensively when confronted.
-It can also be the opposite and they may feel like things are completely out of control and believe that there's no possible way of changing their actions. This often happens with people who have tried to change their behaviour in the past but have been unsuccessful (relapsed).
-They may feel confused when negative things happen to them as a result of their addiction and they may not understand the link between their addiction and it's consequences.

What to do
-During this stage, it isn't often the person who has the addiction seeking help but rather, it is someone in their lives such as a family member or friend who has come forward with their concerns and wishes to find help for the person. Here are some resources for loved ones: How to help a friend with a drug addiction
When a loved one has an addiction

-If you are reading this and are starting to recognize some of the above behaviour patterns in yourself, it's okay. Relax and take a deep breath, we are here for you. Keep reading to find out about some ways in which you can get the help that you need and deserve. Here are some self-assessment surveys you may wish to check out: Alcohol, Drugs, Porn, Gambling, Internet

Contemplation

What is it?
-Contemplation is the stage where a person becomes aware of the problematic nature of their addiction and begins to consider making a change within 6 months.
-Ambivalence (feeling two ways about giving up an addiction) is normal and expected during this stage and it's not uncommon for people to feel ambivalent for long periods of time.
-Support, patience, and understanding are needed to work through these strong feelings and move forward.

What does it look like?
-The person begins to see the potential benefits of making a change but this new insight also comes at the price of making the drawbacks and barriers to changing much more obvious to them. At this point, the cons of changing still outweigh the pros.
-They are open to and show interest in hearing about treatment and recovery options but they aren't quite ready to dive in just yet.
-The person is able to begin to consider what their lives might be like without their addictions. and are likely to be less defensive when questioned about the negative aspects of their addictions then a person in the pre-contemplation stage.

What to do
-Many people report that a good social support network is one the most important tools for success in their recoveries. The building of this network will often begin during the contemplation stage.

-A social support network often includes the following:
-Supportive family members and friends who are empathetic and encouraging and don't have addictions themselves.
Peer support groups such as AA/NA, SMART Recovery, Moderation Management, etc. Here is a link to a list of different groups around the world.
-The Addiction Support Subcommunity and 7 Cups listeners can be a good resource and addition to one's social support network.
-Professional supports such as doctors, social workers, addiction counselors, treatment/rehabilitationcentres play a role throughout the entire recovery process but it's often during the contemplation stage that a person has their first point of contact with one of these professionals.
-A useful tool for a person contemplating making a change is a cost-benefit analysis. To learn more, visit this website

Preparation

What is it?
-This is the stage where a person starts to prepare to make the changes necessary to give up their addiction.
-They have been able to work past the ambivalence seen in the contemplation stage, and they begin to look at the pros of changing as outweighing the cons.

What does it look like?
-The person begins collecting information about change and putting together a plan of action for giving up their addiction. They may start reaching out to professionals and/or doing research about recovery.
-They may begin to make small changes such as cutting back on their use and trying out new strategies such as attending support groups.
-A person in this stage may appear to be anxious and hesitant; however, they have undergone the shift in perspective that's necessary to be able to think seriously about change and to plan for it.
-They have begun to foster a belief in their own capability to make change happen in their lives and see it possible to be able to live without their addictions.

What to do
Creating a plan of action during this stage can be helpful for a person and give them a sense of direction along with identifying resources they have in their lives along with ones they could benefit from making contact with. Many treatment centres and recovery programs do this with their clients. Here is a sample Change Plan worksheet from the SMART Recovery program

Action

What Is it?
-This is the stage where the majority of the active work is done to overcome the addiction. This can include attending treatment, making lifestyle changes, learning coping mechanisms, and relapse prevention planning.
-It is also during this stage that a person is at their greatest risk for relapsing back into their addiction and needing to repeat previous stages. Please see the section on relapse for more information.

What does it look like?
-A person starts taking direct action towards overcoming their addiction such as attending regular treatment and support groups, learning to recognize and cope with triggers, finding healthy activities to replace their addictions, associating less with people they indulged in their addictions with, etc.
-This stage continues until the emotional ties a person has to their addiction are weakened they are able to resist temptation and abstain from their addiction without requiring a constant, sustained effort.
-In addition to the risk of relapsing, a person will likely experience multiple slips or lapses during this stage which are brief episodes of returning to their addiction that doesn't interfere with their progression through the action stage.

What to do
Learning effective coping mechanisms to deal with stress is essential during this stage. Here are a few examples:

Planning in advance to anticipate and identify triggers, cravings, and high-risk situations along with learning how to manage them is a keystone part of the action stage. This process is called relapse prevention planning. Here is a link to a webpage that gives some comprehensive instructions on making a relapse prevention plan.

Maintenance

What is it?
This stage focuses on staying on track with the changes made in the action stage and the long-term development of robust coping mechanisms and a healthy lifestyle free from the addiction.

What does it look like?
-At this stage, the person feels confident in their ability to handle stress without turning to their former addiction. They anticipate and handle temptation and employ new coping techniques they have learned in the action stage.
-Not engaging in the addiction and instead, turning to alternate healthy activities becomes the person's new norm (DiClemente 190)
-They are far less reactive and sensitive to triggers though relapses and slips are still a risk, so it's vital that they still have a relapse prevention plan and are connected with a strong social support network.

What to do
-Continuing to maintain contact with support networks along with keeping an updated relapse prevention plan can help to significantly reduce the risk of relapsing and returning to past unhealthy, addictive behaviours.
-Here is a simple exercise that can be helpful for people in this stage

Relapse

What is it?
-Simply put, a relapse is a return to an addiction after a period of working towards or living without the addiction. It can happen at any time throughout the recovery process during any of the stages of change.
-It differs from a slip or lapse in the sense that the person has to repeat the steps taken in the previous stages of change. Which stage they have to begin at again depends on the person and the circumstances.
-Relapse is a normal and expected part of recovery and can be distressing and embarrassing but also provides a window of opportunity to problem solve and come back to the action stage better equipped to handle the challenges of quitting. Relapse doesn't mean failure or weakness.

Why do relapses happen?
-The number one trigger for a relapse is stress. It's important that a person learns how to effectively cope with it in order to prevent them from returning to their addictions when confronted with stressful situations.
-Addictions are often used as a way of coping with intense emotional pain and traumatic experiences. It takes an immense amount of work to break free from this cycle of self-medication. It often takes a person several tries to learn effective coping mechanisms and to heal their emotional wounds without turning to their addictions.
-In addition, addictions are often tied in deeply to a person's sense of identity and their lifestyle and it can be tough to redefine one's self. DiClemente has likened the process to leaving an intense love relationship (170).
Self-confidence and motivation oftentimes also play a role in relapses. A person can become overconfident and expose themselves to too much stress without having yet developed adequate coping mechanisms. A person can also lose their sense of motivation and confidence during the recovery process which can lead to a relapse.

What to do
-It's essential that a person has access to and is receiving both social and professional support while working through the stages of change to lessen the chances of relapsing and/or making it easier for them to get back on their feet when a relapse inevitably occurs.
-Looking back and examining what lead to the relapse can be helpful in learning what changes need to be made for a person to be successful in maintaining recovery from their addiction. For more information on how to do this, check out this article

Conclusion

Thank you so much for reading my project. I hope that this short explanation has helped to demystify the process of change when it comes to addiction recovery and hope that there are some messages you can take home for yourself. Here are some discussion questions to help engage the community on this topic, help us to share our own experiences, and further our knowledge.

Discussion Questions

1. What has your experience been like when it comes to making changes in your life? Have you accomplished any lasting, sustaining changes youre proud of?
2. Have you ever lost motivation or become stuck when trying to achieve a goal such as recovering from your addiction? What did you do or what kind of support do you feel you need to help get yourself back on track?
3. Reflecting back, have you noticed yourself or a loved one going through any of the 5 stages? What are some examples that stand out for you?
4. Do you feel like any of the coping strategies and exercises mentioned would be helpful for you? Which ones? Do you have any strategies of your own that you'd like to tell us about?

References

1. Addiction and Change, First Edition: How Addictions Develop and Addicted People Recover, Carlo C. DiClemente
2. The Stages of Change Workbook: Practical Exercises For Personal Awareness and Change, James E. Phelan
3. https://www.7cups.com/forum/ListenerLearningJourney_149/ChatSupport_101/GuidanceonMotivationalInterviewingtechnique_25247/
4. https://www.verywellmind.com/the-stages-of-change-2794868
5. https://www.wespath.org/center-for-health/resources/stages-of-change/
6. https://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front9-wk-toc~drugtreat-pubs-front9-wk-secb~drugtreat-pubs-front9-wk-secb-3~drugtreat-pubs-front9-wk-secb-3-3