Understanding the Stages of Change in Addiction Recovery and Treatment.
Recovering from an addiction is never an easy task. It isn’t like learning to do the ‘downward facing dog’ in your yoga or even simply tying your shoes.
But if you think about it, even the most rudimentary of tasks takes time to master and even longer to excel truly.
The process of learning any skill is broken down to smaller manageable steps; each step aimed at bringing forth the desired change.
It is the same philosophy that holds in trying to change from being an addict to becoming a recovering addict.
The National Institute of Health estimates that over twenty million Americans have struggled with drug and substance abuse at one point in their lives.
Fortunately, not all of those affected end up spending the rest of their lives in Gloom and Doom- there is hope for one to make real and lasting change with resources such as rehab centers and programs, counseling, therapy, and 12-step programs.
Nonetheless, there is one question that has baffled addicts, counselors, and the addiction community in general: why is it easier for some people to overcome addiction but harder for others?
Like every other scientific conundrum, a lot of theories have been thrown around, analyzed every which way, discarded as balderdash, and thrown away into the dark, cobwebbed recesses of the library… the internet?
Nonetheless, the Transtheoretical Model of Behavior Change (TTM) is one of the theories that has endured criticism over the years AND still proudly stands strong.
Generally speaking, theoretical models are often far from perfect, but TTM gives some interesting insights on how to approach addiction treatment from an altogether different viewpoint.
So, what exactly is the Transtheoretical Model?
Traditionally, behavioral change was construed as an event- stop drinking, quit smoking, or eat healthier.
The Transtheoretical model proposes a different perspective, which is that for someone to completely eradicate problematic behavior, they must undergo some sequentially defined stages.
The model was introduced by James Prochaska and Carlo DiClemente, who were researching ways to help people quit smoking.
Unlike other models of behavioral change which single out specific aspects of change such as biological or environmental influence, the TTM model incorporates various key constructs of other models.
In doing so, it provides a comprehensive theory of change that applies to a variety of behaviors, settings, and population- thus the name transtheoretical.
DiClemente and Prochaska’s theory also proposes that relapses are simply an inevitable part of the change.
People are different, and it is these differences that determine the time one spends in each TTM stage. That’s why it’s easier for some to recover from addiction and much harder for others.
Even so, to create lasting behavioral change, all addicts must complete the tasks required in each stage.
This raises an interesting question:
How do the TTM Stages of Change relate to addiction recovery treatment?
Stage 1: Pre-Contemplation (In denial)
In the first stage of the TTM model, the addict is unaware of the negative impact of their addiction or/and unwilling to change.
Family, friends, and qualified professional may try to highlight the source of life problems as the individual’s addiction- such efforts will rarely succeed.
The pre-contemplator is metaphorically blind to the adverse effects of their addiction. To them, their addictive tendencies are nothing if not normal!
A helpful strategy to employ is to encourage the individual to rethink their behavior, practice self-analysis, and examine the risks involved.
Some pre-contemplators may have tried multiple times to change but were unsuccessful. This led to feeling demoralized about their ability to change, making them reluctant to try again.
Others will see them resistant, unmotivated, or not ready for change, but the truth is that traditional addiction treatment programs were not designed to help such individuals.
Usually, people in this stage who go to rehab or seek out therapy do so because they are being pressured by others; relatives, friends, or spouse.
The individual feels that the situation is hopeless as the addictive behavior results from genetic makeup, destiny, or society- unchangeable factors.
However, the negative consequences of one’s addictive behavior eventually catch up to you, and this is what ultimately prompts one to the next stage.
Stage 2: Contemplation (Getting Ready)
In this stage, the individual is essentially at war with themselves. They are aware of the harm addiction has wrecked in their lives, but the thought of making a change, moderating or quitting seems ambivalent. Like catching Jerry is for Tom.
For contemplators, the fear of changing far outweighs the potential benefits to the mental, physical, and emotional state. The uncertainty associated with this stage can last upwards of six months.
Nonetheless, the addict is more open to hearing about the negative effects of their addiction than they were in the pre-contemplation stage.
They may also be willing to try out different approaches to cut-down or moderate problematic behavior. That’s not to say they are finally ready to commit to quitting altogether, but they have become more open to the idea of changing sometime in the future.
To help a contemplator move to the next stage, confirm the readiness to change, normalize the idea of change by weighing the pros as well as the cons, and identify specific barriers to behavioral change.
Non- judgmental information giving along with motivational approaches of encouraging change will work better than confrontational methods.
Such individuals are still not ready to embark on the traditional addiction recovery treatment programs which advocate for immediate change.
And until the addict decides to take the leap and make a change, they can quickly reverse to the pre-contemplation stage.
This decision to commit to change is the event that propels the addict to the next stage.
Stage 3: Preparation (Ready)
Addicts in the preparation stage acknowledge that their addictive behavior is a problem, realize the need to make a change, and are preparing to fix their lives.
The idea of changing doesn’t seem so impossible anymore, and one may even be taking small steps to prepare oneself for a more significant lifestyle change.
For instance, if you are preparing to quit smoking, you can start with chewing nicotine gum, using a nicotine patch, getting rid of ashtrays and lighters, smoking less each day, or changing cigarette brands.
People in the preparation stage are not content to just sit and wait for change, as the saying goes if the mountain doesn’t come to Muhammad, then Muhammad must go to the mountain.
Make a plan and begin to take direct action, such as consulting a counselor. Prepare a list of motivating statements and another for the desired goals.
Join NA or an alternative health club. Inform your addiction buddies, family, and friends about your decision to change.
Read up on your addiction to learn different ways to make a successful, lasting change.
After making the necessary preparations, the individual is ready to move to the next transtheoretical stage and can be recruited into action-oriented programs.
Stage 4: Action
In this stage, the addict has made specific overt changes to their overall lifestyle.
It is no longer a question of I don’t want to change, or I can’t change and more an I am changing.
Since the changes here are more observable, it’s not surprising that behavioral change is often misconstrued as an action rather than the 4th stage of change that it is.
The action stage relies on the goals set in the contemplation and preparation stages.
Many people fail at making lasting changes because they don’t give enough thought to the kind of change they want and prepare a plan of action- stage 2 and stage 3.
Let’s take the example of trying to start eating healthier. Most people will be quick to throw out all the junk food in the fridge, immediately enroll in a two-year gym membership, and begin eating only greens.
For a time, your efforts will work, but it may not last. You will come home from a bad day at work/school, and you won’t feel like cooking or even eating greens.
You’ll convince yourself that it’s only this one time while you order an All-American burger from the take out place just around the corner. That first delicious bite will mark the death of your short-lived Healthy Life.
Often, individuals who triumph in the action stage are those who completed the subsequent stages. They seek out rehab, individual counseling, or group meetings as a means to manage the destructive behavior.
The process can seem tedious and boring after the backstage Broadway show that was your addictive life and, therefore, the stage carries the highest risk of relapse.
Nevertheless, if the addict commits to being clean and sober, identifies and eliminates triggers, and enthusiastically embraces their new lifestyle, they should be able to move to the next stage.
Stage 5: Maintenance
Recovering from an addiction is a life-long process, and Prochaska and DiClemente’s original last stage recognizes this fact.
The maintenance stage is concerned with keeping to the intentions made in the third stage and the behaviors implemented in the fourth stage.
Cravings and triggers may dissipate over time, but the temptation to use will never be truly eradicated.
Because drugs affect the neural pathways of the brain and the sensations you felt while under the influence can never be completely forgotten.
However, recovering addicts in this stage have learned how to manage their addiction and maintain their new lifestyle with minimal effort.
They have created a new normal where they integrate change into their lives by continually guarding against triggers, focusing on preventing relapses, and consolidating their efforts to maintain a life free of destructive behaviors.
Although most addiction treatment professionals advocate for complete abstinence, there are a few who acknowledge that it may be difficult for some addicts to go completely cold turkey.
Such addicts would benefit from moderating their addictive behavior, practicing controlled drinking, along with reducing drug and substance use.
The entire addiction treatment and recovery community recognize that relapses can occur at any stage and that battling addictive behavior is a life-long process; nonetheless, a sixth stage was added to the transtheoretical model.
Stage 7: Termination
Theoretically, in this stage, the addict overcomes their addictive behavior and completely stops abusing drugs. The individual no longer craves drugs and as such relapsing is close to impossible. They can sustain a clean and sober life with minimal effort.
Many professionals deem this stage as idealistic and impractical. Termination means the end, and recovering from an addiction is a lifelong process, and as such, there is no end.
All the same, we must take into account that Prochaska and DiClemente invented this theory in the 1970s.
At that time, technology wasn’t so advanced, and the scientist had no way of studying the effect of drugs to the brain and surmise that addiction is incurable.
The model was already receiving criticisms because it was too radical. People believed that addictive behaviors were a matter of willpower such that someone could simply snap their fingers and quite drinking or stop using drugs.
Shockingly, such backward sentiments still exist.
Successful recovery from addictive behaviors occurs in gradual sequential steps over some time.
According to the transtheoretical model of behavioral change lasting change can only happen if you understand the harmful effects of your addiction, are willing to change, prepare a plan of action, and stick to your decision to change.
Remember that relapses can occur at any stage of TTM. All you can do to guard against them is to identify your triggers and be on the lookout. Don’t let relapses frustrate, demoralize, or disappoint you- they are part of the process.
Consider relapses as learning opportunities.
After you recover from your setback, examine the reason for your relapse, and identify what triggered you.
Reassess your strategies for dealing with triggers and come up with new techniques you can use to handle temptations.
Reaffirm your decision to stay sober and clean.
The next time you are triggered, you will be better prepared, and your Recovery will be safer for it.
If you need help with your recovery, you can get in touch with the Hotline at our Recovery Center where trained and experienced professionals are available to assist you in every way.
The staff at Chateau Recovery is always available to help you with all of your questions regarding addiction recovery and treatment. Call anytime.
Chateau Recovery Center
375 Rainbow Lane
Midway, UT 84049, USA
Phone: +1 435-654-1082
Please call our toll-free helpline which is open 24 hours a day, seven days a week and is staffed by experienced and caring professionals who can answer your questions and help you navigate through the process of evaluating and securing a treatment program.
If you or someone you love has questions concerning the rehabilitation process, call our free helpline Phone: +1 888-971-2986 for more information. Calls are always confidential, private, and secure.
Stages of change in addiction recovery and treatment.
This video explains the stages of change and how they relate to addiction recovery. It goes over precontemplation, contemplation, preparation, action and maintenance.
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