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The Stages of Change Model and Addiction

According to the Merriam-Webster Dictionary, change can be defined as ” “to become different” or “to undergo transformation, transition, or substitution.” Change is a simple and common word that we use every day, and in most instances, the word itself means very little to us. But for a caterpillar turning into a butterfly, change is characterized by a complete metamorphosis. The same has also been said regarding the monumental shift from addiction to recovery.

For many, however, even small changes can seem daunting. For those suffering from a chemical and emotional dependency on a substance, a sea change is required and may feel as though it is next to impossible.

The ultimate catalyst for any type of personal change is finding, fostering, and maintaining the motivation to do so. Some change requires little or no motivation on the part of the living being – it’s either a naturally-occurring, biological process (the caterpillar-butterfly transformation for example) or it occurs out of our control, by virtue of a complete accident that we could not have predicted.

But recovery does not reflect either of these scenarios. Motivation is needed to initiate change, and it doesn’t happen by accident or by the strict rules of nature. We as beings must make a decision, and in doing so, use determination instrumentally to see it through.

Motivation is, in essence, the fundamental desire for recovery to occur, and must be maintained throughout the entire process. Without this desire, failure is imminent.

Moreover, some people in recovery start out motivated but then suffer from a lack of resolve as time wears on and new obstacles appear. Others are coaxed into recovery having little or no motivation but over time, somehow find the strength within themselves to buckle down and accept the need for change.

The stages of change model (also known as the transtheoretical model) is a set of five or six stages, depending upon interpretation,* that “assesses an individual’s readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual.”

James Prochaska and Carlo DiClimente developed the most widely-accepted framework for the stages of change model in their book “Changing for Good” (1994). The six stages of change consist of the following:

  • Pre-Contemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Termination

Stages of Change Model – Stage 1: Pre-contemplation

Pre-contemplation is the first component of the six stages of change model and requires no recognition of a problem. Or, he or she may acknowledge deep down that perhaps a problem exists, but has scant motivation to do anything about it or consider the possibility that a change is needed. Sadly, many people who find themselves in the throes of addiction are at this stage and will never leave it.

Rather than takings steps toward change, pre-contemplators more or less wallow in the mire of their existence, making excuses and justifying their decisions. Even when faced with a cost-benefit analysis, people in this stage maintain stubbornness and refuse to believe that their lives could profoundly improve without drugs or alcohol.

Stage 2: Contemplation

Stages of Change Model | Midwood Addiction Treatment

Individuals in the contemplation stage have become more self-aware and have begun to admit their behaviors are destructive to themselves and others. However, they remain unsure as to whether a change is worth the effort, and may prolong their start dates for no justifiable reason (i.e., “I’ll quit when I turn 30.”)

In this stage, however, change is thought of as a real possibility, and toward its conclusion, the conscious desire to recover from addiction begins to take hold. The person also starts to realize that the costs of substance abuse outweigh the benefits and that change is not only necessary but desirable.

Stage 3: Preparation

The preparation stage is the third component of the six stages of change model and can also be described as “the beginning of the end.” Moreover, the person is beginning to locate resources and make plans to receive treatment, go to 12-step meetings, etc. They may start by contacting their insurance company and rehab centers and discussing long-term treatment options with family and employers. Sometimes this stage is initiated with a family intervention.

People who are stymied in their efforts during this phase may encounter legitimate barriers to treatment such as insurance coverage and financial constraints. Many of those who locate assistance, however, successfully enter stage four.

Stage 4: Action

The Action stage is about the execution of plans prepared in stage three. These plans have been developed to promote positive physical, mental and emotional change through immersion in addiction recovery methods (inpatient rehab, for example) in conjunction with abstinence from substances. The attendance of AA or NA support groups, counseling, and inpatient or intensive outpatient treatment can significantly reduce the chance of relapse during the action stage.

Also, people in recovery begin to explore new hobbies and daily activities as replacements for pursuits previously centered on the use of a substance. For example, going to a bar or gathering at a friend’s house to watch a sporting event will almost always trigger intense cravings, not just for the substance but social participation and acceptance as well. A good replacement might be to watch or listen to the game while engaging in a hobby such as carpentry or painting.

Keep in mind that plans for this kind of change do not have to be perfect. Waiting complacently for a supposedly perfect, grand opportunity to finally make all these changes will amount to nothing more than wasted time.

Stage 5: Maintenance

Stages of Change Model | Midwood Addiction Treatment

The maintenance stage heralds the sustainment of sobriety-promoting plans enacted in stage four. Without the ability to step back and gain perspective on our progress accompanied by an honest will to rectify any errors as they arise, we ultimately risk a return to our old ways of behaving. A relapse can occur during any stage but becomes increasingly detrimental during action and maintenance.

Sobriety is like a muscle. When you start working it out, it gets sore, and if we lack resolve, we can let this pain hinder our plans. And yet, if we forge ahead, the muscle breaks down against the new activity, then rebuilds itself to perform that very activity even better.

And though this constant vigilance may seem like a daunting task, over time, overcoming challenges becomes increasingly natural and much more enjoyable. It is an ongoing process that takes nothing less than unflappable courage to obtain the ultimate reward – sobriety. You can think of it just like the start of anything – nobody is ever an expert right out of the gate. If it were that easy, everyone would be doing it.

Stage 6: Termination

The final component of the six stages of change model is termination and is achieved when one’s lifestyle becomes transformed entirely. Consider the muscle analogy: when you break down your previous life (the muscle) which was essentially built to better ‘perform’ substance abuse, you can rebuild your life (the new muscle) to exclude the ability to abuse substances.

Once this is accomplished, accommodating substance abuse back into your life requires you to break it back down, which requires considerable effort and garners no discernable reward.

In stage six, the person now lives in the present and service of his or her own best interests, not those of a substance. He or she is free, exuding the confidence and courage that will safeguard against relapse. We are now referring to a fully transformed, actualized substance-free individual who is no longer an active addict or an alcoholic – he or she is someone who has essentially beat a life-threatening disease.

Being free from a substance does not mean making it impossible to use it. Those who have become independent from a substance must continue to recognize their potential for relapse, and yet always choose otherwise. It is perfectly normal and healthy to fear a relapse because losing the life you have regained to let yourself once again be controlled by a substance is indeed tragic.

Moreover, true sobriety takes resolute courage to face these fears and conquer them – one step at a time, one day at a time.

* Proponents of the five-stage change model state that the termination phase should not be included because change is an ongoing, never-ending process.

Our programs are structured with various components of evidence-based treatment practices and holistic approaches to treatment that provide our patients with the knowledge and tools they need to be successful in their recovery.

If you or your loved one is suffering from substance abuse, please seek help as soon as possible.

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