Addictions and Change

In order to cease an addiction such as smoking, drinking or using drugs, a person needs to go through foreseeable stages of change. Following on from Prochaska and DiClemente’s founding research in 1982, these stages of change have been extensively scientifically validated. It is unusual for a person to able to cease their addiction successfully after only passing through these stages once. In most cases there are a number of attempts at change before ceasing for good. Like someone who ceased smoking seven times over, only to resume smoking five years later during a divorce, then having to cease smoking all over again.

Recognising someone’s specific stage of change is helpful because targeted strategies can successfully aid change. Inaccurate identification of a person’s stage of change can cause rehabilitation to fail – for example, pressure to quit too soon can cause resistance and a determination to sustain the feel-good behaviour. The six stages of change and a few examples of specific strategies to give up an addiction are listed below:

Precontemplation

Denial and avoidance of damaging results of the addiction are characteristics of the precontemplation stage. The person is only aware of the enjoyable sides of their behaviour and they certainly have no motivation to change. People generally dispute the harmful effects of their behaviour by saying something like “Gran smoked 40 a day and she lived to be 91!”.

A wake-up call, like an alcoholic being confronted with the fact that his mate had a serious crash while drink-driving, is the most powerful influence to change. Visiting their GP for a health check can prompt a person to change their behaviour. If this doesn’t work you can discuss the evidence of the health, relationship or vocational consequences of the behaviour (i.e., liver, lover, livelihood). It is useful to ask “What would have to take place to make you realise that this behaviour is having a detrimental effect on your life?”. Try not to give any recommendations or be pushy; rather have the person tell you the reasons why they should give up their behaviour. Bear in mind the dictum “I learn what I believe as I hear myself speak”.

Contemplation

Hesitancy, procrastination and fence-sitting are common traits of this stage as the cracks begin to show. People assess the benefits of change versus the damaging effects of their addiction. Generally at this stage the person will view the costs of changing their behavioural as being considerable. People might change their behaviour in the coming six months.

It is advisable to encourage people in the contemplation stage to weigh up the positive and negative consequences of their addiction. Commend all desires and efforts to quit. It is imperative that you remain non-judgemental as any perceived conflict can elicit resistance and relapse.

Preparation

During this stage the person’s motivation to modify their behaviour increases substantially, and the possibility of change occuring within the next month is high. When people understand that the benefits of change outweigh the costs, they are able to form a plan to quit and then take tentative steps to put this plan into action.

It is important to remain calm, positive and encouraging during this stage. It is useful to collect information on different treatment programs and discuss the options available with the person concerned. Offer to make preliminary contact with the program which the person feels would suit them best, e.g., AA groups are a good option for people with an alcohol addiction who can only manage “one day at a time”.

Action

Throughout this stage change is viewed as being beneficial with minimal costs, and hard work is actively in progress. It is likely that you will notice distinct changes in thought processes.

It is beneficial to assist the person to get to therapy sessions and reflect on these sessions – you can help by organising transport to therapy sessions, talking about the content of the sessions with the person and positively reinforcing efforts to quit. It is advisable that family members and friends are part of the therapy process – they can attend therapy sessions, compile information or even keep records of the person’s progress.

Maintenance

During the maintenance stage, the person becomes gradually more positive that change can be sustained. During this stage the temptation to slip back into old habits is less persistent, and this period can last between six months and five years.

Continually reinforce changes in behaviour as the person practises, consolidates and internalises the new behaviours. In order for the change in behaviour to be maintained, it is imperative that support is offered to the person’s family and friends so they can assist in the therapy process.

Termination

The final stage of change indicates a complete and permanent recovery as the addiction has gone for good, without any temptation to slip back into their old ways, ever. It is more than likely that it will take quite a few years to get to this stage!