Addictions And The Change Process
Individuals who would like to cease an addiction such as smoking, drinking or using drugs need to go through expected stages of change. Following on from Prochaska and DiClemente’s benchmark research in 1982, these stages of change have been extensively scientifically validated. It is not often that a person is able to successfully quit after going through these stages only once. Normally people make numerous attempts to change before giving up for good. For example, after several attempts a person may cease smoking for five years, only to resume smoking again during a divorce and have to cease smoking all over again.
It is helpful to be able to identify a person’s exact stage of change because targeted strategies can successfully facilitate change. Inaccurate identification of a person’s stage of change can cause rehabilitation to be unsuccessful – for example, the person may become resistant to change and may become more determined to maintain the feel-good behaviour if they feel pressure to cease their addiction. The various stages of change and some simple strategies to give up an addiction are:
Precontemplation
Denial and avoidance of harmful consequences of the addiction are features of the precontemplation stage. There is no motivation to change, and the person is merely aware of the enjoyable effects of the addiction. The typical argument goes: “Gran smoked 30 a day and it didn’t do her any harm, she lived until the ripe old age of 93!”.
The most powerful stimulus to change is a wake-up call – for example an alcoholic may decide to change his behaviour after finding out that his mate almost died in a car crash caused by drink-driving. An appointment with their GP for a health check can act as a motivator for change. It is useful to discuss the factual evidence in regards to the health, relationship or vocational consequences of the person’s behaviour (i.e., liver, lover, livelihood). It is useful to ask “What would have to occur to make you realise that this behaviour is having a detrimental effect on your life?”. Try to let the person to tell you the reasons why they should quit and avoid giving advice or being pushy. Bear in mind the dictum “I learn what I believe as I hear myself speak”.
Contemplation
During this stage the person begins to challenge their current beliefs but is not yet motivated to change. People re-evaluate the damaging outcomes of their behaviour and the benefits of change. The costs associated with change generally appear to be significant. It is probable that change will happen within six months.
It is necessary to encourage people in the contemplation stage to reflect on the positive and negative consequences of their behaviour. It is imperative that you are supportive of all desires and endeavours to minimise the behaviour or quit, regardless of how successful they are. Perceived negative judgement can trigger resistance and relapse, so it is essential that you remain non-judgemental.
Preparation
During this stage the person’s motivation to alter their behaviour increases significantly, and the likelihood of change occuring within the next month is high. The person realises that the benefits of change outweigh the costs, sets about forming a plan to cease their behaviour, and begins to put this plan into action.
It is essential to remain non-judgmental, positive and optimistic during this stage. Help research treatment options and be open to talk about any concerns. Offer to get in touch with the program which the person is most interested in, 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 little or no costs, and hard work is certainly in progress. It is possible that you will notice definite changes in thoughts and beliefs.
It is important 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 change. Encourage family members and friends to be engaged in the therapy process – for example they may be interested in attending therapy sessions, gathering information or keeping records of progress.
Maintenance
This stage is characterised by a rising level of certainty that change can be upheld. This stage can last between six months and five years, and the temptation to relapse is less frequent during this time period.
As the person becomes familiar with, consolidates and internalises new behaviours, it is advisable to continually reinforce these behaviours. In order for the change in behaviour to be maintained, it is important to offer support 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 relapse, ever. It is probable that it will take several years to get to this stage!
Dr. S Henshaw is a clinical psychologist in Perth, working with individuals to alleviate depression and anxiety. To learn more about improving your emotional well being, visit: http://www.henshawconsulting.com.au