Addiction and Change
Have you ever been told to “just stop?” Maybe you’ve wondered why a partner says that they won’t drink anymore, but they continue. Do you have friends who promise to show up on time in the future, but don’t? For most people, this can be incredibly frustrating and even ruin relationships.
Although the notion of change suggests that something happens over time (Remember the graph in your physics class?), we often think about change as a specific event. For example, when you think about your friend who stopped overeating, you probably think about the moment when they stopped. Some people even recall specific dates that they made “changes” in their lives (i.e., quit smoking, quit drinking, etc.).
The expectation that a person will change (or you will change) a behavior in a single instance is likely to lead to frustration. In fact, the authors of this model of change (Prochaska and DiClimente) estimate that only 20% of people are ready to take action at any given time. For the other 80% of us, it may be helpful to understand the Stages of Change.
Stages of Change Ideas to Support Change
1. Precontemplation Stage
People in this stage aren’t currently considering change and don’t see their behavior as problematic. They are unlikely to take action in the near future and probably try to avoid reading, thinking, or talking about the change.
You might consider people in this stage unmotivated, although a more accurate understanding is that they aren’t ready for change.
If you or someone you care about is in the Precontemplation Stage, work to validate them. People who are precontemplative are likely demoralized from unsuccessfully trying to change in the past or feel too overwhelmed to consider changing. Encourage the person to think, read, or learn about their target behavior (i.e., addiction) and how it impacts their life.
2. Contemplation
People contemplating change are ambivalent, although they might recognize the impact of their behavior. They might weigh the pros and cons of making change, but don’t feel strongly motivated to change or not change. Often, people spend a long time in this stage! (This is also the stage that most frustrates those around the person!)
Although the tendency is to encourage the person to make action oriented steps, doing so is unlikely to be helpful in the Contemplation Stage. It’s important to continue emphasizing that the decision to change (or not) belongs to the person. It may be helpful to point out ways in which changing would be beneficial and align with their long-term goals. You also might consider sharing ways in which change would positively impact you.
3. Preparation
People in this stage are ready to take action soon. They might consider themselves “trying it out.” You probably observe the person creating a plan for their change (i.e., buying nicotine gum, reading a self-help book, etc.). They might seem determined and can likely tell you how making the change would benefit their life.
It’s now time to begin talking about action. Encourage any steps the person takes toward modifying their behavior – even the smallest ones! Help them identify their supports and problem-solve potential barriers that might arise.
4. Action
This is the stage most people consider “change.” If your loved one (or you) is in the Action Stage, they are consistently demonstrating the new behavior or have stopped the problematic behavior. This is the stage in which a new observable action is taking place and is now being practiced. Still, the modified behavior is fairly new (within the last 6 months).
If you thought your work to support the person is done, you’re wrong. Now it’s time to support them as the cope with the loss of the old behavior (This can be a scary time for people who used an addictive behavior to cope and grieving the loss of that behavior is normal). Continue to help the person modify their environment and social situations to support their healthy behavior by eliminating cues and people that encourage reversion to the old behavior. Don’t be afraid to keep identifying long-term benefits of the new behavior as well as helping the person build confidence that they can continue to leave their addictive behavior behind.
5. Maintenance
People in this stage have sustained the behavior change for some time (more than 6 months). Generally, the person plans to continue with their new way of living and feels more confident that they will not relapse (i.e., their self-efficacy increases).
Your work as a supporter is still not done! You can help the person by pointing out natural rewards that result from the changed behavior. Further, you should have a conversation about relapse and help the person develop alternative ways to avoid it.
6. Automaticity (also called termination)
Reaching the final stage of change is very rare. In this stage people have no desire to return to their previous behavior. The person doesn’t even feel tempted. The new behavior is automatic.
It’s time to celebrate! Enjoy the change with your loved one. Continue to develop the support you provide the person and continue to eliminate stressors. It never hurts to learn new ways of dealing with difficult situations and emotions, so learn with your loved one.
If relapse does occur, respond accordingly (check on their motivation, identify triggers, notice barriers to choosing healthier behaviors, and make a plan to use coping strategies in the future).
Final Thoughts
Keep in mind that the amount of time someone might spend in a certain stage is specific to that person. People also don’t always move through these Stages of Change in order. Instead, people move through one stage and then regress back to that stage at a later time.
Next time you notice frustration that your loved one hasn’t made a “change,” don’t forget that change doesn’t just happen at the moment a new action is observed. Your role in supporting the person must match their stage of change. Finally, be patient with yourself – after all, change is a process.
