The Stages Of Change

This model of addictive behavior is illustrative because it predicts what types of intervention may be useful when approaching an addicted person. Pick the right one and the patient may be open to your suggestions. Pick the wrong one (based on an incorrect assessment of an individual’s readiness for change) and you will alienate them further.

The five stages are…

Precontemplation – also known as denial. People in this stage are not thinking seriously about change and are unlikely to be open to help. They will defend their current behaviors and often become agitated if you challenge their opinions with regard to drug use. The best approach here is often watchful waiting (as painful as that may be), looking for an opportunity that will move the addict to the next stage. This may happen organically (a close friend or family member may die of addiction) causing a period of lucid reflection or they may be forced to acknowledge the problem if they lose a job as a result of drug use or are arrested for a DUI.

Contemplation  – this stage provides the golden opportunity for an intervention. The addict has become aware of the personal consequences of his/her addiction and is willing to at least consider a change of behavior. In this change stage, the individual is weighing the benefits and drawbacks of treating his/her drug or alcohol dependence.

Although one may be tempted to “rush in” when an opening appears, it is important to listen to the addict express his/her ambivalence. Often, we can tip the scales towards treatment during this phase by addressing the addict’s specific concerns and misperceptions. The addict may say “If I detox than I have to go into a hospital for a month and I can’t afford to miss work for that long” to which I might reply “Actually we can detox you at home and you can be back at work within a week”.

Preparation – This is an overlooked but very important stage. The more one prepares for detox and recovery, the better the outcome. Preparation includes both psychological preparation as well as more mundane logistical considerations.

During this phase, the addict should seek support from people they trust and tell them about the changes they are going to make, with the help of a support team that will include a physician, a recovery coach as well as other friends or family members if possible.

Also at this time, the addicted individual who is planning to detox at home will likely have to make some preparations regarding work and childcare. Generally, a one week absence from work is optimal. In addition, although having children around during the process can be motivating, the addict should not be the primary caregiver during this time.

Action – All the other stages lead to this one – when the patient is actually being detoxed and withdrawal symptoms are being controlled with a variety of medications. Although the first day or two of treatment focuses on medical detox, patients are generally comfortable enough to begin the process of recovery with the help of a Recovery Coach who will provide much of the initial support as the addict re-acclimates to a sober lifestyle

Maintenance – This is the most overlooked stage of recovery. Although detox is certainly a triumph, once accomplished the next goal is to achieve a sustained recovery. Support systems during this phase are completely individualized and may require a Recovery Coach (for those who find do not find AA or NA to be suitable) and regular physician visits (especially if the patient is receiving ongoing treatment for mental health conditions such as depression or anxiety).

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