Five Stages of Change

The Transtheoretical Model of Change is currently the most complete picture we have in psychology to explain how and why individuals are able to create and sustain behavioral or attitudinal changes in their lives. It is my hope that by helping the reader to better understand this model I can help you to better understand the behavior of a loved one suffering from addiction. This model is primarily based on the work of Prochaska and DiClemente who first developed it in a study published in 1983. While useful and informative when dealing with substance use it should be understood that the insight provided by this model need not be limited to the treatment of addiction. It has been shown to be descriptive of behavioral change across a wide spectrum of behaviors and individuals.

1. Precontemplation

Individuals in this stage often are resistant to any mention or conversation of the behavior in question.

The precontemplation stage is characterized by an individual having no intention of modifying his or her behavior. Often he or she is not able to acknowledge that said behavior has any negative impact on themselves or others. Individuals in this stage often are resistant to any mention or conversation of the behavior in question. He or she is not engaged in the change process in an immediate sense and may resist any effort from others aimed at getting them to quit. Often individuals in this stage are thought to be in denial. My experience of these individuals, more often than not, is that they are aware of their behavior(s) but don’t see them as a problem yet. 

2. Contemplation

He or she is now more aware of the personal and social consequences of their actions.

During the contemplation stage of change the individual in question is becoming aware that his or her behavior is problematic. He or she is now more aware of the personal and social consequences of their actions. Parallel to this, the individual is beginning to be more cognizant of the benefits of change. That said he or she is often still ambivalent of undertaking the change. At times an individual will pass through this stage very quickly while for others it may take months or years. As someone concerned with a loved one suffering from addiction you will most often find them more open to conversation and information surrounding their problematic behavior. Often for substance use disorder the fear of the detox process, and other short term costs associated with quitting will nag at the individual. They are thinking about quitting and want to want to stop.

3. Preparation

Preparation is one of the shortest stages and often lasts no more than a couple of weeks

In the preparation stage of change the person of concern is now prepared to make a change. This could also be called the research phase as often one in this stage will actively be attempting to accumulate information and knowledge germane to their problem. He or she may be calling treatment centers and other providers, or be searching on the internet for information about their problem. He or she may even be attempting to take their first tentative steps toward modifying their behavior or abstaining completely. Preparation is one of the shortest stages and often lasts no more than a couple of weeks.

4. Action

This is also a very tenuous time as success is largely dependent on the willpower and commitment of the individual

This is the shortest of the stages and lasts no more than six months. The individual has begun to take decisive noticeable actions to change or abstain from the behavior in question. This is also a very tenuous time as success is largely dependent on the willpower and commitment of the individual. He or she is paying the short term costs of change without yet enjoying many of the benefits. Also, the individual will not yet have been able to develop many methods for staying committed to change or coping mechanisms for when stress and temptation arise. Risk of relapse is greatest during the action stage.

5. Maintenance

By this point one will be able to mostly avoid temptation to return to former behavior and if tempted will have developed coping mechanisms to successfully overcome the temptation.

After six months in the Action stage an individual will progress into the maintenance stage of change. During maintenance an individual’s behavior has changed. With addiction he or she will be abstinent. By this point one will be able to mostly avoid temptation to return to former behavior and if tempted will have developed coping mechanisms to successfully overcome the temptation. A maintainer will be increasingly focused on the good that has come as a result of change and will be determined to maintain the new state of affairs moving forward. He or she will feel a strong sense of self efficacy and satisfaction at having been able to change.

In the original work by Prochaska and DiClemente there was a sixth stage that they termed Termination. In Termination, former behaviors are non existent and are no longer perceived in a positive fashion ever. I find the inclusion of this stage problematic as it relates to addiction. Addiction is a chronic disease and often relapse is a component of change. This is true of many other chronic medical conditions. The rate of relapse in addiction is lower than with asthma and hypertension, and only marginally higher than with diabetes. Therefore, while not a necessary consequence relapse happens often enough that it needs to be considered a part of the process of change. It is most useful to move away from the conception of relapse as a personal failing. Rather in viewing it within the broader scope of chronic illness, as I’ve tried to illustrate above, we can empower an individual to learn from the process and not to let it derail the overall effort at recovery.

While not specifically noted in the research it is imperative to understand that most often it is the efforts of family and friends to support an individual in making a change that creates momentum moving through the stages. It is never too early to start a conversation. There are many methods which can be employed to do so and to help support health change in an individual and within a family system.

If you are concerned that a loved one is in active addiction and need help please consult a professional, their guidance can be indispensable. If you have questions, or concerns, and we can be helpful please don’t hesitate to contact us at Granite Mountain BHC, through our website or by phone at 844-878-3221. We are here to help.

Until next time

Your friend in service,

Rob Campbell


If you or someone you know is in need of help for substance use disorder call us today at 1-844-878-3221 or reach out to us via email.

3 Early Warning Signs of Active Addiction

Spotting the signs that your loved one could be using could help save their lives

Addiction can be defined as self-induced changes in the neurochemistry of the brain that result in negative consequences and unhealthy behavior.  Many individuals employ various methods to change their neurochemistry in healthy ways such as meditation, exercise, certain forms of therapy, and others.  Most people will even engage in some activities that cause changes in neurochemistry and are neutral such as, social consumption of alcohol, social gambling,eating, and many others. It can be challenging to identify when a loved one’s behavior has progressed from health behavior into addictive behavior.

Addiction to a substance differs from social usage in important ways.  First, addictive behavior results in negative consequences and unhealthy behavior. Second, addiction (when it is chemically based) is typically accompanied by increased tolerance for and dependence on a substance or substances.  Further, addicts typically express feelings of being out of control running parallel with a feeling that they don’t know how to stop. It is worth noting here that in the early stages of addiction it is often the case that the addict is suffering from high acuity levels of delusion and cognitive dissonance that inhibit their ability to properly self-diagnose and take personal responsibility for their actions. Addiction is a lethal disease and the earlier it can be identified and addressed the better, as the likelihood of recovery is then increased.  It is never too early to begin addressing a loved one’s behavior. Honest conversation with friends and family is indispensable.

In this article I will present three early warning signs that can help identify an addiction in a loved one.  This list is not meant to be comprehensive. If you are concerned with a loved one consultation with a professional is advisable.  

 

1. Behavioral Changes

The first category we will consider are changes in behavior.  Be on the lookout for:

  • Increased mood swings
  • Increased secrecy or demands for privacy
  • Dramatic changes in sleep patterns or energy levels
  • Lying and other deceptive behaviors including stealing
  • Dramatic change in disposition (introvert suddenly becomes an extrovert or the opposite)

You know your loved one well.  If he or she is a family member you may have lived with him or her for many years.  If you notice major deviation from the behavioral norms he or she has expressed over the years this is cause for concern.  There are of course many potential causes in change in behavior, that said, at the very least you owe it to your loved one to investigate the possible causes of the change and will want to begin paying closer attention.  If you observe that these changes in behavior are happening in concert with the sort of changes discussed below you have cause to be very concerned.

2.  Social Changes

Social changes can take many forms but it is almost always the case that they are an escalation from behavioral changes.  This is not to say that one will necessarily notice the behavioral manifestations first. Yet, if you do notice social changes in your loved one this ought to be considered as a progression in severity.   Examples of these are:

  • Absenteeism from work or school
  • Loss of interest in hobbies and other pursuits
  • Inability to meet family and social obligations
  • Sudden change in friend group

Over time active addiction will consume increasing amounts of an individual’s time and attention.  This renders the individual unable to maintain involvement in and connection to the activities that used to provide meaning to his or her life.  During this stage of active addiction the consequences of one’s actions begin to accumulate. Loss of job, poor grades, loss of friends, and others can be anticipated.  Often early in this phase their will be stories and justifications the addict will express in an effort to explain the results to themselves and to others. Over time these stories will become less plausible.  Often when questioned the addict will become angry and attempt to escalate the situation rather than address the issue head on.

3.  Physical Changes

If your loved one’s addiction has progressed to the stage where there are obvious physical changes to their person he or she is in a serious condition which needs to be addressed immediately.  Delay at this stage may prove catastrophic. Be wary if you observe any of the following:

  • Rapid fluctuation in weight
  • Skin has a grey or yellow hue
  • Limited responsiveness to stimulation
  • Persistent itchy skin, excessive scratching
  • Trembling in hands
  • Dilated or constricted pupils
  • “Track marks” marks left by persistent injection

Any of the three above observable categories of change are a cause for concern and should be addressed.  Two or more is highly suggestive of active addiction and all three is substantially conclusive. It is never too early to begin honest dialogue if you are concerned with a loved one, and it is never too late to intervene.  It is always better to overreact to these warning signs than to under-react.

While addiction is a serious and deadly disease it is treatable and many people do recover and go on to lead fulfilling lives.  If you are concerned that a loved one is struggling with addiction consult with a therapeutic professional, treatment center, intervention specialist, or all three.  There are many tools at your disposal in trying to help a loved one into recovery.

If you are concerned and need help please reach out to us at Granite Mountain BHC through our website or by phone at (844)878-3221 we are here to help.

Until next time

Your friend in Service,

Rob


If yourself or somebody you love is struggling with substance use disorder please call us today! We understand what you are going through and are here to help.

Patient Brokers, Who’s Responsible and What Can be Done?: Part 1

By now I’m sure many if not all of you reading this are familiar with the terms “patient broker” or, “client broker”.  If you are not what the terms refer to is an individual who for a fee, paid by a treatment facility, will make a referral to that facility.  The way that this often works is that the broker “identifies” an addict in need of help, and then the broker starts calling treatment centers and negotiating a fee for placement.  These fees can be in excess of $5000 dollars per client. Thus referrals are made not based on clinical need, therapeutic fit, or really in any way meaningfully tied to the interests of the patient.  Rather these placement decisions are being made on the financial incentive for the facility and the broker. I want to spend a few minutes today sharing with you my thoughts on this problem and perhaps begin to describe a better way forward for our industry and our patients.

The Hydra of Our Industry

Sly And Cunning

Patient brokers come in many different forms.  Many are individuals with no professional background in addiction treatment at all.  These individuals quite literally will troll 12 step meetings, local detoxes, and in some instances even the local skid row,  trying to identify individuals who are suffering from addiction and desperate for help. When they find somebody they approach them under the guise of being able to help them find treatment. Many represent themselves as working directly for treatment centers when in fact they do not.  They will assure the individual addict that they can get them help, that they can get them to a safe place, that they can help them get sober. When the addict, desperate for a new life, agrees to seek treatment, the brokers work begins. The broker will begin calling treatment centers.  Leading not with questions about the therapeutic validity of the facility’s work but with the insurance information. The most valuable are those with PPO insurance with out-of-network benefits. the line between this sort of activity end human trafficking seems murky to me.

Not all patient brokers are this blatant, or have quite this level of amorality.  Many come in the form of professionals. Some are Therapeutic Placement Consultants, some are Interventionists.  Brokers of this stripe will charge a family anywhere from a few hundred to a few thousand dollars with the promise, again, of being able to help an addict to recovery.  After collecting money from the family and doing their work they turn around and “sell” the human being to the highest bidder. Often times in this sort of arrangement it is not on a per head basis.  Rather payment comes in the form of large year end “bonuses”. I know of one program that pays their “best” therapeutic placement consultant $50,000 at the end of the year. I try not to be a cynical person, but it is hard for me to see how a many thousand dollar payment would not influence placement decisions.   Many times these financial arrangements are not disclosed to the families of the addict. By not disclosing this information the family is not in a position to make a free and informed decision. I want to be clear that in no way am I alleging that all placement consultants or all interventionists operate in this way.  There are many highly competent, highly trained, and highly ethical individuals in both of these positions across the country. I have had the pleasure of knowing, and working with many.

The Buy-Side

Bad Actors Ruin It All

The bad actors in the industry give anyone trying to do a professional job with high standards of conduct a bad name.  It would be very easy to just cast blame at the brokers and say that they are the problem. This, in my view, is not true.  They are without hesitation a part of the problem, but only a part. Another part of the problem are the facilities who work with these individuals.  In any transaction the “buy” side has as much culpability as the “sell” side. If collectively treatment centers refused to buy patients the brokers would have no one to sell to, and the problem would go away.  The persistent nature of this issue appears to be a reflection of an inadequate understanding on the part of treatment facilities of how to engage patients and their families in a meaningful way, how to create meaningful relationships with clinicians and other providers who are already engaged with the population of addicts.  In some ways it is a failure of innovation on the part of treatment facilities. As long as facilities continue to be willing to buy their patients there will be individuals willing to sell them patients.

 

Root Cause

I believe that the problem runs even deeper than these two aspects.  The true nature of the problem is associated with the stigma we as a community still have in regards to those suffering from addiction.  Many in our communities, in the face of the science attached, still want to believe that if an addict wanted to change enough they would.  As a consequence of this belief they view (often unconsciously) addiction as a moral failure, or a failure in character. As a result our communities are less concerned with how addicts are treated when compared to the care and concern we express toward other sufferers of chronic disease.  Can you imagine an oncology hospital “buying” cancer patients, or a memory specialist “buying” patients suffering from Alzheimer’s without public outrage? I have a hard time imagining such a situation. What then is the difference? All are chronic diseases, which cause massive destruction to the lives of the suffer and those tied to them by affection.  The difference, as stated above, is in the way society views these diseases. If we want to change the outcomes for those suffering from addiction we need to change the way, we as a society, view addiction. We need to end the stigma.

 

Moving Toward A Solution

How do we move toward a solution?  The most immediate answer I see to this dilemma is to raise the bar of entry into the industry for professionals.  In any domain, a low bar of entry allows bad actors in. We need to adopt a standard of professionalism across the industry.  We need increased oversight and licensing requirements for those working in the field. By doing this we will make it harder for those with bad intentions to get in, we will be able to identify and stop them sooner, and will make it more transparent who can be relied on.  This will only happen when our industry demands it of ourselves. If we do this it will give us time to change the stigma attached to addiction. It will restore the public’s faith in us as a means of recovery for those suffering from addiction.

In the next part of this series we will be examining the proposed state bill in Arizona that is currently under consideration, and whether or not it will adequately address the problem.  In subsequent segments we will present interviews from each side of this issue. I believe that it is only in honestly facing a problem that we can begin to heal from it. We can and must do more.

 

Until next time
Your friend in service,
Rob Campbell
VP of Communications & Market Development


If you or your loved one is in need of help for substance use disorder please call us today @ 1.844.878.3221

Changing the Stigma of Addiction

In the above video clip Michael Botticelli makes a compelling argument for the necessity of changing the stigma attached to addiction. In it He makes an impassioned plea from personal experience. At one point in the clip he makes the statement that he feels more comfortable coming out as a gay man than being transparent about his history of addiction. This he feels after more than twenty years in recovery. Those of us who have addiction in our lives either actively or in our past don’t need to be told this. We know first hand about the stigma of addiction.

I have not had a drop of alcohol in my body for more than nineteen years and still find myself hesitant to disclose my recovery to people outside the recovery community. I want to be clear, I am in no way ashamed of my past. Perhaps it sounds paradoxical but, the single greatest thing to ever happen to me is that I became an alcoholic. How many people move through their lives feeling not quite right, being sad, isolated, or alone but don’t know why? I felt all these things and more. When alcoholism finally brought me to my knees, and I had nowhere to turn I found my answer. Through treatment and membership in a 12 step fellowship I was able to understand why I felt the way I did. I was also offered a solution. I have accepted that solution and have since been able to enjoy a life beyond my wildest dreams. A life of purpose, meaning, and connection.

I do not bring this up to be self congratulatory. On the contrary I want to illustrate what is possible for every single person suffering from a substance use disorder if they are able to access treatment and recovery. In his talk Mr. Botticelli makes the point that the stigma attached to addiction is the single greatest hindrance to people who need help getting it. As a community we need to begin to recognize addiction for what it is. A brain disease, a medical condition. If we are to come to grips with our current opioid epidemic we need to begin to treat those afflicted as what they truly are, sick people who need help. There is no doubt this can be hard to do, but it is necessary.

I agree with Mr Botticelli that in order for this to happen those of us who have overcome this disease need to be open about that fact. This may enable those around us to begin to form a different viewpoint about addiction. They may be able to see that as Mr. Botticelli states, “people are more than their disease.” Moving forward I am committed to being open and candid about my own recovery with anyone who asks. I will weather the inevitable questions, the confusions, the awkward attempts at “protecting” me. I will do this not for myself, but as an example that addiction does not define a person, that as with most other diseases we can and do recover.

 

Until next time
Your friend in service,
Rob Campbell
VP of Communications & Market Development


If you or someone you love is in need of help for substance use disorder please give us a call today. We understand and we are here to help.


 

https://www.ted.com/talks/michael_botticelli_addiction_is_a_disease_we_should_treat_it_like_one#t-570345

 

“The Opposite of Addiction is Connection”

An Inability To Connect

In his Ted Talk from TEDGlobal London, Johann Hari makes the statement that, “the opposite of addiction is not sobriety, the opposite of addiction is connection.” This powerful statement is at once a message of hope to those suffering from addiction and an indictment of the way our culture has treated addicts for the last 100 years. Mr. Hari spent three years studying addiction by traveling the world speaking to individuals on all sides of the issues. What he was left with was an understanding that behind and underneath addiction of all sorts is an inability to connect, to engage in a life of purpose. While I do not agree with everything Mr Hari says during his talk, I am passionate about this idea of connection. The most common experience for any addict is a feeling of isolation and inability to connect in a meaningful way with others and the world around them.

Overcoming The Mental Challenges

In order to overcome addiction and transform our lives we need to do many things. First we need to be in a community that encourages connection and commitment. Many addicts find this community in treatment. In this safe community we can take the next step which is to address the root causes of the lack of connection. For many this will be some form of trauma they have suffered which causes their lack of connection. For others it is underlying behavioral or mental health disorders. Therapeutic measures can be utilized to great effect in both sets of circumstances. Once an individual has begun this work the next step is to find a life of purpose that they can show up for. There are as many ways to find a life of purpose as their are individuals. The challenge for many who suffer from addiction is they don’t know how to go about it.

Constantly Seek Purpose

At Granite Mountain BHC we first find purpose in the gym, and in the commitment to our peers not to quit. We build from this initial purpose by drawing parallels from our experience in the gym to the rest of our lives, and by creating meaningful connections within our Granite Mountain community. If I can meet and overcome challenges during the Recover Strong group, maybe I can push through when I’m having a bad day at work, or my relationships are difficult. Our clients are able to transform their lives through the three pillars of commitment, connection and community. At Granite Mountain they are able to experience connection with their peers, staff, and themselves. This connection is at the heart of their purpose as they strive to better themselves and the community they are a part of. After their time with us they are then able to take these three pillars back to their community of origin and continue building upon this foundation, a life of meaning and purpose.

Please take a moment to view this inspiring video, and perhaps re-conceive what you think you know about addiction.

 

Until next time,

Your friend in service,
Rob Campbell

VP of Communications and Market Development


If you or someone you love is in need of help for substance use disorder please give us a call today. We understand and we are here to help.

What To Expect During The Alcohol Detox Process

We have received many questions lately through our website, social media, and intake line related to the process of alcohol detox. As a result I thought I would write an article laying out the detox process as it relates to alcohol use disorder. I will endeavor to cover the stages of detox, the symptoms associated with each, and some tips on how to make the process easier. 

I would like to start by stating some facts which are germain to the topic.

  1. Alcohol is the third leading cause of preventable deaths in the United States.  Almost 90,000 people a year die of alcohol related deaths in this country

  2. 1 out of every 3 emergency room visits in the United States is related to alcohol use

  3. More than 17.6 million Americans suffer from some form of Alcohol use disorder

The above statistics make clear the scope and nature of the social problem that alcohol use disorder presents. It affects every community in our country, and many families. If you or a loved one are suffering from alcohol use disorder know that you are not alone, and that help is available if you want it.

When an individual who has been drinking excessively decides that it is time to stop drinking it is seldom wise to undertake this process alone.  Rather it is advisable to place yourself under the care of a doctor or other medical professional.  It is perhaps because of the wide acceptance of drinking in our society that many underestimate the severity of the alcohol withdrawal process, thinking it “won’t be that bad”. Conversely the alcohol detox process can be one of the most challenging both mentally and medically speaking.  The withdrawal process from alcohol is most often characterized as having three distinct phases. They are:

  • Phase 1 typically begins from 6 hours to 24 hours after an individual last consumes alcohol.  The severity of the the symptoms during this phase will be determined by how long and how much alcohol a person has been consuming.  The typical symptoms of the first phase of withdrawal can include; nervousness, anxiety, headache, nausea, vomiting, tremors, loss of appetite, tremors, and mood swings.

The first phase of withdrawal can last for anywhere between 24 and 72 hours. 

  • Phase 2 typically sets in from 24 to 72 hours after an individual last consumed alcohol.  The typical symptoms of this phase can include; increased levels of mental confusion, irregular heart rate, difficulty breathing, muscle rigidity, increased blood pressure, and in some cases hallucinations.  It ought to be clear that this phase is potentially much more dangerous to an individual, and often requires one be under the care of trained medical staff.

  • About one out of three people enter into phase 3 of withdrawal from alcohol.  This phase is called Delirium Tremens (DT).  A person can enter DT anywhere from 3 days after cessation of drinking to as long as 2 weeks after last consuming alcohol.  This phase of withdrawal is the most dangerous and absolutely requires an individual to be in some form of inpatient treatment.  Some of the symptoms include; disorientation, dissociation, hallucination, Grand Mal seizures, and in some cases death.

If you or a loved one are considering cessation of drinking, consult with a medical professional and seek treatment. There are many medications available to help ease the symptoms of detox from alcohol, and a trained medical professional can help you to make sound decisions as to their potential to help. 

The withdrawal process from alcohol can be dangerous and the decision to undertake the process can be frightening.  However, if you or a loved one is in a position where life is becoming impossible it is important not to let the fear of detox keep you from transforming your life.  Many of us have been through it and when we look back believe it was the most important decision we have ever made.  It is my hope that this short article has answered many of the questions the reader may have regarding the process of detox.  If after reading this you still have questions or concerns please reach out to our team.  We are happy to help whether you utilize our services or not.  The most important thing to us is that you or your loved one gets the help they need.

 

Your friend in service,
Rob Campbell

VP of Communications & Market Development


If you would like to speak to a professional about treatment for you or your loved one, please don’t hesitate to contact us today!


1. CDC, Fact Sheets: Alcohol Use and Your Health (2018), https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm.

2. Lisa Mahapatra, 1 out of 3 ER Visits Are Alcohol Related (IBT: 2013), http://www.ibtimes.com/1-out-3-er-visits-are-alcohol-related-heres-what-patients-drank-charts-1395699.

3. NCADD, Facts About Alcohol (2015), https://www.ncadd.org/about-addiction/alcohol/facts-about-alcohol.