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.

Creating a Different Outcome

How Will It Be Different This Time Around?

If you or a loved one has been through treatment for substance use disorder one or more times in one or more different facilities, and have yet to find lasting recovery, you are most likely asking yourself what will be different this time. This is a question which can plague the thoughts of those attached by bonds of affection to an addict. While there is no simple answer to this question I do believe I can give some helpful suggestions which can greatly increase the likelihood of success. 

When dealing with any disease of the brain, such as addiction, it is very challenging to know how to help a loved one “fix” their problem.  One reason for this is that brain science is still very much in its adolescent period. Our understanding of the brain and its functions is growing rapidly, but it has only been in  the relatively recent past that we have been able to begin to understand its functioning. This is as true with our understanding of addiction as it is for any other brain disease, as a result we are in the very beginning of our ability, as a community, to offer comprehensive solutions for those suffering from addiction.

Another aspect of the difficulty is that addiction is characterized by problems of perception.  Addicts suffer from high levels of delusion, cognitive dissonance, and other perceptual challenges that can make self-report and consistent decision making challenging, at best. The behavior patterns that can follow from these perceptual challenges can make assessment and treatment hard to manage for an individual.  

Third, and not unimportantly, the social stigma surrounding addiction can make it hard for an individual to feel confident in seeking needed help.  This is true certainly true leading up to the initiation of treatment. It is also true during recovery, when an addict may be suffering internally but is unwilling or unable to ask for the help he or she needs.

Commitment to Change

“Nothing Changes Until You Change Something”

Having a commitment to change is indispensable for the addict themselves. Much has already been written about this elsewhere. For our purposes today I am talking about the families commitment to change.  Often within a family afflicted with addiction there are dynamics that exist that are preventing each member from experiencing happiness and contentment.   Living with an addict and trying to cope with his or her behavior is most often a tremendous strain on loved ones.

One such dynamic that can develop is a tendency to treat information and secrets as a form of emotional currency.  When this is present within a family unit, trust and connection are the price paid. Left unchecked this can result in one or more members of the family suffering some form of attachment disorder. Instead of secrets and individual alliances transparency and togetherness need to be the aim.  Finding time and methods to communicate with one another honestly and transparently is vitally important for both the addict and his or her family.

Another form of trouble can be enabling behavior of members of the family toward an addict. This can take many forms but the simplest may be providing material support in the form or financial assistance (for rent, phone, car, other bills, etc).   In my experience very few addicts recover while they are still able depend on others for material support. For long term recovery it is indispensable that recovering addicts feel the full weight of responsibility for their lives. Of course we want to encourage this to happen in safe ways, that said, its importance cannot be overstated.  

Above are just two examples of the ways in which an addict’s behavior can impact a family, and the healing that needs to take place for a family to begin moving in a healthier direction together.  These changes can be quite difficult, especially if long standing patterns of behavior are present. Both individual and family counseling can be a great help. There are also many support groups, such as ALANON and ALATEEN, for the families of addicts that can be incredibly helpful.

Creating a Life of Meaning and Connection

A Happy Life Is A Life With Meaning and Purpose

Years of active addiction causes a hyperactivity within the stress and avoidance centers of the brain (primarily within the amygdala, and ventral hippocampus).  Practically speaking this means that within an addicts brain stress is felt more acutely than in the brain of an average person. There is no greater stress for humans, as social animals, than exclusion.  Throughout the years of active addiction addicts have lived lonely lives. This, of course, is primarily driven by their own behavior. The brain can heal itself, through a process of neuro-regeneration, but this takes time.   It is crucial then, especially in early recovery, that an addict is able to create a lifestyle that is centered around connection and community. This of course, can take many forms. Involvement with a 12-step fellowship or other recovery community is a great start.  Ideally though, the move toward connection should not end there. Family involvement, meaningful work, volunteerism, and social hobbies can all be utilized to create connection, community, and meaning in the life of a recovering addict.

Moving Toward Impactful Aftercare

Treatment Is Just The Beginning To A Life Long Journey Into Long-Term Recovery

Addiction is most often accompanied by one or more underlying co-morbidities. Most often unprocessed trauma or a mental health condition. It is imperative for long term recovery that these co-morbidities be addressed with a professional on an ongoing basis.  Treatment in most facilities lasts for between 30 and 90 days. This is truly not enough time to fully treat any trauma or mental health challenge. Increasingly, treatment centers are taking an active role in helping patients connect with professionals within a patient’s local area to continue the work that is started while under the care of the facility.  If a patient or the family is not given these resources from a facility they need to take it upon themselves to seek them out. Even in cases where there is no co-morbidity present it can be wise to continue treatment at a lower acuity level. This can take the form of out-patient treatment, or work with a local addiction specialist.

While the above should not be considered a comprehensive picture of how to make treatment succesful it can be regarded as creating a helpful starting point. Each individual and each family will have their own needs and consultation with one or more professionals is advisable. That said if:

  1. If the family moves together in the direction of long term health

  2. The addict can create a life of connection and community

  3. And, a meaningful aftercare plan is put in place and executed

Then, you will be well on your way toward lasting recovery.  If after reading this you have any questions or you feel that we, at Granite Mountain, can be of any assistance to you and your family please do contact us 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 love is in need of help for substance use disorder don’t hesitate to call us. Reach out to us today to get the help you need and the life you deserve.