The Stages Of Recovery – where to begin?
Recovery demands an overhaul.
Not just in behavior and thought, but the whole belief system.
We can simplify by calling it a total change of lifestyle.
At any rate, whatever we choose to call it, it’s intimidating.
This is particularly true for an addict contemplating a day free of addiction, let alone considering a sober lifestyle.
It can feel like such an overwhelming if not impossible task, that even the thought of it is burdensome.
It helps, however, if one has one clue of what to expect.
I find that all the unknowns keep people tightly attached to what they do know, be it alcohol or some other substance.
So what do we know and how can the stages of change inform us?
Well, years ago, behavioral researchers James Prochaska and Carlo DiClemente developed the transtheoretical model (TTM), better known as the stages of change.
This model can provide insight as to what to expect in treatment and the progression of recovery.
According to Prochaska and DiClemente there are six main stages of change in addiction recovery: precontemplation, contemplation, preparation, action, maintenance, and termination.
It’s important to understand that people rarely move through these stages in order. Rather, they sway back and forth, going up a stage then back two stages, even simultaneously being in two different stages.
The idea, however, is to paint a picture of how the behavioral change unfolds.
If you can visualize how sobriety occurs, in fact how all change occurs, you can start to construct a mental blueprint of how the addictive behavior can be treated and managed.
The Transtheoretical Stages of Change
Webster’s dictionary defines contemplation as:
- the action of looking thoughtfully at something for a long time.
- deep reflective thought.
- the state of being thought about or planned.
“Pre” is a preposition meaning “before or previous to.”
So, this stage is evidently before all that deep reflective thought. As a matter of fact, at this point the behavior in question is not even considered an issue.
It’s not even in the mental ballpark.
This is due primarily to two reasons:
- Adverse consequences haven’t been experienced yet (all those “yets” can always become a reality!)
- Denial (swimming in shark infested waters and commenting on the beauty of the weather variety)
Believe it or not, much of this stage is characterized as pleasant and the addictive behavior is generally positive (point number 1).
Try as you might to convince the addict that the behavior is harmful, they are not even slightly interested in your advice.
For example, consider this scene from the comedy Walk Hard: The Dewey Cox Story. There are multiple scenes where Dewey interacts with his friend Sam. Sam is always trying to dissuade Dewey from taking drugs by pointing out all the benefits they provide.
Though it’s a comedy, Sam describes the phenomenon addiction counselors often observe, that addicts can only see what the drug does for them, they cannot see what it does to them!
[Dewey goes into a bathroom where Sam is with groupies]
Sam: Get out of here, Dewey!
Dewey Cox: What are y’all doing in here?
Sam: It’s called cocaine, and you don’t want no part of this shit!
Dewey Cox: Cocaine?
[Sam nods and smiles]
Dewey Cox : What’s it do?
Sam: It turns all your bad feelings into good feelings. It’s a nightmare!
See the dilemma there?
Researchers often group people in the precontemplation stage of change into four distinct categories.
Reluctant precontemplator: this individual just lacks the motivation to change. Why? Because they are utterly unaware that a problem even exists!
Rebellious precontemplator: as the name suggests, this individual simply has a deep aversion to authority and being told what to do. This the “don’t push the red button” type of alcoholic, and guess what? They’re pushing that damn button.
Resigned precontemplator: this addict is acutely aware of their addictive behavior. The knowledge is so overwhelming and stressful that they have given up any possibility of change. Do not pass go, do not collect $200.
Rationalizing precontemplator: this individual has all the answers. They are the ones with the MASSIVE opinions. They are one week into treatment as telling you how to run the place and how you should be doing your job. Not only are they the rehabilitation gadfly, they can provide a litany of reasons as to why addiction isn’t an issue for them and how they are different. They stop short of a PowerPoint presentation demonstrating how you are wrong.
Contemplators have come to terms with the severity of the issue. They have a problem that needs a solution and they know it.
Usually they want to change; often desperately.
Nonetheless, they usually are hesitant and don’t believe they can commit to the process.
In this stage, the addict is often more receptive to learning about their addiction and interacting and exploring with different options and remedies.
But they’re still contemplating.
There are three frogs on a rock. One contemplates jumping off. How many are left? Three. Contemplation without action is like a plate with no food.
This stage is usually characterized by its noncommittal attitude. Change is desired, but usually, a low-stress threshold undermines the specific strategy to create change.
This stage can often last year’s. It’s an excruciating time for all parties involved.
Usually, due to low self-efficacy people away back and forth between the first and second stage of change.
Psychologist Albert Bandura has defined self-efficacy as people’s beliefs in their capabilities to exercise control over their own functioning and over events that affect their lives. One’s sense of self-efficacy can provide the foundation for motivation, well-being, and personal accomplishment.
Once this increases, commitment naturally follows.
An individual is this stage is, as previously noted, on board and committed to life change.
Perhaps they meet with their healthcare professionals, sponsors, or pastors, to help them determine precisely where they are and what options, strategies, and plans are available.
Stage one is the “what.”
Stage two is the “why.”
Stage three is the “how.”
Pretty basic, right?
Real change – that is, a change in one’s behavior – starts at stage four.
This looks different to everyone.
For some it can be walking into an Alcoholics Anonymous meeting or perhaps going into a detox or residential center.
For others it can be getting a sponsor and finally getting honest; it might be completing a fourth step, making amends, or making a clean break with toxic relationships.
Whatever it may be, the addict finally begins to engage in treatment that targets the underlying causes of addiction.
It’s no nonsense time.
One way underlying causes and conditions can be unearthed is through individual and group therapy, such as:
- Cognitive Behavioral Therapy
- Acceptance and Commitment Therapy
- Dialectical Behavioral Therapy
- Mindfulness-Based Stress Reduction
- Neuro-linguistic Programming
Additionally, numerous complementary therapies assist in promoting holistic wellness and bolstering recovery (every 12-Step program, Celebrate Recovery, various yoga and somatic therapies, etc.).
The action stage is the equipping process.
It fosters healthy and effective strategies for coping with stress and triggers. It provides the tools necessary for an individual to progress through the maintenance stage without relapse.
5. Maintenance & Relapse
“It can take anywhere from 18 to 254 days for a person to form a new habit and an average of 66 days for a new behavior to become automatic.” This, moreover, assumes consistent engagement of the new behavior.
The reality is that it takes hard work, grit, time, and considerable effort to sustain any change.
The maintenance stage is really the process of adaptation.
It’s the process wherein one’s entire lifestyle begins to reflect sobriety. At this point their personal philosophy simply becomes incompatible with the drink or the drug.
In a sense, addiction becomes increasingly unnecessary.
As momentum builds and this new way of living becomes second nature, the threats of relapse gradually become less and less.
An important word of caution:
Substance abuse disorder is a chronic disease.
This usually refers to an illness “persisting for a long time or constantly recurring,” most however translate it as incurable.
The point is that with all chronic diseases the risk of relapse will always be present.
This point can be debated. As long as cars are driven the risk of getting hit remains, and as long as you’re alive the risk of the whacky human condition is liable to make you do all types of wacky things. Alcoholics Anonymous has a saying:
“Recovered, not cured.”
The posit that we can be recovered from the alcoholic state of mind, essentially operating from an entirely new philosophy. However, they also argue that the one can abandon that philosophy and eventually revert back to the alcoholic state of mind.
Recovered, not cured.
Therefore, despite the skills and tools acquired in the action stage to avoid relapse, a relapse can still occur.
I’ve heard one gentleman comment during a group session that he can go through all 6 stages and back before 9am.
Of course this is facetious, but he aptly described the finicky nature of an emotional human being.
Nonetheless, if relapse does occur it’s not a sign of failure or weakness. Some professionals go as far as to say “relapse is a part of recovery.”
The truth is that every behavioral change comes with its share of backsliding and regress. Addiction is no different; true change just persists and continues to move forward in spite of it.
This stage is what I call “substance incompatibility finale.”
As you’ve progressed through the stages you’ll eventually craft a lifestyle that makes drinking or drugging completely unnecessary.
This is the ultimate goal for the stages of change, namely, termination.
Relapse is no longer a threat. It’s rather now a far off possibility.
Confidence and comfort now thrive in an alcohol-free and/or drug-free lifestyle.
At this point, you’re well on your way to sober to stay 🙂