Addiction Masterclass: The Stages of Change

What if everyone who is trying to recover from addictions did so in a predictable pattern, one that better helps us understand how recovery works and also how we can apply that to improve people's success? Well, we have that. I'm Evan. I'm your resident mental health and addiction therapist, and this is my addiction masterclass. Today we're going to be talking about something known as the stages of change. The stage is a change model, also known as the trans theoretical model, came out of the 1970s from researchers pro Haska and D.

Clemente. And these individuals were studying people who were quitting smoking and looking at how certain people are more successful over others. Are there certain patterns? Are there stages they go through in the change process? And how can we utilize those to help people making difficult changes? And what they found is that typically for people who are going through the change process, it happens in six distinct stages. So let's go over each one. The first stage of change is known as pre contemplation.

And this essentially means before you are thinking about changing, let's say I may not have the most healthy diet, but I'm not ready to change that, or I'm okay with that. That would be pre contemplation. Now, as a clinician and I'm working with someone who's in this stage, it's thought that there's really not that much I can do. If they don't have motivation, how can I enhance it? The only thing that I find could be helpful is getting that individual to start talking about any consequences there may be, and maybe doing some education, though they may not be ready to change or take any steps that could plant a seed for them to decide later that they want to start exploring the change process.

The next stage of change is known as contemplation. And this is when you're in a state of ambivalence, meaning I kind of want to, but at the same time, I don't. For example, smoking. There are benefits I get from smoking, otherwise I wouldn't do it. Maybe it's relaxing, helping with anxiety on the other end. It's costing me a lot of money, and it's giving me anxiety about my health. Right? So it's this constant balance. Now, this stage corresponds with the model and my habit. Tripod motivation, because as a therapist, I'm working with clients to try to enhance their motivation, to get them to be more on the side of change versus staying the same.

And one of the ways I do that, similar to pre contemplation, is trying to get them to talk about, as much as possible the benefits of change and the consequences of staying the same, but also kind of going through the grief and loss process and allowing them to talk about the benefits and acknowledging the benefits and what's going to be difficult about giving that up. Anyways, this is extremely important, and you can work with others in your life to try to get them to talk about their motivation for change in a non judgmental way.

The next stage of change is kind of an in between, and this is known as preparation. And this corresponds with my model having a plan. So if we're going into any change, we need to prepare because change is difficult. So, for example, if you are quitting cigarettes, having the nicotine gum ready, or whatever else you're going to use to help you get through cravings, if you're running into a battle, you want to have a battle plan. So you want to be prepared and think ahead to what the difficulties are going to be and what you're going to do if you run up against them.

For example, what happens if I do relapse and I go back? What am I going to do? But really more so, how am I going to prevent this in the best way as possible so I don't have to relapse and essentially start over? May not be the worst thing ever, but it can be really detrimental. At the same time, a relapse can also give you more information and help you create a new plan that makes you more likely to have success. But don't worry, we're going to talk much more about relapse later. The next stage of change is known as action, and this is where you actually initiate the change.

So this is the last cigarette I smoke. After that, I am in action. I'm putting my plan into place. And this is one of the most difficult because your body and mind have to readjust. Maybe you're going through some form of withdrawal. Whether it's physical or even psychological or emotional, it's most important to try to get through this stage as best as you can, most comfortably following your plan. Because when you break through, which could be three days, seven days, up to a month, maybe to have a firm enough adjustment where you're not craving that old behavior all the time, you can get through it, especially if you implement those replacement behaviors we learned about in the habit loop.

The next stage of change is essentially the light at the end of the tunnel, and this is known as maintenance. So you followed your plan, you got through that action stage. Your body, your mind is starting to readjust. You've implemented some new routines and behaviors to get you through the craving, and now those have become habit. You've created these new neural pathways in your brain. So this just becomes second nature. It's now part of your life. And at this point, all you want to do is just keep the ball in the air.

If all the other stages before was going from zero to 60, and what we know is that's where you use the most gas mileage, that's what takes the most energy. Now you're just cruising highway miles, you're just keeping that ball in the air. You're maintaining your change, you're continuing with your plan, and it just doesn't take as much energy and effort. But you have to be on guard. You can't get fully complacent. And you have to recognize that relapse is possible even when you're past those early stages and you're not having cravings every day.

But we'll talk about that in the next stage. Now, the last stage of change is relapse. You may be wondering, how is that a stage of change? Well, it's very commonly a part of the change process. Because forming any new habit or routine can be quite difficult. We often fall back. Maybe our plan didn't anticipate some of the difficulties that were coming ahead. No matter what type of change, whether it's a severe addiction or even taking your medications every day, there's a similar rate of relapse.

Now with addictions especially, we want to try to avoid relapse because they can be deadly, right? Drinking excessive amounts of alcohol, doing opioids that may have fentanyl in it. One relapse could mean death. Not for every substance, but even if it's not a physical death, it can be emotionally taxing and it can weigh on your confidence for next time. The more you relapse, maybe the less optimistic you are of your chances. So it's best to avoid it if you can. However, sometimes relapse is part of recovery, and it can be a benefit.

And that is because you are learning something new. You're learning what I did that did not work, what did I not anticipate. And then from there, you can come back stronger as you have a better plan. But relapse is a complicated process. And later in the masterclass, I'm going to break down the different types of relapse and go much more into it. Well, I hope you now have a better understanding of the change process and the science of how we make changes. When we put all these pieces together, such as the neuroscience of addiction, the habit loop, the stages of change, my habit tripod method of forming new habits and routine.

All these start to fit together and paint a picture of some of the things you can do to make yourself most successful or encouraging a loved one to do these things as well. Anyways, we have a lot more ground to cover, so check out some of the videos that are coming soon.