What makes a person with an addiction decide to change? It might be legal issues, a fear of loss of love, or a medical problem. There are dozens of reasons why people make a conscious decision to end their addiction. But whatever it is, they must work through the “stages of change.”
The stages of change were introduced by addiction experts in the early 1980s. They realized that there was not a precise, single “cure” for addiction, but rather a journey — or process — someone dealing with addiction must take.
“There are multiple ways people get to the first stage toward recovery,” says Dr. Monica Hinton, a behavioral health therapist with Sharp McDonald Center, a chemical dependency recovery hospital in San Diego. “It is usually due to some kind of life challenge — maybe even the proverbial ‘hitting rock bottom.’ Some don’t even realize that they have a problem or want to address their addiction, and are forced to because of legal problems, family demands or a medical emergency brought about because of the addiction.”
Understanding which stage of change a person with an addiction might be in can help determine an appropriate method of treatment. The six stages of change are:
Precontemplation — Individuals in this stage are not yet thinking about changing their behavior. They may not even see it as a problem.
- Contemplation — A person is willing to consider the possibility that he or she may have a problem, but may be ambivalent about seeking treatment and is not yet fully committed to change.
Determination — People in this stage have made a decision to fight their addiction and are ready for and committed to change. They will seek out treatment and devise a plan for making this change, whether it is a rehabilitation program, medical care or self-help meetings (such as Alcoholics Anonymous or SMART Recovery).
- Action — This is when the decision to change and the plan to make it happen are put into action. People in this stage are in treatment and will typically make a public commitment to stop their addictive behavior.
- Maintenance — True change requires the creation of a new pattern of behavior and sustaining that pattern over many years. The goal is to be armed with a variety of relapse prevention skills and moving toward a point where there is confidence that life can be resumed without the drug or fear of relapse.
- Termination — Change is accomplished and the person has adopted a new self-image based on his or her desired behavior.
Dr. Hinton points out that the stages are meant to be seen as a circular, rather than linear, process. Relapse is often part of recovery. Addiction is a chronic disease and the possibility of relapse is always present. Falling back into using the substance responsible for a person’s addiction can happen, but it does not mean a person must return to the precontemplation stage.
“Returning to old behaviors can occur,” says Dr. Hinton. “However, it doesn't mean that a person won’t be able to recover. In fact, some who relapse learn from it, and their commitment to return to sobriety and continue the recovery process can be strengthened.”
To avoid relapse, Dr. Hinton recommends that people in treatment attend addiction support group meetings at least four times each week; have a support system of sober family and friends; schedule each day with positive activities, such as work, exercise and substance-free, fun activities; and avoid others with addiction problems.
Family members supporting a loved one with an addiction should also make sure they practice self-care by attending their own support groups and setting healthy boundaries within the relationship.
“What’s great about the stages of change is that they can be applied to anything you want to make happen in your life,” Dr. Hinton says. “Positive change of any kind requires awareness, motivation, determination, a plan to make it happen, the willingness to work at it and a support system to help you get there.”
Talk to your doctor if you are concerned about your or a loved one’s use of alcohol or other substances. Sharp McDonald Center, Sharp Grossmont Hospital and Sharp Mesa Vista Hospital all provide substance abuse programs to help define a recovery path that works best for you.
For the news media: To talk with Dr. Monica Hinton about addiction and recovery for an upcoming story, contact Erica Carlson, senior public relations specialist, at firstname.lastname@example.org.