Maintaining Change in the Process of Recovery
Whether changing relationship behaviors, health related behaviors, alcohol and drug abuse or self destructive behaviors, the change process is the same for everyone. People in the Pre-Contemplation stage of change are not interested in changing, though those around them may recognize problems with alcohol and drugs or self destructive behaviors and the need for change. Effective alcoholism treatment programs and also drug treatment programs recognize that everyone changes at a different pace.
On the other hand, people in the Contemplation stage are considering that they may have a problem, are weighing the pros and cons of changing their alcohol and drug abuse and might be making plans to do so.
Those in the Preparation stage are taking steps or laying the ground work for change by gathering information, trying out desired behaviors or limiting undesirable behaviors, while those in the Action stage are actually engaging in new behaviors, like gathering information about alcoholism treatment programs or drug treatment programs, going to meetings, treatment and initiating new or different skills to cope with their alcohol and drug abuse.
As you can see, behavior change is rarely a discrete, single event; instead, most people move gradually from being uninterested (pre-contemplation stage) to considering a change (contemplation stage) to deciding and preparing to make a change (preparation) and finally taking steps to implement the change (action). Hence, we think of people in terms of the “readiness to change” and as you can see, everyone is at their own, unique point of readiness to change.
Confrontation is usually not helpful in moving people along from one stage of change to the next, but education, support and preservation of the relationship are very important, though not at one’s own expense. The role of natural consequences, such as relationship loss, job loss and/or declining health, can be important and necessary motivators that can help someone become more ready to enter alcohol abuse treatment or substance abuse treatment to cope with their alcohol and drug abuse.
After the Action phase, the next stage of change is the Maintenance phase. In this stage, following successful alcohol and drug abuse treatment, or any substance abuse treatment, an alcoholic or drug abuser has changed his/her pattern of use and is trying to sustain these changes.
In the initial maintenance stage, there is still considerable uncertainty; stressful situations must be anticipated, and relapse prevention plans must be addressed. This means that both psychological and relapse triggers must be identified and relapse prevention plans for both psychological and “using” precipitants must be developed to prevent alcohol and drug abuse relapse.
Managing cravings, urges, criticism, saying “No” and working on alternative behaviors all occur during the Maintenance stage, which are designed to sustain the behavioral change. Changing “people, places and things” continues in the Maintenance phase, and would include building new support systems, engaging in new, alternative behaviors, and initiating new endeavors, all of which are designed to help you maintain the difficult changes you have managed to make to reduce or stop your alcohol and drug abuse.
For most people, the Relapse stage of change has come to be dreaded. In other models, relapses may be viewed as negative signs of weakness, resulting in discouragement, feelings of failure, and giving up hope of trying to change.
However, in the Stages of Change model, relapses are inevitable, but they are not catastrophic. Instead, relapses are viewed as a normal part of the change and recovery process from alcohol and drugs and should be expected. In the example of the relationship that has broken up, a relapse might be viewed as returning to your ex, whereas in the substance abuse example, it might be a binge. Relapses are part of the natural course of recovery from alcohol and drug abuse.
In the Stages of Change model, relapses are viewed as necessary learning opportunities in which one can build needed coping skills and strengthen one’s resolve. For example, one could evaluate the thoughts, feelings and circumstances which contributed to the relapse of alcohol and drug abuse. Perhaps there were warning signs that a relapse was coming that would be helpful to identify for the future. Or maybe one’s reaction to the relapse played an important role in spiraling out of control and turning a relapse into a complicated crisis. People, places and things can also play very important roles in relapses, and learning how they affect us plays a crucial role in managing relapse.
In the Stages of Change model, relapses represent necessary and important learning opportunities that contribute to achieving the desired behavior change of reducing alcohol and drug abuse. In fact, most people relapse and go through the change cycle several times before their recovery from alcohol and drug abuse becomes more stable and enduring. This is to be expected and should not be viewed as a failure.
Whether it is leaving a relationship that is not good for you, or engaging in substance abuse, it is important to try to limit the duration of a relapse into alcohol and drug abuse, learn from it and get back into the change cycle as quickly as possible, in order to prevent a relapse from turning into the destructive cycle of addiction.
In the Termination or Transcendence stage, total abstinence from alcohol and drug abuse may or may not occur. Instead, there may be a lifetime of careful maintenance. In other cases, abstinence is maintained and temptations to renew the old behavior ceases; it has been transcended and recovery achieved.
Eventually, if one “maintains maintenance” long enough, they will reach a point in their recovery where they can work with their emotions, understand their behaviors, and cope with situations in new and different ways. This is the stage of recovery is also called “transcendence”; transcendence to a new way of life. In this stage, not only has abstinence from alcohol and drug abuse been achieved, but to return to them would feel odd, unusual, and undesirable.
When someone reaches this point in their recovery, they have transcended their old alcohol and drug abuse habits and no longer need them.
These Stages of Change are helpful for all people considering change and have a proven track record in helping those with alcohol, drug and dual diagnosis or co-occurring disorders. Dual diagnosis disorders, also called co-occurring disorders, are comprised of at least one substance abuse disorder in addition to one or more psychiatric disorders, such as depression or anxiety.
Treatment for dual diagnosis or co-occurring disorders is referred to as integrated treatment, because both the substance abuse and psychiatric problems are addressed in the same treatment program. Research shows that for dual diagnosis disorder treatment, integrated treatment is the most effective, especially when compared to substance abuse treatment alone or psychiatric treatment alone.
The Stages of Change model has proven to be particularly helpful in assessing readiness to change with substance abuse and psychiatric problems, otherwise known as individuals with co-occurring or dual diagnosis disorders. Alcohol and drug abuse typically co-occurs along with the presence of a psychiatric disorder, such as depression or anxiety.
Motivational Interviewing is an evidence based type of cognitive behavioral therapy that has been demonstrated to be a very powerful form of treatment, especially when combined with the Stages of Change, in the treatment of substance abuse and dual diagnosis disorder treatment. Motivational Interviewing assumes that all behavior is motivated and that a collaborative relationship with the client is the most important vehicle for learning about these motivations to engage in alcohol and drug abuse.
Trust, acceptance, empathy and listening are used to help the client reflect on his/her experience, assess their readiness to change alcohol and drug abuse patterns, and develop a change plan for the treatment of substance abuse. A Motivational Interviewing approach in is non-judgmental and non-confrontive.
In Motivational Interviewing, as well as the Stages of Change, it is the client, not the program that defines the dual diagnosis treatment goals. As you can see, the Stages of Change, combined with Motivational Interviewing, make for a very unique and individualized treatment package to address alcohol and drug abuse, which tends to result in people staying in rehab treatment longer and achieving positive dual diagnosis treatment results. If you are trying to change your alcohol and drug abuse, remember that relapses are an inevitable part of the change process and if you need professional help, consider someone who is experienced with Motivational Interviewing and the Stages of Change.
Don’t let substance abuse and psychological disorders rob you of peace, fulfillment and a sense of purpose any longer. MHR offers effective treatment for alcohol and drug abuse in Memphis, TN – available now. Call us at 901-682-1434 to schedule an appointment.