The Stages of Change Model
Using the SCM can help people assess where their loved one is in the stages of change in order to understand how to offer help and support most effectively.
"The worst thing is watching someone drown and not being able to convince them that they can save themselves by just standing up." –unknown
Addiction continues to be one of America's biggest public health problems. According to the National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia), 40 million people age 12 and older meet the clinical criteria for addiction in the United States. For every person struggling with addiction, there is at least one concerned spouse, family member or friend who is greatly affected by the loved ones' disease.
As many of us know far too well, loving someone who struggles with addiction is one of the hardest, most painful things we go through in our lives. Most of us experience frustration, anger and helplessness when faced with confronting a loved one about his or her addiction. In the end, we often are left emotionally exhausted, saddened and pained, with the question of "What do I do next?" running through our minds.
Stages of Change Model
In order to handle the many ups and downs of a highly emotional and challenging time, I would like to introduce to you the Stages of Change Model (SCM), a theory about the stages we all go through when we do successfully change. Whether it is you or someone you know who suffers from addiction, I hope this theory will offer valuable insight and understanding to help you better navigate the challenges.
The Stages of Change Model was developed by James Prochaska and Carlo DiClemente in the late 1970s and early 1980s at the University of Rhode Island. They were studying how smokers were able to give up their addiction. Since then, the SCM has expanded to apply to a broad range of areas such as overeating, drinking excessively and using drugs.
The SCM focuses on the idea that change does not happen in one step. Rather, people on their way to successful change tend to progress through different stages at their own speed.
With this said, expecting someone to change by simply telling that person who is still in the "pre-contemplation" stage that he or she must go for help is often ineffective or even counterproductive. He or she is not ready to change. According to the SCM, it is up to the individual to decide for himself or herself when a stage is completed and when it is time to move on to the next stage. It is important to remember that long-term change cannot be imposed from the outside. The decision to change must come from inside the person struggling with addiction.
The Stages of Change
According to the SCM, each stage requires the person to face a different set of issues and tasks that relate to behavior change. Below is a brief description of each stage of change:
- Pre-contemplation: A person has not yet acknowledged there is a problem behavior that needs to be changed.
- Contemplation: A person acknowledges there is a problem but is not yet ready or sure he or she wants to make a change.
- Preparation/Determination: A person is getting ready and prepared to change.
- Action/Willpower: A person is changing his or her behavior.
- Maintenance: A person is maintaining the behavior change.
- Relapse: A person returns to old behaviors and abandons new changes.
For the purpose of this blog, I will focus on Stage 1 and Stage 2. For people dealing with loved ones who suffer from addiction, these first two stages tend to be the most challenging, because the person has little to no acknowledgment of the problem.
Stage 1: Pre-contemplation
In the pre-contemplation (or denial) stage, people are in denial of their addiction and are not thinking seriously about changing their behavior. People in this stage are not interested in any kind of help and tend to defend their bad habit(s) because they do not think they have a problem. This mentality makes it very difficult for the people around them who are trying to offer help and support. Loved ones may be met with defensiveness and push back as they put forth efforts to pressure them to quit or change their behavior patterns.
Stage Two: Contemplation
The contemplation stage can be viewed as the stage of ambivalence. People in this stage become more aware of the consequences of their bad habit(s) and tend to spend time thinking about their problem. Although they are able to consider the possibility of changing, they tend to exhibit great uncertainty around it.
Weighing the pros and cons of quitting or modifying behavior is an important part of this stage. People may think about the negative consequences of their addiction and the positive aspects associated with giving up (or moderating) the substance; however, they still have significant doubt that the long-term benefits of quitting will outweigh the short-term costs. It can take anywhere from a few weeks to an entire lifetime to get through the contemplation stage, with some people never progressing beyond this stage.
Despite how frustrating and painful it may be for loved ones trying to help a person struggling with addiction, people in this stage tend to be more open to receiving information about their addiction. In addition, they are more likely to be receptive to educational interventions as well as to reflect on their own feelings around their addiction.
How can we help?
People trying to help a loved one suffering from addiction should remember that long-term change comes from within the individual. Using the SCM can help people assess where their loved one is in the stages of change in order to understand how to offer help and support most effectively. Finally, people attempting to help a friend or loved one with these issues should consider the most important and challenging stages to be the pre-contemplation and contemplation stages. Interventions should be tailored to people in these stages.
For more information, support or guidance around helping a loved one who suffers from addiction, please contact HAMSA@jfcs-atlanta.org.