With rare exceptions, the road to recovery from substance use disorder isn’t easy. It’s often steep, winding, and full of switchbacks and obstacles. Sometimes it can seem impossible to navigate. Treatment programs are getting better and better as more research increases our ability to accurately diagnose the underlying causes of these disorders, and our understanding of effective modalities of treatment. There’s lots of hope!
Both before embarking on a journey, it is often useful to have a map. And midway through, when lost or stuck, The map shows landmarks that help us have an idea of what to expect, and when lost, how to locate ourselves during the process, knowing that others have come this way before, and made it through.
Decades ago, researchers Prochaska, DiClemente and Norcross developed such a map. They noted patterns that arise when people undertake a major behavioral shift, and outlined six stages of change. It is known as the “transtheoretical model.” This model offers insight into how treatment works, and how recovery is achieved and maintained. It is compatible with most evidence-based and holistic treatments. This can be a powerful instrument for change as it offers the addicted person a tool for self-understanding.
There are six major stages of transformation in addiction recovery: precontemplation, contemplation, preparation, action, maintenance and termination.
Note that people don’t necessarily move through these stages in a linear fashion, allocating a set amount of time for each one. It’s an organic process, and it’s normal for people to move forward and backwards, or be in more than one stage simultaneously.
At this stage, a person is not considering treatment. There are several reasons for this, which can include the following: They might not see or understand that their addictive behavior is problematic, because they haven’t experienced negative consequences from it. Some are in denial, think they know everything themselves, and can “handle” the substance. There are those who don’t want to change their behavior because they are rebellious and don’t like being told what to do. And some have had multiple rounds of unsuccessful treatment, and have lost hope of change.
In this phase, a person is aware they have a problem. They might be ambivalent about letting go of their substance dependency, still cognizant of the benefits they receive from it. They may want to change, but are hesitant about making a commitment. However, they are likely amenable to learning about treatment options.
This stage can sometimes last for years. The choice to move forward and commit to a treatment plan is a big one, and some people simply aren’t ready, and revert back to the precontemplation stage. Others continue to the next stage.
Amy Crichton, Executive Director of Phoenix Rising in Palm Desert, California, finds that people are uncomfortable with the thought of having to confront themselves on many emotional, physical, and spiritual levels. “Facing emotions that have been numbed out can seem unbearable. People are still battling their own internal dialog, wondering if the problems in their lives are caused from their addictions and their own behaviors, or wanting to believe they are just the result of life’s normal challenges.“
In this stage, a person has decided that they want to become sober, and they have a sense of urgency about it. They might attempt to abstain from substance abuse on their own, or they might begin initial interviews with treatment programs, counselors and health care professionals to seek out the plan that is right for them. At this stage, emotional triggers can come up, and some will revert back to the contemplation or precontemplation stage. With the appropriate support, and internal readiness, others will move forward to the next stage.
Amy Crichton continues, “common issues are that people wonder if they can do this on their own, or if they really need to go into treatment and get professional help. They are also nervous that they will not find common ground with, or be judged by others already in treatment. Making a decision to be sober is a major life change, and change is usually challenging.”
In the Action stage, a person is committed to their sobriety, and is practicing abstinence. Detox at a residential treatment center is often necessary. Withdrawal symptoms, physical cravings, and emotional swings are common challenges. In this stage, a person learns to recognize what their triggers are, and is introduced to coping strategies that don’t include substance use. Both individual and group therapy help the person address the underlying causes of addiction. Lifestyle changes are encouraged, including nutrition, exercise, good sleep hygiene, and self-care routines which support sober living.
Stephanie Rosten, the Director of Admissions at Renewal Recovery, has observed “people struggling with the early stages of addiction are at their most vulnerable, and are fearful of making a change. They find hope and relief in knowing that their experience is shared and they are not alone”.
Creating enduring change requires time and effort. In the maintenance stage, a person is working hard to maintain their sobriety, practice healthy lifestyle habits, and build momentum. They don’t feel the urge to relapse as frequently as people in the action stage, so their confidence grows and they truly believe in their ability to maintain sobriety long term. It’s important to recognize that substance use disorder is a chronic condition that requires continuous active effort. For most people, it takes two to five years of sobriety to truly break their substance dependence and solidify change.
The goal of recovery is not simply to give up substance dependency, but to live a happier and healthier life. The stage of Termination is when a person no longer feels threatened by their substance of choice. They are able to focus on developing long term goals. They feel confident and comfortable with their sober lifestyle. They are able to sustain long term relationships, and ready to give back and support others. Substance use disorder no longer takes center stage in everyday activities. There is room to breathe and grow in new ways.
These stages may seem overwhelming to someone at the beginning of their recovery journey. However, they can serve as a general overview of the most common signposts one can expect to meet along the way.
The impact of substance dependency can be devastating to both the users and their loved ones. Permanent recovery is possible. And knowing what one can expect during the journey towards that goal will hopefully help a person feel more confident about undertaking this ultimately rewarding and liberating journey.
“When in Doubt, Reach Out!” Renee Baribeau
Article by staff: Susan Reiner