Addition
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There are dozens of reasons why someone makes a conscious decision to treat their addiction. It might be due to a legal issue, an ultimatum from a loved one, a medical problem or something else altogether. Whatever the cause, the stages of change are an important part of addiction recovery.

Oftentimes, people engage in substance use as a coping skill. Typically, they are unable to effectively cope with something going on in their life, so they turn to substances.

Unfortunately, substance use ends up worsening the initial problem that an individual has and creates additional issues. However, mental health providers can help when someone desires to make changes.

The Stages of Change

The stages of change were first introduced by addiction experts in the early 1980s. They realized that there was not a precise, single moment when recovery happens — rather, addiction recovery is more like a journey including these stages:

  1. Precontemplation — Individuals are not yet thinking about changing their behavior and are not seeing their behavior (drinking or using other substances) as a problem.
  2. Contemplation — Individuals are willing to consider the possibility that they may have a problem and are ambivalent about changing. Ambivalence is a painful state of feeling two ways about an issue.
  3. Preparation/Determination — Individuals have decided to change and are engaging in exploration of their options. They will devise a plan for making a change through researching rehabilitation programs, outpatient and inpatient programs, self-help meetings (such as Alcoholics Anonymous or SMART Recovery) and other avenues for treatment.
  4. Action — Individuals have decided to execute the plan that they prepared. People in this stage are in treatment and will typically make a public commitment to stop their unhelpful behavior, such as sharing their choice to stop using substances or drinking with their support system.
  5. Maintenance — Individuals develop a new pattern of behavior and coping skills. They adapt to this behavior over many days, months and years. Individuals have a variety of relapse prevention techniques and have more confidence about not partaking in substance abuse.

Relapse Is Part of the Journey

Within the stages of change, there is also the termination stage, which involves individuals entering back into their routines of daily life. We have intentionally left termination out of the list of primary stages, as we believe patients need to continually maintain the changes they made.

What’s more, individuals go in and out of the stages in no particular order, and relapse can be a part of the recovery process.

When a patient relapses, that does not mean they are back in the precontemplation stage. Rather, it means that they fell back into an old coping skill, and they can make the choice to do something different now and get back into their recovery.

Relapses are an opportunity to learn what was missing from someone’s initial plan. We see relapses as “a hole in your jeans.” Now that we know the hole is there, we can work to create a plan to patch that hole with additional coping skills. For many, this can lead to increased confidence in their recovery and ability to remain sober.

The Importance of a Support System

Patients are most successful in the recovery process when they have a support system, including support groups and professional support. Groups consisting of sober individuals allow for encouragement and belonging, and professional care can provide both assistance and constructive challenges.

Including care partners, such as the patient’s loved ones, is also immensely helpful when one is in treatment, as we know addiction impacts more than just the person who is addicted. Additionally, spending time with sober individuals while developing new hobbies can be helpful.

Finally, it’s important for family members and friends supporting a loved one with an addiction to practice self-care during what can be a very challenging time. They can attend their own support groups, such as Al-Anon, and set healthy boundaries within the relationship.

Shelby Espiritu is a lead therapist in the dual intensive outpatient program at Sharp Mesa Vista Hospital.



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Ellen Bullock