Addiction is a debilitating disorder that effects millions of people each and every year, and overcoming this illness is much more complex than many people recognise. Although recovery can be an unpredictable process for many recovering addicts, addiction experts have taken notice to trends, or stages, most people experience on their path to sobriety.
While there are a number of ways to break down the recovery process into easy-to-digest steps, one of the most compelling was introduced by psychologists James Prochaska, John Norcross and Carlo DiClemente in their 1994 book Changing for Good. In the book, Prochaska, Norcross and DiClemente break down the addiction recovery process into six stages of change. Each of the 6 stages — pre-contemplation, contemplation, preparation, action, maintenance and termination — correspond to particular phases in an individual’s journey from active addiction to lasting sobriety.
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Before starting the stages, bear in mind that this concept applies as much to behavioural addiction, as it does to alcohol and drug addiction. Let’s now look at these stages one by one:
Stage 1: Pre-contemplation
During the pre-contemplation stage, the addict has become aware of the consequences of addiction, but he or she is either justifying or minimising them. At this stage, defence mechanisms are in high gear, and people are reluctant to even acknowledge they have a problem. They may be going through the motions due to pressure from legal trouble, a loved one, or even an employer, but they are still unaware of the severity of the situation. During this phase, addicts will typically avoid conversations about addiction or avoid those who bring them up.
People in the pre-contemplation stage are not even considering changing their addictive behaviour. They may be in denial of their issues or believe that anyone who might point out their problem is exaggerating. In short, the perceived benefits of continuing with their addiction are thought to be greater than the cost and repercussions.
There are four reasons someone might be in the pre-contemplation stage when it comes to their addiction: Reluctance, Rebellion, Resignation, and Rationalisation. Reluctant people in this stage may lack motivation or knowledge about change and the vision of their problem may not have come into their awareness. Those who are rebellious have an investment in their addiction and making their own decisions. They have an issue letting go of negative habits because they don’t like being told what to do. Resigned pre-contemplators have given up on the possibility of change and are overwhelmed by their addiction. Many of these people have already attempted to quit. Those who rationalise believe they know all the answers and have reasons why their addiction is not a problem for them.
Stage 2: Contemplation
At this point, the addict has accepted they need to make changes, but they are not only struggling to understand the root cause of their addiction, they are also unsure of how to move forward. Choosing to seek help is a huge step. Addicts may continue to abuse drugs or alcohol or indulge in harmful behaviours during this stage, but many report enjoying it less, even if they are using more.
Individuals may waffle back and forth between wanting and not wanting to change. Procrastination, or stalling, is common in this stage. They may decide, for instance, that they’re going to seek treatment sometime in the next six months but won’t set a definite date.
It’s also common for people in this stage to attempt to curb their addiction on their own or to make plans to do the same. People can remain stuck at this stage for a long time — knowing that they need to make a change but not feeling ready to act on it.
Contemplation can be an uncomfortable process, and feelings of guilt, shame, hopelessness and desperation are common as people reach the crossroads in their addiction journey. The end of the contemplation stage is characterised by simultaneous anxiety and excitement. Once people in the contemplation stage shift away from just thinking about their problem and begin focusing on a solution, they move towards stage three of recovery.
Stage 3: Preparation
In transitioning from contemplation to preparation, the addict realises the repercussions of addiction far outweigh any perceived benefits. Moreover, he or she decides the changes necessary to kick addiction are attainable, and accepts that there’s a need for treatment, thus beginning the preparation stage. After reaching the preparation stage, the addict is fuelled by excitement, as he or she has made concrete plans for their recovery.
These plans may be taking a pledge of abstinence or admitting themselves into a rehabilitation facility. Regardless, these people are preparing for a life sanz their addiction, and they have more than just a vague idea as to how they are going to accomplish this.
It is not uncommon for those in the preparation phase to report having to overcome feelings of ambivalence before progressing to the next stage. However, once they have committed to a plan of action, they are likely to move on smoothly. It’s also at this point that the addict begins to accept support from family members, close friends and other important relations. Just by choosing a day, month, or even a year to focus on recovery helps addicts in the preparation stage move on to the next phase.
Stage 4: Action
During the action stage, the addict immerses himself or herself into recovery, which can include enrolling in a treatment program, joining a 12-Step group, or utilising some other type of resource for rehabilitation. The individual is committing to making significant lifestyle changes that will ensure a healthier and more productive life moving forward. In addition to learning the skills and strategies of recovery, the individual is also creating dietary, fitness and career plans, as well as repairing and re-establishing relationships.
For many addicts, the first step of this stage involves going through a detoxification process. Detoxing in a medically managed environment is advisable, regardless of whether the addiction is substance based or behaviour based. Once detox is complete, people can begin work on the psychological, social and behavioural problems that accompany their addiction. Many types of addiction treatment programs are available, including long-term residential treatment, short-term residential treatment, outpatient treatment programs, individualised counselling, group therapy and 12-step programs.
Stage 5: Maintenance
In the maintenance stage, the individual assumes responsibility for remaining abstinent. In short, he or she must “maintain” the sobriety acquired during the action stage. This is an extremely important stage because once a recovering addict’s time in treatment has come to an end, they may return home and face situations that once triggered them to get addicted. This stage is often not taken seriously, which is why most individuals who relapse do so during the maintenance stage. Much like a person must practice a skill or trade after learning it, someone in the maintenance stage must practice living life in recovery.
Stage 6: Termination
At termination stage, the transformation of recovery is basically complete. Although remaining sober is a lifelong endeavour, an individual in the termination stage of recovery is likely to have regained his or her health, maintains healthy relationships, has a stable job or career, is financially independent, and feels confident that he or she will remain in this state. When asked, most individuals in this stage have no desire to return to active addiction and are relieved to no longer have the same habits as when they were addicted.
Here's a summary of the stages of recovery:
Now while some addicts progress through the stages of recovery in a linear fashion, many do not. It’s more common for people to move back and forth through the stages of change as they tackle addiction. Relapse is a common feature of addiction, and it is more the rule than the exception. In fact, 40 to 60 percent of people recovering from any addiction relapse at some point - but this doesn’t mean their treatment has failed.
Approximately 15 percent of those who relapse regress to the pre-contemplation stage, and approximately 85 percent return to the contemplation stage before progressing to the preparation and action stages. Most people recovering from addiction will cycle through the stages of change three or four times before completing the cycle without a slip. Some people may progress much faster while others can take longer to fully recover.
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