STAGES OF CHANGE
I interned at a very busy detox center as part of my program to become a licensed alcohol/drug counselor. The detox center I interned at helped clients have a safe medical withdrawal from opiates, alcohol and benzodiazepines.
In this particular article I want to discuss the stages of change in addiction. The stages of change model was developed in the late 1970's and early 1980's by James Prochaska and Carlo Diclemente at the University of Rhode Island. In the following I will use a fictitious character named Jimmy to help make my explanation become more real. Often clients will come to a detox in various stages of change before they final take action and make a permanent change in their lives.
- People in this state of change are not thinking about changing and are not interested in help.
- People at this stage do not feel that they have a problem and often get very defensive if people pressure them to quit their addiction.
- Clients at this stage do not make any attempt to quit.
- In AA this stage is called denial.
In the detox I was at there were many people (particularly young guys) who were at this stage of change. Now, someone might ask me--How could they be at the pre-contemplation stage if they are at a detox center? Isn't that in itself acknowledging that you have a problem? However, clients come into detox centers for various reasons. Some clients would come in because there probation officer was making them, while others would come in to just shut their family up for a few days. These types of clients (as said earlier) think they do not have a problem.
EXAMPLE: Jimmy's first time in detox was not that bad. He only went to please his girlfriend who has been nagging him about his drinking. Jimmy does not think that he has a problem because he gets up for work everyday and is very productive. In fact, he is very worried about some of the landscaping accounts that he is responsible for. Being away for six days is going to make him behind on his work.ct, he is really worThis is a good example of someone in the pre-contemplative stage. I had one client who would talk about how much money he was losing while being in detox. This seemed to be the only thing that he was concerned with. He seemed oblivious of his severe heroin addiction. People in this stage of change are not open to what people are saying to them.
PEOPLE ARE VERY AMBIVELENT DURING THE CONTEMPLATIVE STAGE
- In this stage clients become more aware of the personal consequences of their habit and they spend time thinking about their problem.
- Usually these are the clients who have started to feel some of the negative effects of their habit. Whether it be an arrest or an ultimatum from a girlfriend they are starting to see some of the negative effects of their addiction.
- At this stage clients are very ambivalent of change. They are really on the fence on whether they really want to change. They often do not think the long term benefits of quitting outweigh the the enormous effort to do so.
- People at this stage are more open to receiving information about their habit.
- People can be in this state of change their whole lives.
At the detox center I interned at there were a lot of guys who were in this stage. Most of these guys had been to detox many times and were getting tired of it.
EXAMPLE--- Jimmy's second time in detox was a little more serious. However, he still thought he just was "not ready" yet to entirely quit. He was starting to see some of the negative effects of his opiate addiction. His girlfriend had broken up with him and he was starting to miss work sometimes. He made good money but most of it went to support his habit.
- This is the stage where people really start to decide that they are going to make a change. They are at the point that they realize that if they do not change serious consequences are going to result from continuing their habit(if it already has not).
- Some people call this the research phase. This is when someone might do a lot of research and collect information and resources that will help them overcome their addiction.
- People at this stage might even have experimented in quitting the substance they are using.
In the detox center I was at we saw plenty of clients at this stage. These are the clients who might ask a lot of questions about the different options that they have post detox or may come in with some information of their own about aftercare options.
Example: Jimmy is really becoming desperate. This is his third time in detox and he knows he needs to make a change. This time Jimmy is really interested in what the counselor is saying. Jimmy also is very interested in getting information about the aftercare programs offered by health care agencies.
- This is the stage of change where people believe they have the ability to change their behavior and are actively involved in taking steps to change their bad behavior.
- This is the person who is most receptive to aftercare after detox. This person has become tired of their addiction and believes that they can change.
- This is the stage when real change happens.
- This stage might feel strange to people because they are used to the chaotic life of their addiction.
- It is crucial in this stage that people develop effective ways to deal with stress.
This stage often times starts in a detox center. However everybody in a detox center is not at this stage. Clients who are in this stage in a detox center will go on to aftercare, whether it be an inpatient or outpatient program.
EXAMPLE: Jimmy has finally made up his mind that this time in detox will be his last. He has wored hard with his counselor and is going to an inpatient program for another two weeks until he can get into a half way house.
- The goal of the maintenance stage is to continue the new change that you have made in your life. Often this is very hard.
- People in this state of chane might be attending AA or NA to help them in support of their new life.
- After a period of time, people can become complacent during this stage. This is when the risk of relapse is the highest.
I have attended several AA and NA meetings over the past year and have talked to many people who go to these meetings. The people who continue their recovery often seem to be involved in NA or AA in some way. I have heard numerous clients say that the reason why they relapsed was because they became complacent and thought they could continue sobriety on their own. These clients would stop going to AA or NA and eventually relapse.
EXAMPLE: Jimmy has really enjoyed his new sober life. He goes to a NA meeting at a local church every Sunday morning. He has made a lot of good friends there and participates in a lot of sober activities.
- This is not an official stage in the stages of change model but is very common among people who have addiction problems.
- Relapse can be very discouraging to people
- People who examine themselves and learn why they slipped will be even more successful the next time they try the cycle of change.
EXAMPLE: Jimmy stopped going to his NA meetings because he needed to work during that time. He did not think this would be a problem because he felt like he could handle life by himself. Jimmy had one week that was particularly stressful and was having a hard time coping. He happened to bump into some of his old fiends during this week and was tempted to use again. On Saturday he slipped up. It was only one time but Jimmy is immediately going back to detox. He wants to nip this in the bud right away.
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