The stages of addiction recovery may not appear to have much in common with a family road trip. But, these two journeys have plenty of similarities, not to mention some significant landmarks along the way. The Ranch is here to help as you navigate your recovery journey.
When you leave for a big road trip, having a map handy on your smartphone is reassuring. As you move along the path, you can see you’re headed in the right direction as you get closer to your destination. Reaching certain landmarks or milestones along the trip gives a sense of accomplishment and the motivation to keep going.
Knowing the stages of addiction recovery is much the same. By educating yourself about these stages and mile markers, you empower your own or your loved ones’ recovery from a substance use disorder.
While the stages have some grey area in terms of timeline and intensity, most people recovering from addiction feel a familiarity with each one.
The “Stages of Change” were first developed in 1992 and introduced by three clinical psychologists in their book, “Changing for Good.” The authors, John Norcross, Carlo DiClemente and James Prochaska defined the six stages of change: Pre-contemplation, contemplation, preparation, action, maintenance and termination. Ultimately, these psychologists created a road map to lasting recovery when tackling any significant life change.
For a more in-depth discussion about the stages of addiction recovery and treatment, read “Treatment Improvement Protocols” written by the U.S. Department of Health and Human Services: Substance Abuse and Mental Health Services Administration (SAMHSA), in cooperation with the Center for Substance Abuse Treatment in Rockville, MD.
Pre-contemplation
In pre-contemplation, you, as one working through addiction, have no time to listen to anything about substance use disorders. In this stage, your drug of choice, be it alcohol or narcotics, is not a problem, according to you. This stage is especially tough for loved ones.
Consider this story about a real family dealing with addiction. Jack is eight years old. Last night, his dad came home drunk at 3 a.m. and woke everyone up by crashing into some furniture in the dark. The next morning, Jack’s dad sleeps late and misses having pancakes with his wife and kids. This event is typical and happens every few months.
Jack, even at 8 years old, sees his dad’s behavior is hurtful and inappropriate. He feels a little sad and angry at his dad. While mom confronts dad about his actions, dad is incapable, at this stage, of seeing any problem. He tells himself everyone is making too much of nothing.
Even though his family may see reality in a much different way, Jack’s dad tells himself:
I don’t do this every night.
I worked hard this week. There was a ton of stress. Anyone would need to blow off some steam.
I’ll make it up to them. It’s really no big deal. Nobody’s perfect.
At no point does Jack’s dad seriously consider giving up his drinking. And, he can’t honestly see how his behavior is impacting his family. During pre-contemplation, the drug of choice holds all the cards. For Jack’s dad, alcohol is king at this point.
If confronted, Jack’s dad may lash out in anger, disbelief or completely dismiss any concerns.
In this stage, a court system, school system or employer can demand admission to an addiction recovery center even though the person using the substances may not see any problem.
Motivating someone to make changes in the pre-contemplation stage is a tricky business. A thorough discussion on the subject is presented for clinicians in SAMSHA’s “Enhancing Motivation for Change in Substance Abuse Treatment,” published and reprinted last in 2013.
Contemplation
If reality was a three-layer cake, the Contemplation Stage is a bit like eating one spoonful. Someone who is contemplating their alcoholism may put down the spoon for a bit, then take another bite when clarity around their drug use sinks in.
Let’s go back to Jack. His dad’s drinking has escalated during the past year. Jack has suffered numerous broken promises and disappointments. His dad forgot about a little league game, he didn’t show up for Jack’s school orientation, and he drank too much at Jack’s birthday party.
Jack’s mom always seems angry, preoccupied, or sad. She’s started to explore the possibility her husband has a drinking problem. Late at night, usually when Jack’s dad is out, she searches online for addiction and treatment information.
The birthday party was embarrassing. Jack’s dad got drunk and started a fight with his brother. The next day, Jack’s dad felt uncomfortable about what had happened. For a moment, he was able to see how his drinking impacted his behavior.
While at the gas station, Jack’s dad runs into an old friend from college. They meet for lunch. When his friend tells him he doesn’t drink anymore, Jack’s dad asks some questions about sobriety. The friend reveals he went to treatment for a substance use disorder and hadn’t had a drink in three years.
After lunch, Jack’s dad decides he’s only going to drink beer from now on—and only on the weekends.
Deciding to cut back on certain substances is expected during this stage. While Jack’s dad sees some negative consequences resulting from his drinking, he’s unable to confront the possibility he needs to remove alcohol from his life altogether. He still hopes to maintain some recreational drinking.
A seed has been planted, however, in his mind. He begins to consider he may have a problem. Sadly, some people will remain in this stage for the remainder of their lives, realizing they “might” have a problem with substances but only thinking about making a change.
The Partnership to End Addiction offers information, resources and support for loved ones, particularly parents of those actively suffering from addiction.
Preparation
Back to Jack. His parents argue whenever Jack’s dad is home, which isn’t often. His dad wasn’t able to keep this self-commitment to only beer on weekends. One night, during a terrible argument, Jack’s dad punches a hole in the wall. Jack’s mom takes Jack and leaves. She threatens her husband with divorce.
At this point, Jack’s dad feels fear. He realizes he does hurtful things when he’s drunk and sees he could lose his family. At the same time, his job performance is suffering.
At work, he spends an afternoon searching the internet for information about addiction, treatment and recovery. He sees himself in the alcoholic self-assessments online. He’s able to admit his efforts to quit or modify his drinking without help aren’t working. Still, he holds out hope he can drink socially. A world without alcohol is impossible for him to imagine during this stage.
Sometimes, the Preparation Stage is skipped entirely. Some see themselves as having a substance use disorder, and they decide to stop drinking. Without adequate education and support, however, efforts to quit usually aren’t successful.
Preparation is a valuable stage. It is where the person struggling with addiction opens their eyes to what the actual problem is. They are finally able to put a name to what has been happening to their lives. It could take one month or more as the addict gradually settles into this reality.
After a month of preparation, Jack’s dad recognizes he has a problem. He’s doing his research and preparing himself for what he now understands is a major lifestyle change.
Action
Jack’s dad has been calling addiction recovery programs to gather information for the past month. He considers calling his high school friend, who is in recovery. Still, in the preparation stage, he hasn’t taken any real steps of action.
It’s not until Jack’s dad is served divorce papers that he calls his old friend. They attend an Alcoholics Anonymous (AA) meeting. Jack’s dad goes to six AA meetings with his friend. He begins to befriend other AA members. He begins to refer to himself as an alcoholic. His wife tells him she will only consider reconciliation if he gets help for his alcoholism. He misses his family, who refuse to see him.
Jack’s dad is open to help. An AA friend recommends a nearby residential addiction recovery center. Jack calls and admits the same day.
The Action Stage is unpredictable in terms of length. Some will remain in the stage for months while attending 12-step meetings or therapy. Like Jack’s dad, others will take action hours after something drastic like an impending divorce, DUI, court action, job loss or the like result from their substance use.
The stage is marked by positive action taken, which improves their self-confidence and support system. Positive actions usually include asking for help in some way.
Author, professor, and clinical psychologist James Prohaska founded Pro-Change Behavior Systems about 20 years ago after his work on these Stages of Change also called the Transtheoretical Model of Behavior Change. Pro-Change helps companies, government organizations, and other groups support and motivate lifestyle changes around addiction, mental health disorders, weight, relationships, and more.
Maintenance
Jack’s dad finished 90 days in a residential treatment program for a substance use disorder. During this time, his wife received support herself professionals at the addiction recovery center and elsewhere. The family, including Jack, are now educated when it comes to addiction and recovery.
Jack’s dad isn’t living at home. Instead, he’s attending aftercare and living in a house with other men in recovery. Staying sober while back on his job, visiting his son and taking on some of his former responsibilities is challenging. He understands he needs to take certain actions daily to stay sober. For now, the recovery house provides the needed support as he transitions back to his family.
Last week, Jack got in some trouble at school. He got into a fight with another student on the playground. Jack’s dad and mom were called into a meeting at the school. After the meeting, Jack’s mom and dad argued. This argument left Jack’s dad wanting a drink.
Instead of drinking, however, he called a friend in recovery. They went to a 12-step meeting. Jack’s dad was able to stay sober another day.
The Maintenance Stage is marked by small episodes like the above. Jack’s dad is committed now to living alcohol-free. He understands he has a chronic, lifelong condition.
However, life still has challenges. With each challenge, Jack’s dad becomes a little more confident in himself. He learns how to live his new sober lifestyle even when daily life causes stress.
For now, he stays away from old drinking spots, drinking buddies and anything which could trigger a craving for alcohol. His main goal, for now, is to stay sober.
The Maintenance Stage can last from six months to more than five years. Increasingly, a life without substances will become a new normal. Jack and his family will continue to heal as his dad remains committed to recovery, and his mom remains committed to healing.
Relapse
For some, the relapse is a part of the recovery process. For others, maintenance continues without disruption.
If relapsing is a part of you or your loved ones’ journey, just consider the stages above and get back to action as quickly as you’re able. To some, this could mean another stay at an addiction recovery center.
This recovery renewal is true for a loved one as well as the person in addiction recovery. If Jack’s dad relapses, his chances of getting back to recovery increase dramatically as long as his friends and family stay committed to their own recovery.
Termination
Termination is the end goal, according to the original authors of the “Changing for Good.” The Termination Stage is marked by an ability to live without craving the substances formerly used. After 10 years of his dad’s sobriety, Jack’s family doesn’t see alcohol as a threat any longer.
Addiction impacts everyone in a family. It’s often the loved ones who recognize someone has a substance use disorder before the addict does. Ask questions, research the help available and reach out for support. Dealing with addiction is overwhelming to most people. Remember help is available, along with recovery checkpoints at whatever stage you or a loved one may experience.
Let us help you rewrite your story and find the path to healing. Call us today at 717.969.9126.
