The belief that you can change is the key to change. Addictions are really no different from other behaviors—believing you can change encourages commitment to the process and enhances the likelihood of success. For many, this seems to be a conflicting message when compared with the AA’s message of being powerless over the addiction, and the loss of control over drinking. However, there is a degree of powerlessness or loss of control once an addict starts engaging in the addictive behaviors:
“One drink is too many and thousand is not enough”, meaning once an alcoholic starts drinking, he/she cannot stop. It does not mean that he/she is helpless and cannot make a change.
Choose Treatment that Best Suits Your Needs
The type of treatment is less critical than the individual’s commitment to change. People can select how they want to pursue change. The can pursue change in accordance with their own values and preferences. There is no “one size fits all” treatment for addiction. People don’t need to be told how to change, what program to follow, what theories to apply, they need to be aware of the options available to them and open to experimenting with the options as it makes sense to them.
In fact, there are many paths to recovery, perhaps as many as there are people who successfully recover. Those who achieve stable recovery tend to find their own way, some with the help of friends and family, some without; some with the help of formal religion, others making use of philosophical disciplines like Zen, or nothing at all; others find recovery in the rooms of self-help groups such as AA, NA or SMART Recovery; still others utilize some sort of professional treatment facility. Many who recover choose more than one path, or a combination of paths, depending upon what works best in our own particular circumstances.
Decide on The Right Length of Treatment
The length of treatment does not ensure success and long-term sobriety. In some situations, brief treatments can help a person change longstanding habits. It is not the duration of the treatment that matters, but rather its ability to inspire change. Some people make a decision to change, and facilitate change fairly quickly, possibly after having their doctor advise them to do so at one of their routine check- ups. Other people will utilize a number of intensive residential treatment programs on more than one occasion over the years, and continue to struggle with addiction without great success. The length of treatment is not a single determining factor in predicting its success.
To determine the length of treatment, here are some of the considerations:
- Has there been an assessment completed of the current situation (done by a professional)?
- What is the extent of the effects of addiction on his/her life
- What is the best choice of treatment that best suits their needs ?
- What is the treatment option that they can get excited about?
- What is the feedback from family and friends?
- Other considerations, for example, for those more severely debilitated by drugs and alcohol, a treatment program focusing on development of coping and life skills can be the key to long term success. Those with co-occurring mental health issues may need specialized services, or access to medication and others may need specialized interventions, i.e. gender specific services, youth services, and so on. Another issue affecting success in recovery is the individual’s readiness, motivation, willingness and confidence in own ability to facilitate change.
Recognize Improvement Without Abstinence
Repeated efforts are critical to changing. People do not get better instantly. For most of us, change takes multiple efforts. Imagine a baby learning to walk. It will try to walk smaller distances first. It will bump into things, trip, and fall. It will get up and try again, ideally, with lots of encouragement and support from the parents. The baby will try and try again until it learns to be steady on its feet, and at some point in the future confident enough to start walking longer distances, and even running. It may sound silly, but recovery is very much like the process of learning to walk. It will take multiple efforts, repeated tries, some bumps and falls, but if we do not give up, the change will come soon enough.
So, the first step to recovery could be treatment, but the second, equally important, is allowing the time needed for the change process to talke place, and being patient with it.
Providing a variety of treatment options to choose from and a solid follow-up care allows people to maintain focus on their change goals; it allows them to learn the skills they need for recovery, time to practice the skills in treatment, and then transfer these skills into their daily lives. Some believe, that returning home from Rehab, is really when recovery begins. It is the time to implement the skills you’ve learned, and practice alternative lifestyle that may include: meeting new friends, healthy leisure activitiesEventually, they stand a good chance of achieving their goal of abstinence as well as improving the overall quality of their life. It is important to remember than terminating substance use itself does not constitute recovery. Recovery also entails learning about coping skills, balanced lifestyle, healthy relationships, and overall feeling healthy and happy. There is a lot of improvements that need to happen that are just as important as maintaining abstinence.
So, if the first step is treatment, the second step is to allow the individual a sufficient amount of time to practice the skills they learned, sometimes falling back into old patterns. Remember, most of us do not get better instantly, and change does take multiple efforts. Improvement, even without abstinence, also counts. If a person picks up a drink, and is honest about it where in the past they’d lie, this indicates some positive change in their behavior, even though the abstinence was disrupted.
Other improvements without abstinence may include:
- Person is becoming more positive/hopeful
- Person is taking medication as prescribed, or following a treatment plan
- Person is becoming less angry
- Person does not blame others for their drinking
- Person is using other coping skills
- Person takes responsibility for their actions/relapses
People do not usually succeed all at once. There can be slow, but significant improvements; and all improvements should be accepted and rewarded.
Understand Stages of Change
Whatever the path and treatment options are chosen, we all go through the same “stages” of change. Change is a process as we have learned from the millions of people who have successfully overcome addiction. Even though, in this article the focus is on recovery and abstinence, this model of change has relevance to virtually any change a person would like to make in their life. Whether your goal is to quit something entirely, or moderate your behavior, the model remains the same.
A Simple Model of Change
In a 1984 paper, two researchers, J.O. Prochaska and C.C. DiClemente proposed a seven-stage model of change, they called “The Transtheoretical Approach”, to explain the theories of therapy being used in the process of smoking cessation. Their attempt to explain the process of change is not a perfect model, but it will serve as a starting-point for this discussion. Their change model is as follows:
- Precontemplation: These are individuals who are not considering changing, because they do not as yet see the need.
- Contemplation: Those who are considering change, they are starting to see the connection between the problems in their lives and the substances they are using.
- Preparation: The person has decided a change is necessary, is starting to make plans to change, and is deciding how best to make the change.
- Action: This person is taking the actions necessary to bring about change; these actions vary depending upon the course chosen in step 3.
- Maintenance: These people are doing what is necessary to maintain the change they have made; again this varies depending upon the program.
- Relapse: This is an optional stage, and is certainly not a requirement for recovery, but should be considered a normal, but by no means universal, part of the change process.
- Termination: After a prolonged process of change, thoughts, beliefs, and actions are no longer the same, one is an ex-user, and moves on with their life.
Many researchers consider behavior change a much more complex issue than these seven stages, and others maintain, quite correctly, that many people seemed to have changed without going through all of the stages. For example, some alcoholics who recovered on their own seemed to have completed the change as soon as they decided to do so. In other recoveries, the addict moves from pre-contemplation to action, or action to pre-contemplation, without any obvious reasons and seemingly skipping the intermediate steps.
What we can gather is that change, like substance abuse itself, is a continuum, not really a ‘staged’ or ‘step by step’ process.
PRECONTEMPLATION CONTEMPLATION PREPARATION ACTION MAINTENANCE
The key seems to be the degree of motivation the individual has when the process starts, the willingness, readiness and the confidence in one’s ability to accomplish change. Other aspects include access to information, supports and individual’s environment that can be either a barrier to change, or a much needed “safety net”.
When discussing stages of change, it is important to remember that there is no time limit between the stages. We are all individuals, and we progress at decidedly different rates, depending on many factors. There are those who have a “great awakening,” and quit overnight whatever behavior is causing them problems. Yet, the majority of us are not so lucky, and take our time, making baby steps, and often a few steps forward and a couple steps back, before a permanent change seems to occur.
Another aspect is that moving between the stages requires a lot of effort, and often generates pain and discomfort. It’s never easy to leave what we perceive as a familiar situation, and venture into unknown. It’s as though we are being asked to step from the solid steel deck of a Supertanker, which we know is sinking, into a floating lifeboat where we will be bobbing about in the middle of the ocean. The fear of the unknown is real, and we must acknowledge it, but we also must face it, knowing that the benefits of remaining aboard the ship are far outweighed by the consequences.
The next aspect of this is that change is a continuum, and it’s difficult to differentiate between the stages at times. A person may be in ‘preparation stage’ because they are afraid of losing their job, but once job is secured, they may once again move into pre contemplation. A person may be in ‘contemplation stage’, enter into the ‘action stage’ and “fail”, possibly leading them back into pre-contemplation stage.
PRECONTEMPLATION CONTEMPLATION PREPARATION ACTION MAINTENANCE
Some of the reasons for moving back on the continuum of change:
- making decision to quickly, decision was ‘not final’
- being solely motivated by external factors: job loss, jail time, family pressure
- lack of tools ad coping skills needed to sustain change
- lack of confidence
- lack of supports
- environment not conducive to change
- lack of willingness to follow through
- mental health issues or other complicating factors
To summarize, we are happy to tell you that a change you are embarking on is more than possible. There are a few things that can help with the change process as discussed earlier:
- believe in yourself- have confidence in your ability to succeed
- choose most appropriate treatment options
- choose a suitable length of treatment
- recognize improvement without abstinence (positive changes in thinking, feeling, behavior)
- Understand the stages of change and use them to self-assess