Ceasing an addiction such as smoking, drinking or drug use requires a person to go through expected stages of change. These stages have been comprehensively scientifically reviewed since Prochaska and DiClemente’s hallmark research in 1982. It is rare that a person can successfully quit by passing through these stages only once. In most cases there are several attempts at change before giving up for good. Like someone who ceased smoking seven times over, only to resume smoking five years later during a divorce, then having to cease smoking all over again.
Targeted strategies can be used to successfully facilitate change if a person’s specific stage of change is correctly determined. Misidentification of a person’s stage of change can cause rehabilitation to fail – for example, pressure to quit can create resistance and a determination to continue the feel-good behaviour. The six stages of change and some targeted strategies to quit are:
Precontemplation
The precontemplation stage is about denial and avoidance of negative results of the behaviour. There is no motivation to change, and the person is only aware of the pleasurable results of the addiction. People generally dispute the damaging effects of their behaviour by saying something like “Gran smoked 40 a day and she lived to be 95!”.
The most powerful motivation to change is a wake-up call – for example an alcoholic may decide to change his behaviour after learning that his mate almost died in a car crash caused by drink-driving. Going to see the doctor for a health check can act as a stimulus for change. If this doesn’t produce any motivation to change, try discussing the effects of their behaviour in regards to their physical and mental wellbeing, their relationships with others and their occupation (i.e., liver lover, livelihood). It is useful to ask “What would have to happen to show you that this behaviour is having a negative effect on your life?”. Try not to give advice or be pushy; rather have the person tell you the reasons why they should cease their behaviour. Be mindful of the dictum “I learn what I believe as I hear myself speak”.
Contemplation
During this stage the person begins to question their current beliefs but remains ambilivant about change. During this stage, people weigh up the damaging consequences of their behaviour versus the benefits of change. However, the costs related to change are still substantial. People may alter their behaviour in the coming six months.
It is necessary to encourage people in the contemplation stage to reflect on the positive and negative consequences of their behaviour. Praise all desires and endeavours to minimise or give up the behaviour altogether. Perceived confrontation can trigger resistance and relapse, so it is essential that you remain non-judgemental.
Preparation
During this stage the person’s motivation to modify their behaviour increases substantially, and the likelihood of change occuring within the next month is high. The person acknowledges that the benefits of change outweigh the costs, sets about developing a plan to give up their behaviour, and begins to put this plan into action.
It is important to stay non-judgmental, positive and supportive during this stage. Assist to research treatment options and be available for discussions. Be mindful that some types of programs might be more suitable than others – for example, joining an AA group might work best for someone who feels they can only manage ‘one day at a time’ – and offer to make initial contact with the program.
Action
During the action stage change is viewed as being beneficial with very few costs, and hard work is certainly in progress. Specific changes in thoughts and feelings are noticeable.
Simple things such as assisting to organise transport to therapy groups, helping with homework and positively reinforcing efforts to change can motivate a person to consistently attend therapy sessions. It is advisable that family members and friends are part of the therapy process – they can attend treatment sessions, compile information or even keep records of the person’s progress.
Maintenance
This stage is characterised by a rising level of confidence that change can be upheld. During this stage the temptation to relapse back into old habits is less recurrent, and this period can last between six months and five years.
It is advisable to continually reinforce behavioural changes as the person becomes accustomed to, consolidates and internalises the new behaviours. Provide support to the person’s family and friends in helping to maintain behavioural changes.
Termination
This is the final stage of change; it is characterised by a total lack of temptation to relapse – ever, where the addiction has gone completely and the person has made a absolute recovery. It is more than likely that it will take several years to reach this stage!
Dr Henshaw is a highly experienced clinical psychologist in Perth who can help you work through your depression and anxiety. To learn more, visit: http://www.henshawconsulting.com.au
