It’s difficult loving someone with an addiction, especially once you’ve accepted that you have no control over their behaviors. You can bargain with them to stop using drugs or alcohol, even coerce them into treatment, but until they’re intrinsically motivated to get better, they’ll likely continue their destructive behaviors. Sometimes people can find this motivation once they’re in treatment, but ideally some sort of intrinsic motivation exists before entering drug rehab.
While there’s no way to predict when or if an individual will attempt to overcome addiction, for several decades now, mental health professionals have been using an integrative behavior change theory that helps them gauge a client’s readiness for recovery.
What Is the Transtheoretical Model (Stages of Change)?
The Transtheoretical Model (TTM) of behavior change is frequently used by therapists and other behavioral health professionals to assess where an individual is in their awareness of unhealthy behaviors and their willingness to change those behaviors. This helps them determine what type of therapeutic approach to use with the client. The Transtheoretical Model was developed by psychologists and researchers in the late 1970s with substance abuse in mind, but TTM is applicable to many behaviors such as sexual addiction, eating disorders, gambling, smoking, staying in an abusive relationship, and others.
According to TTM, people move through a series of stages when modifying behavior; change such as quitting drinking, smoking or overeating does not happen as a single event in time.
Here are brief descriptions of the five stages of change and some scenarios of how each can play out in addiction:
1. Precontemplation (Not ready)
People in the precontemplation stage don’t plan to take action in the foreseeable future. They likely haven’t faced any hard consequences of their behaviors and are unaware of or ambivalent about how their behaviors are impacting themselves and their loved ones.
In the precontemplation stage, an individual’s alcohol or drug use has reached a concerning level. Loved ones, coworkers and others have likely noticed their substance misuse and may have confronted them about it. The individual may not be experiencing significant financial, legal, relationship or social problems, especially if their loved ones are enabling them and preventing them from enduring the consequences of their actions. They may stay stuck in the precontemplation stage until they feel more of the negative aftermath of their drug or alcohol use.
2. Contemplation (Getting ready)
Contemplation is the stage where people are considering whether to make changes in their lives and behavior. Often people stay in this stage for long periods of time weighing the costs and benefits of changing.
An individual in the contemplation stage is aware that their drug or alcohol abuse is a problem, but aren’t ready to get serious about sobriety yet. Pressure to get help may be building from outside of themselves – loved ones, employers and others – but their intrinsic motivation for recovery is not strong enough to prompt them to take any real action.
3. Preparation (Ready)
In this stage, people clearly see their behaviors as problematic and intend to take action. They understand that the pros of sobriety outweigh the costs of their continued addiction. They’re usually more committed, decisive and confident and have taken some positive actions that foster their recovery. During this stage, building confidence is key and these people tend to be particularly receptive to coaching and support that help them move forward in their recovery.
4. Action (Active change)
People in the action stage are making specific, overt modifications in their lifestyle. Because action is observable, the overall process of behavior change is often misinterpreted to only be synonymous with observable action. However, action is just one of the five stages of change. In order for change to take place and be maintained over time, a person must pass through all five stages of change.
The action stage is where an individual is actively getting help for their addiction and wholly invested in their sobriety. They’re addressing triggers and the reasons why they’ve abused substances. They’re learning healthy coping skills, repairing relationships, and making changes in their lives that support long-term sobriety.
5. Maintenance (Sustaining change)
This is the stage where people have made distinct, discernible changes in their lifestyles and are working to prevent a return to unhealthy behaviors. They don’t need to apply change processes as frequently as those in the action stage do in order to sustain these changes. They become increasingly more confident in their behavior changes and their ability to handle new challenges. However, it is important to note that recovery is maintained through action. It is a lifelong process.
In the maintenance stage, an individual is less tempted by triggers and relapse is less of a concern than in previous stages. They’re effectively managing any underlying issues like mental health disorders and trauma. Healthy coping skills and self-care come more naturally and are ingrained components of their lifestyle.
How People Move Through the TTM
While people may progress through the Stages of Change in a linear fashion, a nonlinear progression is common. Sometimes people recycle through the stages or regress to earlier stages from later ones. People may move through one stage quickly and stay in another stage for a much longer period of time.
Ideally, people enter drug and alcohol rehab in the preparation stage and leave in the action stage. In order to successfully continue on their recovery journeys, it’s crucial that they continue to work on sobriety once they leave treatment – attending therapy, practicing healthy self-care and participating in sober support groups.
As a loved one of an addicted individual, it’s important to remind yourself that you can’t control the progression through the stages of change. You can support and encourage your loved one and hold healthy, loving boundaries, but their motivation to recover will ultimately need to come from within.