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Alcoholism’s Stages of Change

stages of motivation

………………….Motivation Interviewing

Alcoholism’s stages of change has seven parts. Usually a person will progress through them in order when they are going forward. When they are going backward, however, they may go from stage six to three or any other place. It’s hard to tell where they might wind up. Here are alcoholism’s stages of change, these stages apply to the alcoholic or any other addict.

1) Precontemplation At this stage, you may not recognize the problem or you may think the problem not worth the trouble of changing. You may be thinking about change because someone or something is forcing you to. At this point just gathering information can be useful. Like coming to this website or attending a meeting.

2) Contemplation At this stage, your doing a cost benefit analysis. Your deciding if it is worth the effort. Does alcohol do more for good things for you than it does bad.

3) Determination/Preparation Here you are ready to make plans. Your formulating a plan of attack and strengthening your resolve to go forward. A change plan worksheet can be helpful in discovering options.

4) Action This is where you have your plan and you implement it. You may go to a self help group, you may choose professional alcoholism treatment help, you may decide to make a go of it on your own. (Spontaneously quitting, with no help, isn’t as rare as you might think. In college they told me as many as 1/3 of all problem drinkers just stop. They also told us these were the group of people who suffered the fewest relapses.) Anyway, this is the stage that the rubber meets the road.

5) Maintenance This is a few months into your sobriety. At this point you are looking for new social situations that don’t trigger your old behaviours. Your developing new hobbies and habits that don’t involve alcohol. Your avoiding situations that you used to revel in. Your trying to prevent a relapse.

These stages of change are for the addict.

6) Relapse Some people never have a relapse, most do. It is best not to beat yourself up if this happens. Try to view it as a normal part of the change process and learn from it. If it turns out meeting with your old army buddies leads to alcohol consumption don’t meet with them. Or, meet with them one on one. Or meet with them in an environment where there isn’t alcohol. Hell, just tell them alcohol is messing up your life and you need to stay away from it. You’d be surprised at how many people are very supportive. At any rate, develop new tactics to overcome whatever caused your relapse.

7) Termination This is where you are no longer actively in maintenance. You’ve given up your scandalous ways and moved on to others. Your old habits have been replaced by new ones. In short, you’ve got a new life and your leading it.

For alcoholism’s stages of change there is no time frame. It can take a year or it can take ten. People have relapsed after ten or fifteen years. It isn’t common to relapse after that long but, it can happen. Most relapses happen in the first year or so.

 

 Treatment and Motivations at Different Stages

PRECONTEMPLATION

The user is not considering change, is aware of few negative consequences, and is unlikely to take action soon.

Treatment

This client needs information linking his problems and potential problems with his substance abuse. A brief intervention might be to educate him about the negative consequences of substance abuse. For example, if he is depressed, he might be told how his alcohol abuse may cause or exacerbate the depression.

Motivational Strategies

  • Establish rapport, ask permission, and build trust.
  • Raise doubts or concerns in the client about substance-using patterns by

– Exploring the meaning of events that brought the client to treatment or the results of previous treatments

– Eliciting the client’s perceptions of the problem.

– Offering factual information about the risks of substance use.

– Providing personalized feedback about assessment findings.

– Explore the pros and cons of substance use

– Helping a significant other intervene.

– Examining discrepancies between the client’s and others perceptions of the problem behavior.

  • Express concern and keep the door open

 

CONTEMPLATION

The user is aware of some pros and cons of substance abuse but feels ambivalent about change. This user has not yet decided to commit to change.

Treatment

This client should explore feelings of ambivalence and the conflicts between her substance abuse and personal values. The brief intervention might seek to increase the client’s awareness of the consequences of continued abuse and the benefits of decreasing or stopping use.

Motivational Strategies

  • Normalize ambivalence.
  • Help the client “tip the decisional balance scales” toward change by

– Eliciting and weighing pros and cons of substance use and change

– Changing extrinsic to intrinsic motivation.

– Examining the client’s personal values in relation to change

– Emphasizing the client’s free choice, responsibility, and selfefficacy for change.

  • Elicit self-motivational statements of intent and commitment from the client
  • Elicit ideas regarding the client’s perceived self-efficacy and expectations regarding treatment.
  • Summarize self-motivational statements.

PREPARATION

This stage begins once the user has decided to change and begins to plan steps toward recovery.

Treatment

This client needs work on strengthening commitment. A brief intervention might give the client a list of options for treatment (e.g., inpatient treatment, outpatient treatment, 12-Step meetings) from which to choose, then help the client plan how to go about seeking the treatment that is best for him

Motivational Strategies

  • Clarify the client’s own goals and strategies for change.
  • Offer a menu of options for change or treatment.
  • With permission, offer expertise and advice.
  • Negotiate a change-or treatment-plan and behavior contract.
  • Consider and lower barriers to change.
  • Help the client enlist social support
  • Explore treatment expectancies and the client’s role.
  • Elicit from the client what has worked in the past either for him or others who he knows.
  • Assist the client to negotiate finances child care, work transportation, or other potential barriers.
  • Have the client publicly announce plans to change.

ACTION

The user tries new behaviors, but these are not yet stable. This stage involves the first active steps toward change.

Treatment

This client requires help executing an action plan and may have to work on skills to maintain sobriety. The clinician should acknowledge the client’s feelings and experiences as a normal part of recovery. Brief interventions could be applied throughout this stage to prevent relapse.

Motivational Strategies

  • Engage the client in treatment and reinforce the importance of remaining in recovery.
  • Support a realistic view of change through small steps.
  • Acknowledge difficulties for the client in early stages of change.
  • Help the client identify high-risk situations through a functional analysis and develop appropriate coping strategies to over come these.
  • Assist the clients in finding new reinforcers of positive change.
  • Help the client assess whether she has strong family and social support

MAINTENANCE

The user establishes new behaviors on a long term basis.

Treatment

This client needs help with relapse prevention. A brief intervention could reassure, evaluate present actions, and redefine long-term sobriety maintenance plans.

Help the client identify and sample drug-free sources of pleasure (ie, new reinforcers).

Motivational Strategies

  • Support lifestyles changes.
  • Affirm the client’s resolve and self-efficacy
  • Help the client practice and use new coping strategies to avoid a return to use.
  • Maintain supportive contact (e.g., explain to the client that you are available to talk between sessions).
  • Develop a “fire escape” plan if the client resumes substance use.
  • Review long-term goals with the client.

RELAPSE

The client has experienced a recurrence of symptoms and must now cope with consequences and decide what to do next

Help the client reenter the change cycle and commend any willingness to reconsider positive change.

Treatment

None listed.

Motivational Strategies

  • Explore the meaning and reality of the recurrence as a learning opportunity
  • Assist the client in finding alternative coping strategies.
  • Maintain supportive contact.

Sources:
http://www.csam-asam.org/sites/default/files/pdf/misc/StagesofChange.pdf
https://store.samhsa.gov/shin/content/KAPT24/KAPT24.pdf

 

How Long Until It is Time To Change

With every bad experience people can step into the contemplation stage of change. Sometimes that takes a long time and many, many bad experiences.

Unhealthy change

http://i.dailymail.co.uk/i/pix/2014/03/26/article-0-1C9273D200000578-797_634x291.jpg

 

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