It’s hard to make lasting changes. Many people will crowd the treadmills and weight benches in January, but as the month passes, the resolve to follow through on their resolutions dwindles.
Making a lasting change for someone with a substance abuse disorder can be extremely challenging. There are many barriers to recovery, including financial concerns, withdrawal symptoms, and family responsibilities. But the most common barrier to recovery is your willingness to change. If you don’t see the problem or the need to change regarding behaviors, bad habits, and addictions, it will be difficult for anyone to get you to change.
The transtheoretical model refers to a scientifically proven approach developed in the 1970s to better understand how people, particularly smokers, make changes for the better. It consists of six distinct stages people go through when they focus on improving their lives. Any behavioral change can be applied to the stages, whether it’s losing weight or overcoming an addiction. If you’re struggling with addiction, recognizing your stage of change can help you get the help you need.
Find out how you can take steps toward recovery using the transtheoretical model.
Can Treatment Be Effective If You Aren’t Ready to Change?
Even if it’s challenging to seek treatment before you’re ready, it’s not impossible. Treatment doesn’t even have to be voluntary to be effective.
Many people don’t seek addiction treatment because they don’t realize they need it. Some people go to treatment to appease persistent family members, others are compelled to go into treatment by court order, and others believe the only way to get clean is to hit rock bottom and realize that help is needed.
There is some truth to the fact that your mindset toward recovery is critical to successful addiction treatment, but you do not have to be the first to decide to change.
According to a University of Pennsylvania study conducted between 2007 and 2010, mandated treatment was effective in treating people under criminal justice supervision. Moreover, researchers found that court-ordered criminal offenders were more than 10 times more likely to complete treatment than those who entered treatment voluntarily.
The Six Stages of Change
Precontemplation, contemplation, preparation, action, maintenance, and relapse are the stages of change. They are often depicted as wheels, where each stage leads into the next. The stages of change may not occur in an orderly manner. There are no constraints on jumping from one stage to another, skipping stages, or leaving and entering at any point.
A person may be in the preparation phase when they decide not to consider making a change and return to pre-contemplation. Then, they may reconsider and return directly to planning without going through contemplation again. You are taken out of the maintenance phase when you relapse, but when you decide to continue, you will be back in the action phase.
The following is a brief overview of each stage:
Pre-Contemplation
The transtheoretical model describes pre-contemplation as the earliest stage of change. It is characterized by denial or total ignorance of the problem. When people are pre-contemplation, they aren’t considering change, and if confronted with it, they may remain in denial. It is possible to be ignorant of your damaging behavior and the strain it takes on your health, relationships, finances, and other areas of your life because of denial.
Denial can become resignation when you’ve been through several relapses. You might feel you can’t achieve sobriety if you’ve been through several relapses. To determine whether you’re in this stage, ask yourself what you need to do to change. In addition, you may want to consider what friends and family members have said about your substance use. Are these concerns justified?
Contemplation
During the contemplation phase, an individual begins to think about making a change. At the same time, people in this phase may find the prospect of changing daunting. They may become more aware of the harms their substance abuse may cause, but they may also start to see the positives that could come from making a change.
Also, they may have difficulty quitting a substance for good. Contemplation can last for a long time and be characterized by mixed emotions and internal conflict. Getting past this phase can be challenging. Unfortunately, many people never get past it. To help you get through change, think about it from the perspective of the benefits of sobriety.
Preparation
During the preparation stage, you begin experimenting with small changes and collecting information about what is necessary to create a change. This stage is often marked by collecting information about what you need to do to create the change.
In the case of drug use, you might start cutting back on your doses or taking them less frequently. To prepare for recovery, you may need to gather information about detox, treatment, and community resources. Write down your goals and what you need to accomplish to begin the recovery process. Plan and take action toward your goals.
Action
Change is most visible during the action stage, which involves taking action to achieve a lasting change. Strategies include:
- Seeking support and accountability.
- Rewarding yourself for your successes.
- Creating a list of motivational factors.
During this phase, it’s important to assess your strategies regularly and make adjustments when necessary. If you have a problem with addiction, you may benefit from addiction treatment or relapse prevention methods.
Maintenance
When you are in recovery, this is the time when you apply your relapse prevention strategies to your independent life as you continue to maintain your new behavior. Maintaining your connection to your support system and being involved in community resources like 12-step programs can help you maintain your recovery.
Relapse
Relapse is often a part of the recovery process and can occur anytime after you start making changes. Some people present the stages of change without the relapse stage so that it does not appear to be an inevitable part of the process.
The relapse experience is marked by the return of old behaviors and can lead to disappointment, self-doubt, and hopelessness. It is helpful to revisit triggers and barriers to success that can be addressed in the future.
It may also help to realize that treatment and the work you have done up until the relapse isn’t worthless since it allows you to gain new insight into yourself and your addiction. Relapses are not inevitable, but if they do happen, they don’t mean you cannot succeed in recovery.
Therapy Designed Around the Stages of Change
The purpose of motivational interviewing (MI) is to help people make changes in their lives when they are going through a change. It is used to treat substance use disorders for several reasons, but it can also treat other mental health and behavioral disorders.
In motivational interviewing, an individual’s goals and reasons for making a change are explored to strengthen their motivation to make healthy changes. During addiction treatment, the change may be to enter or stay in a treatment program, devote more time to recovery, or complete specific recovery tasks.
The purpose of motivational interviewing is to honor and encourage the autonomy of individuals. You engage with their motivations instead of confronting them or simply dumping information on them. Instead of giving direct advice or commands, therapists or counselors using MI might encourage clients to come up with their arguments for change.
MI explores the reasons a person desires to achieve sobriety in the context of addiction recovery. It may also increase treatment buy-in, which is the willingness to participate in treatment and the expectation that it will be beneficial because it involves your deeper motivations. The chances of lasting change may increase if treatment buy-in is increased.
MI is an evidence-based treatment approach, which has been tested in scientific studies and proven effective. However, alternative treatment options aren’t consistently effective in research, even though they may be helpful for some. Alternative therapies like yoga and art therapy may be included in treatment programs, but they should only complement approaches such as motivational interviewing and behavioral therapy.
How Does Motivational Interviewing Work?
There are five principles at the heart of motivational interviewing. If your therapist is trained in MI, they will keep these factors in mind when speaking to you. These principles intend to facilitate a productive, collaborative conversation that guides you toward a necessary change.
Empathy
During a motivational interviewing session, you will likely feel you are not being judged. A skilled counselor will not judge you or ridicule you in any way. Empathy describes the process of emphasizing the understanding of others, which is a term commonly used in clinical settings.
The goal of MI is to motivate you to change your behavior, but it is also a collaborative process that relies heavily on empathy. Your therapist will try to tap into your motivations and drives, which will be challenging if they cannot empathize with you.
Carl Rogers, the founder of MI, developed a person-centered approach in the 1950s. As part of Rogers’ approach, therapists and counselors must respect and understand each client as a human being. According to Rogers, a collaborative, empathic approach to therapy is the key to using the person’s knowledge and will to create change. People are unique, and they know their situations better than anyone else.
Goal and Behavior Discrepancies
It is normal for humans to be ambivalent about change. Usually, we avoid making a change until circumstances become so uncomfortable that it becomes necessary to do so. However, it may have serious consequences in our lives before we make a change. A therapist in MI will try to establish discrepancies between your current behavior and your goals and desires for your life. When addiction occurs, even consequences may not be enough to spur change.
To improve your health and repair your relationships with family members, you might find and keep a job. But if you’re still using the drug that threatened those things in the first place, your behavior does not align with your goals. How can you make a lasting change if you are reluctant to participate in certain parts of your treatment plan while you are trying to achieve sobriety?
Your therapist may try to make you aware of some of the consequences of your past and current behavior. This may be a challenging process because it means coming to terms with the things you’ve done that hurt yourself and others. In order to help you find a solution, your therapist will use empathy rather than accuse and shame you. By doing so, they may separate you from your behaviors and examine them objectively.
Would anyone be able to achieve your goals if they engaged in some of your behavior? Could anyone achieve a healthy body without paying attention to nutrition or exercise? You may not find out the answer from your therapist. It is possible that they will ask for clarification, and as they do so, you will be able to understand the discrepancy between what you really want and what is getting in your way.
Avoiding Arguments
MI is unlikely to cause you to argue with your therapist unless something goes wrong. Having a natural argument with your therapist may be natural. Even if you do not feel like you need to or are not ready to change, your therapist may be trying to encourage you to change your behavior, even though you feel like you don’t need to or aren’t ready to.
Since MI is a cooperative approach to therapy, your therapist will try to avoid direct confrontation. It is not that you will never be frustrated with your therapist, but arguments may result in less progress. MI is meant to increase your motivation. You may experience more resistance or ambivalence toward change if a therapist tries to drag you into a change or imposes their motivations upon you.
The MI model suggests that your therapist will attempt to avoid direct confrontation by following the following principles:
- Arguing isn’t productive. Arguing can waste both the therapist’s and the client’s time since it usually produces limited results. Additionally, it may lead to clients resisting the therapist’s suggestions.
- Defending breeds defensiveness. Therapists who become defensive in response to contention may just make their clients more defensive.
- Resistance means it’s time to shift strategies. A therapist should not attempt to break through with a client who is receptive to certain ideas or thoughts. Media portrayals of therapy often show a tense breakthrough moment, but that’s not the case in real life, especially in MI. MI is collaborative, so your therapist would be better off exploring other topics or approaches that engage you.
- There’s no need to label. An individual is labeled based on his or her behavior or mental illness in psychology. As an example, we can look at addiction, alcoholism, gambling, etc. Although some organizations like AA embrace these terms, a MI therapy session may not be the right place for them. Labeling can be associated with blame, so your therapist probably won’t use it.
Adjusting to Resistance
In MI, resistance is a sign that something isn’t working. It could mean the interview has taken a direction that’s uncomfortable. It is possible for your therapist to adjust to resistance by using various methods. You might be shifted to a less contentious topic of conversation, you might be mirrored or reflected to get you to explore your statement more deeply, or you might be reframed in a positive light if you have a negative mindset.
As a result of your momentum, your therapist may be able to help you. It is normal for MI to shift to talk about the issue you brought up instead of what they had in mind if you’re frustrated during an interview. Reframing your perspective may also help you cope with resistance. This is part of the collaborative nature of MI.
Motivational interviewing involves shifting your perspective about change, which may begin with your expressions of resistance or frustration about your life, your treatment, or the issue you are trying to resolve.
Self-Efficacy
Motivational interviewing and behavioral therapy use the concept of self-efficacy to refer to your own belief that you are capable of taking on challenges. Although many people don’t resist change when there is a problem out of obstinacy, they may resist change because they do not believe that they can make a lasting change.
Changing our behavior long-term is a challenge, and many people try multiple times before succeeding. Those with substance use problems frequently try quitting or cutting back repeatedly before relapsing and becoming addicted again.
Making behavioral changes requires a lot of self-efficacy, which can be developed over time. To boost your self-efficacy, your therapist may point out and celebrate your accomplishments in treatment. They may also draw your attention to those who have succeeded despite many setbacks and relapses.
Self-efficacy can also be built by learning more about yourself, your problem, and your treatment options. Coping strategies that can prevent relapses can also increase your self-efficacy since they are tools that can protect your change.
A lack of belief in the possibility of change can be detrimental to lasting change, and belief in the possibility of change can be a powerful motivator. If you don’t believe that you are capable of maintaining change, you might relapse quickly. Your counselor or therapist needs to believe in you as well if you are to succeed.
