Individuals with a substance use disorder are oftentimes in denial about their addiction for a period of time. Denial is a simple way to minimize and rationalize any problem at hand. It is a defense mechanism that shifts the blame away from the denier and hands it off to anyone available to accept the responsibility.
Disordered substance users will argue against evidence, minimize the facts, and deny responsibility. Denial functions as an ego defense mechanism for them that is meant to ward off discomfort caused by repeated emotional injuries. It results in poor treatment outcomes and is a major obstacle in diagnosis. It is a hostile shield, and certainly not a long-term solution for any problem.
The Stages of Change Model
When individuals are in denial, or simply not motivated to change, clinicians are encouraged to refer to “The Transtheoretical Model,” otherwise known as the “Stages of Change Model”. This model, developed by Dr. James Prochaska, Ph.D. and Dr. Carolo DiClemente, Ph.D., acknowledges that individuals change behaviors gradually in a cyclical series of phases. Prochaska and DiClemente determined that intentional change is key to changing habitual behaviors; in other words, individuals must want to change their behavior and be ready to do so. In the addiction field, this means that drug users need to want to stop using before they can continue through the rest of the recovery process.
There are six theoretical stages of change: precontemplation, contemplation, preparation/determination, action, maintenance, and relapse. Determining which stage of change a person is in can help clinicians to decide which therapies and treatment methods should be applied. The “ideal” stage of change is maintenance, though it should be noted that it is quite common to cycle through the stages multiple times before settling in to a new habitual behavior.
1. The Precontemplation Stage
Individuals in the Precontemplation Stage have no intention of changing in the foreseeable future, which Prochaska and DiClemente define as “within the next six months.” The person is often in denial or legitimately unaware that his or her behavior is problematic. They are inwardly focused and predominantly think about how changing their behavior will negatively affect their lives. They put no consideration into the idea that change might bring about positive effects.
The Two Dreams staff works with individuals in this stage to determine why and how the drug use behavior came about. They acknowledge the individual’s thoughts, fears, concerns, prior efforts to quit, etc. and explore their previous life experiences, both with the drug and otherwise, to glean clues about their motivation. They discuss the advantages of quitting drug use and explore any thoughts and emotions that the idea brings up.
2. The Contemplation Stage
Individuals in the Contemplation Stage are no longer in denial about their behavior. They recognize that it is problematic, and contemplate the positive and negative effects equally. They intend to reform their behavior in the foreseeable future, though they may be unsure about the decision. They are thoughtfully considering change, but not yet pursuing it.
The Two Dreams staff works with individuals in this stage to investigate potential reasons for wanting change. They discuss future goals and explore the advantages and disadvantages of quitting drug use. They also evaluate the individual’s level of resistance to change and explore potential barriers to success. These barriers might include ignorance, personal choice, denial, defiance, fear of failure, fear of success, etc.
3. The Preparation (Determination) Stage
Individuals in the Preparation (Determination) Stage are ready to take action and plan to do so within 30 days. They start making small steps toward change genuinely believe that behavioral adjustment is a positive. They are determined to take action, but not yet doing so.
The Two Dreams staff works with individuals in this stage to support their motivation and encourage commitment to action. It is important to maintain a clear message about the necessity of quitting and to select preparation strategies that best fit the individual’s lifestyle. The staff also helps to develop a structured plan of attack and refer out for detoxification as necessary.
4. The Action Stage
Individuals in the Action Stage have initiated behavioral change and plan to continue moving forward. They modify their lifestyle to add healthy actions and subtract problematic ones. They are no longer engaging in the problem behavior and are actively changing for the better.
The Two Dreams staff works with individuals in this stage to support their progress, explore their relationship to the drug(s), and provide appropriate treatment. The focus is on identifying relapse triggers and avoidance strategies while staying committed to their specific behavioral change.
5. The Maintenance Stage
Individuals in the Maintenance Stage have refrained from engaging in their problem behavior for more than six months. This is the ideal stage of change; positive behavior is being maintained and the negative behavior is kept at bay. It is important for people in this stage to actively work to prevent relapse back to earlier stages of the cycle.
The Two Dreams staff works with individuals in this stage to further identify relapse triggers and specific countermeasures. They help to pinpoint self-defeating behaviors, explore the individual’s personal growth, and generally monitor their health through the process of active setback prevention.
6. The Relapse Stage
Individuals in the Relapse Stage have broken the period of maintenance and started to engage in their problem behavior again. People in this stage are usually overwhelmed with negative emotions and tend to return to some form of comfort zone. It is important to recognize that relapse is not synonymous with failure; cycling through the stages multiple times is an accepted and normal part of creating lasting change.
The Two Dreams staff works with individuals in this stage to reduce feelings of shame and identify barriers to success. They thoroughly explore relapse triggers, as well as the events around the relapse. They help the individual to start back at the determination stage and encourage them to prepare for a return to action.
The Transtheoretical Model and Two Dreams
The professional team here at Two Dreams uses the Transtheoretical Model to inform our approach to addiction treatment. Our staff members are specially trained to develop treatment plans that are individualized based on the stage of change our clients are in, among other factors. We encourage individuals struggling with substance use to call our facility today at 504-510-2331. We are here to help guide you through the cycle of recovery one stage at a time.
Barthwell, Andrea. “Parents Academy: Treating the Adult Adolescent” PowerPoint presentation. Two Dreams, Oak Park, IL. 22 Aug 2015.