What is the Process of Change That Somebody Goes Through In Order to Quit Consuming
Alcohol and Other Drugs?
Dear Dr. Steve:My husband
and I have been at odds for the last two years over his drug and alcohol use. He recently
got his second DUI. This occurred shortly after he was fired from his job for stealing
money. We just took out a second mortgage on our house, one we can’t afford I might
add, to pay off his legal bills for the DUI and the trouble he had with his last job.
Whereas my kids once idolized their father, they dread the moment that he walks through
the front door every night and starts in on them and me. His mood swings are so severe
that it seems that there’s never a moment of peace and quiet when he’s around.
He steadfastly denies that he has a problem, although the evidence to the contrary is
unavoidable. Any time I try to talk to him about his alcohol use, he becomes defensive,
changes the subject, and in the end switches the focus to me and my short-comings. I
don’t get it, I come from the old school where you pull yourself up by your
bootstraps--there’s a problem, you see there’s a problem, you dig in, roll your
sleeves up and start working on fixing whatever the problem may be. He should just stop
drinking. But that’s not happening here. What will it take for him to see the light
and start changing his ways?
In order
to best answer your question, let me first present to you a description of the underlying
process that people move through in order to change behaviors. This underlying process of
change was empirically demonstrated by three very gifted researchers, James Prochaska,
John Norcross, and Carlo DiClemente. These researchers developed a paradigm that explains
how people change behaviors by moving through an underlying process that has six stages to
it. For purposes of our discussion, I will only focus on the first five stages. The six
stages are:
1.) precontemplation, 2.) contemplation, 3.) preparation, 4.) action, 5.) maintenance, and
6.) termination.
Precontemplation
Stage of Change
People
who are in this stage of change are best described by a quote by G.K. Chesterton: It
isn’t that they can’t see the solution. It is that they can’t see the
problem. Five things can be said for certain about people who are at this stage of
change: 1.) they are resistant to change, 2.) they don’t see that any problem exists,
3.) they have no intention of changing their behavior, 4.) they are more intent on
changing the behavior of people around them rather than their own behavior, 5.) any help
they seek is only because of external pressure applied by their family, friends, boss,
spiritual leader, and/or legal system.
Precontemplators
are adept at denying that a problem exists. If you talk to a precontemplator about a
problem, they’re skilled at shifting the focus of attention to another topic,
devaluing your opinion and/or the opinion of others, and assigning blame to others rather
than taking ownership of their own behaviors.
Contemplation
Stage of Change
In the
contemplation stage, people acknowledge that they have a problem and want to do something
about the problem. People in this stage often say, “I want to stop feeling so
stuck!” The reason that a contemplator feels so stuck is because they are struggling
to understand their problem—the cause(s) of their problem, the solution(s) to solve
their problem(s), and the technique(s) to execute the solution(s). Although the
contemplator may acknowledge that there is a problem and that they are stuck, this does
not mean that they are ready to do anything about their problem. Contemplators can spend
years stuck in this stage, not because they don’t want to change but because they are
afraid to try and perhaps fail. Many contemplators stay stuck in this stage by
intellectualizing the problem and the solution. They continue to shop for the best
treatment or the best self-help approach without ever taking any action. Once a shift
takes place in the contemplator’s focus of their thinking from the problem to the
solution and from the past to the future, then and only then will they be ready to move on
to the next stage of change.
Preparation
Stage of Change
Most
people in the preparation stage of change are within a month of taking the necessary
actions to start changing their behavior. In this stage of change final adjustments are
made prior to actually changing their behavior. As the preparation stage unfolds two
things are necessary to take place before the individual moves on to the next step of
change. First, the individual must make a public pronouncement of their intent to
change—“I will stop smoking next Monday.” The second thing that must take
place is the individual must resolve any final residue of ambivalence towards change by
convincing themselves that changing their behavior is ultimately what is necessary
to solve whatever problem that they’re trying to solve.
Action
Stage of Change
This is
the stage where the individual most overtly modifies their behavior and their environment.
It is during this time that the individual joins a health club, throws their beer down the
drain, stops buying cigarettes, or confronts whatever fears that they’ve been
avoiding. During the action stage of change, the individual brings together all the
preparation and contemplation that they have expended in the earlier stages of change.
Although the action stage is the most obvious stage of change to the outside observer, it
is not the first stage of change nor the last stage of change. The individual could not
have gotten to the action stage of change without first working through the issues
associated with the earlier stages of change and will not be able to effect permanent
change without going through the following stage of change.
Maintenance
Stage of Change
The
maintenance stage of change is the stage where the individual consolidates the gains from
the precontemplation, contemplation, preparation, and action stages of change. Although
from the outside looking in, it may appear as if not much is happening, this is a critical
aspect of change without which no change can become internalized in order that the
individual is less vulnerable to relapse. It is during this stage that the individual
integrates cognitively, emotionally, and behaviorally the changes that they have
undergone. During this stage of change the individual shifts the focus of
control for the solution to their problems from external sources such as an
unreasonable wife just getting off my back, an overbearing therapist finally cutting me
some slack, a threatening husband taking anger management classes, a backstabbing boss
being fired, a controlling sponsor working his own program, and/or an overzealous legal
system finally stops persecuting me to the internal resources of the individual
being the sole agent of change. Examples of an individual’s internal resources might
be the individual’s own motivation, their ability to manage impulses, and an
individual taking ownership of their role in whatever their problem might be as well as
their role in what the solution is. Depending on the type of behavior(s) that one is
attempting to change, the maintenance stage may last from six months to a lifetime.
From your
letter it seems clear that your husband is still stuck in the precontemplation stage of
change, yet you are clearly ready for him to change yesterday. But there is still
hope for you and your family. You are likely in the preparation stage of change. Apply
your old school boot-strap philosophy to yourself and your children. Begin taking
action. Attend Al-Anon meetings. See a therapist. Have your children evaluated to best
determine what impact your husband’s drinking has had on them. Learn as much as you
can about Recovery for family members. Learn how to detach with love. Learn how to
stop enabling. Teach your children positive responses to inappropriate behavior. Model for
your children what effective self-care is. Just remember, keep the focus on you and your
children and off of the behaviors associated with alcoholism.
Learn
how to prevent and recover from chemical dependency as well as the aftereffects of
chemical dependency on you and your family. Read Dr. Frisch’s, Psy.D. series of
Recovery books—From
Insanity to Serenity.
Pathfinder’s Checklist
1.) There is an underlying process to changing behaviors that has six stages.
2.) People move at their own pace through these six stages.
3.) People change their behaviors when they’re ready to change not when somebody else
is ready for them to change.
4.) Don’t wait for somebody else to change their behavior, focus on moving through
the six stages of change and change your own behaviors.
G.B.U.
Steve
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