In the last chapter, we learned that 75% of all addicts quit using on their own without benefit of formal treatment or 12-step groups. In this chapter, we are going to explore exactly how they manage to overcome alcohol and drug dependence, which the prevailing wisdom tells us that one cannot do without help. What is there that appears to be different about those who recover on their own that separates them from the other 25% who show-up in treatment centers and 12-step groups, some of them over and over, and many of whom never recover from their condition.
There are many paths to recovery, perhaps as many as there are people who successfully recover. Those who achieve stable recovery tend to find their own way, some with the help of friends and family, some without; some with the help of formal religion, others making use of philosophical disciplines like Zen, or nothing at all; others find recovery in the rooms of self-help groups such as AA, NA or SMART Recovery®; still others utilize some sort of professional treatment facility, usually 12-step-based, but not always, as there are other therapies available. Many who recover choose more than one path, or a combination of paths, depending upon what works best in our own particular circumstances.
Whatever path is chosen, we all go through pretty much the same “stages” of change, and that’s what this chapter will focus upon: What these stages of change are, exactly, what triggers them, how do you tell what “stage” you’re in, and, most importantly, how do you begin?
This is about the process of change, as we have learned it from the millions of people who have successfully overcome not only substance dependency, but many other problems as well. Along with our review of the general change process, we will discuss some specifics that, as substance abusers, effect our basic decision to try and change in the first place.
I will also introduce an outline of the decision process designed to help you arrive at the most effective action method for you, should you indeed decide to make a change in your current behavior. This chapter will focus upon the process, and the psychological barriers you must overcome in deciding to change, and determining the method. The following chapter will address, with a broad brush, the actual programs and methods available, and include a decision matrix you can use to choose between the various options, which will consist of everything from going it completely on-your-own, to various cognitive behavioral programs, to the ubiquitous 12-step method itself.
There will be far-fewer endnotes in this chapter, although there will be a few, mainly because, instead of studies and professional analysis, I will be interweaving my own experiences and those of recovering substance abusers I have met and worked with over the years. Hopefully, you will find something to identify with and relate to in these experiences, because there is very little I and others have done or experienced that is outside the range of behaviors and feelings associated with substance dependent individuals. I must assume that if you are reading this, you are at least considering making a change, and I feel it will be useful to you to discover that you are no different than many of the rest of us, so if we can do it, just like the people in the last chapter, so can you!
Although our focus will be upon substance abuse and dependence, and the expressed goal of most of the programs we will be discussing is abstinence, the model of change has relevance to virtually any change you would like to make in your life, as well as any degree of change you desire. Whether your goal is to quit something entirely, or moderate your behavior, the model remains the same.
A Simple Model of Change
In a 1984 paper, two researchers, J.O. Prochaska and C.C. DiClemente proposed a seven-stage model of change, they called “The Transtheoretical Approach”, to explain the theories of therapy being used in the process of smoking cessation. Their attempt to explain the process of change is not a perfect model, but it will serve as a starting-point for this discussion. Their change model is as follows:
1. Precontemplation: These are individuals who are not considering changing, because they do not as yet see the need.
2. Contemplation: Those who are considering change, they are starting to see the connection between the problems in their lives and the substances they are using.
3. Preparation: The person has decided a change is necessary, is starting to make plans to change, and is deciding how best to make the change.
4. Action: This person is taking the actions necessary to bring about change; these actions vary depending upon the course chosen in step 3.
5. Maintenance: These people are doing what is necessary to maintain the change they have made; again this varies depending upon the program.
6. Relapse: This is an optional stage, and is certainly not a requirement for recovery, but should be considered a normal, but by no means universal, part of the change process.
7. Termination: After a prolonged process of change, thoughts, beliefs, and actions are no longer the same, one is an ex-user, and moves on with their life.
Many researchers consider behavior change a much more complex issue than these seven stages, and others maintain, quite correctly, that many people change without going through all of the stages. For example, many of the substance abusers who recovered on their own in the studies presented in the last chapter completed the change as soon as they decided to stop. In other recoveries, the addict moves from precontemplation to action, seemingly skipping the intermediate steps.
What we can gather from the studies is that change, like substance abuse itself, is a continuum, not really a “staged” or “stepped” process. The key seems to be the degree of motivation the individual has when the process starts, and at best it’s a complex relationship between behavior, the individuals state-of-mind, and his current environment.
Having said all that, I will be using The Transtheoretical model to illustrate the change process for the balance of this discussion, because it offers a way to make some sense out of what is otherwise a very complex and confusing situation. I will discuss each of the stages in detail, with emphasis upon what is necessary to advance from stage-to-stage. Before we get started, I should mention a few additional things about this model: First of all, there is no time limit between the stages. We are all individuals, and we progress at decidedly different rates, depending upon our degree of motivation for change, and many other factors. There are those who just have a “great awakening,” and quit whatever behavior is causing them problems overnight, but that just isn’t true for most of us, it wasn’t true for me, and probably not for you either or you wouldn’t be reading this.
Secondly, is that moving between stages generates the most pain, and requires the most effort. It’s never easy to look within ourselves, and it takes a degree of courage to leave what we perceive as a familiar situation, even though we have come to realize that the “familiar” is also untenable. It’s as though we are being asked to step from the solid steel deck of an ocean liner, which we know is sinking, into a tiny, fragile, lifeboat where we will be bobbing about in the middle of the ocean. The fear of the unknown is real, and we must acknowledge it, but we also must face it, armed with the cognitive decision that the dubious benefits of remaining aboard the ship are far outweighed by the consequences.
The third thing is that change is a continuum, and it’s difficult to differentiate between the stages at times. It’s possible, for instance, for a person to contemplate making a change, decide upon a program, enter it, and fail because the original decision wasn’t quite “final.” There’s nothing wrong with that, that’s part of what this book is about, trying to make sense out of what is by necessity a difficult and complex process.
The next excerpt will begin the process of examining, in detail, the stages, one-by-one, beginning with the Precontemplative stage.
 Excerpted from Chapter 5 of the forthcoming book: Powerless No Longer: How You Can Join the 75% of Addicts Who Recover Without 12-Step Copyright© 2011, Pete Soderman
 Prochaska, J.O., DiClemente, C.C. (1984). The Transtheoretical approach: Crossing traditional boundaries of therapy. Homewood, IL: Dow Jones-Irwin.