Stages of Change: A Christian Response to Addiction, part 1
When people think of helping those with addictions, the usual goal is to get the person to achieve and maintain sobriety. For most people with addictions, this means receiving professional treatment. It is therefore natural to try to help people with addictions by motivating them to enter a recovery program. Often, however, this approach is unsuccessful. The person is unwilling or unable to enter treatment and will sometimes lash out in anger at those who suggest they have a problem. When this approach fails, family members and loved ones are unsure what other steps to take. In order to formulate a Christian response to addiction, it is necessary to understand how people change. One of the primary tools for understanding change was developed by James O. Prochaska and his colleagues. Their approach, known as the transtheoretical model, is the result of studying people who have successfully changed various aspects of their own behavior,1 including smoking, overeating, and a host of other problems. They discovered that people inevitably move through six stages on their way to changing: precontemplation, contemplation, preparation, action, maintenance, and termination. In the precontemplation stage, a person is not considering changing, and usually does not even acknowledge that he or she has a problem. In contemplation, people have begun to accept that they have a problem but are not ready to change. They generally expect to change in about six months. People who intend to take action in the immediate future, generally within the next month, are in the preparation stage. They are formulating a plan of action. When they actually start to change, they have moved to the action stage. After achieving the change they want, a period of maintenance is necessary during which people have to work to make the change permanent. The final stage is termination. Those who achieve this stage have reached a point where the danger of reverting to their prior behavior is minimal.2 Prochaska estimates that only 20 percent of people who are seeking to change are ready for the action stage at any given time. This means that the vast majority are not ready to take action. Most are in an earlier stage of change. If they move to the action stage before working through the other stages, their chance of success is limited. This sheds light on why people who try to help others escape addiction are often unsuccessful. They want the addict to stop using and enter treatment. That is, they want them to take action. If they are addressing someone who is in the preparation stage, their encouragement is exactly what is needed. But if they are talking to someone in precontemplation or contemplation, their call for action is premature. It is important, therefore, that people who seek to help addicts engage in actions that will help the addict move through the appropriate stages so they reach a point where the are ready to change. Another insight that the transtheoretical model brings is a recognition of the processes of change. Prochaska’s team isolated nine processes that help people move from one state of change to the next. These are:
- Consciousness raising
- Social liberation
- Emotional arousal
- Environment control
- Helping relationships
In addition, they found that successful changers applied the right processes at the right time. For example, consciousness raising was helpful in moving people from precontemplation through contemplation to planning, but it did little to help people move beyond that point. By contrast, reinforcement management and countering were not beneficial in the initial stages but were important in the action and maintenance stages. Most of the processes are dependent on the person with the addiction. Other people can offer educational opportunities that will allow consciousness raising (i.e., becoming aware of the problem and its effects), but the addict must be willing—at least on some level—to have their consciousness raised. The same holds true for most of the other processes. The one exception is social liberation. According to Prochaska, social liberation includes all those things that society does to make change easier for the individual. Some of these are done through enacted laws, while others are done at the initiative of private individuals and companies. Non-smoking facilities are one example of social liberation for people who are trying to break an addiction to nicotine. Being able to go places without encountering the smell of smoke helps them avoid the physical cravings that can be brought on by that particular stimulus. Another example includes the healthier dishes that many restaurants now offer on their menus. These are a form of social liberation for people who are trying to change their eating habits. Because social liberation is the one process that is external to the addict, it is an ideal practice for those who are seeking to help people recovery from addictions. And social liberation is a processes that helps people move through the early stages of change. It is most effective in the precontemplation, contemplation, and preparation stages. In other words, it helps people with addictions move through the stages that prepare them for taking action. As mentioned above, these are the stages where most addicts are. The fact that this is where addicts need help combined with the fact that this is a process dependent on those who are trying to help them makes it an excellent area of response for people trying to help those with addictions. 1 They made their work available to a popular audience in James O. Prochaska, John Norcross, and Carlo DiClemente, Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward (New York, NY: William Morrow, 1994). 2 For some addictions, such as alcoholism, it is unclear whether someone can ever reach termination. For this reason, most alcoholics refer to themselves as being in recovery instead of saying that they have recovered. They foresee themselves remaining in the maintenance stage for the rest of their lives.