A Stage of Change in Recovering from Addiction
BY: T. Franklin Murphy | April 9, 2020
The contemplation stage of change is more than thoughts, it is how we think, expanding our view, dismantling excuses, and new building motivations.
Mark was caught in thought. For the first time in years, he mused over a drug free life. He contemplated family and a fulfilling career. Mark sacrificed these goals for chasing highs and living fast. He snapped at any suggestions that he should change, “Go live your own life,” he scowled. “I’m happy!” Yet here, years later, problems were mounting. Mark wondered if sobriety was even possible. His thoughts were shifting. New possibilities were beginning to formulate. Mark was contemplating change.
Contemplating change is a readiness marker, indicating movement in the Transtheoretical Model’s (TTM) stages of change. According to Carlos DiClemente, change is a process that can be tracked through stages. Each stage has different tasks to accomplish before advancing to the next phase. DiClemente’s model has five stages: precontemplative, contemplative, planning, action, and maintenance.
“Patterns of behavior are not usually created, modified, or stopped in a single moment of time or with a single flick of a switch. There are steps or segments to the process that the TTM labels stages of change” (DiClemente, 2018, p. 25). Krebs, et al. (2018) defined the contemplation stage as “the stage in which patients are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a commitment to take action.
Each stage has different tasks to accomplish before advancing to the next phase.
Change is complex—a process of moving forward and backward, starting and stopping. Theoretical models simply help us grasp the slippery complexity of human behavior. We trudge over an obscure trail, not certain whether we are progressing or wasting time. But now and then grace provides a vista where we catch a glorifying glimpse of our progress. Rigidly defined steps fail to capture the magnitude of a majestic journey of change.
Theoretical models have a functional purpose. They provide a framework. DiClemente’s transtheoretical model provides objective markers to measure progress and provide direction. DiClemente argues that “understanding the process of change helps us ascertain key influences that promote change and increase recruitment, retention, and the successful cessation among substance abusers (2004).
Stages of change aren’t exclusive to DiClemente and TTM. Many researchers recognize that change occurs in stages. Stall and Biernacki (1986) proposed a three-stage sequence for recovery from addiction. The first stage is the summoning of strength and resolve to terminate the ongoing relationship with drugs. Klingemann (1992) also documented that change proceeds through stages. The first stage is developing the courage and motivation to change. Both Stall and Bernacki’s and Klingemann’s first phase mesh with DiClemente’s contemplation stage. This is the beginning, preparing the individual by enhancing motivation, strength and courage, leading to commitment and action.
Readiness scales assess client’s so treatment can be geared towards their needs. Two of the most used scales are The University of Rhode Island Change Assessment (URICA) and Stages of Change Readiness and Treatment Eagerness (SOCRATES).
A few items from the University of Rhode Island Change Assessment Scale:
We begin the arduous journey by contemplating possibility. Action doesn’t spontaneously happen—not usually. DiClemente explains prior to the contemplation stage “there is little consciousness raising or self and environmental reevaluation going on” (2018, p. 115). The addicted person simply follows the current trajectory, engaging in habitual functions that maintain their current lifestyle.
From a casual glance, addictions aren’t rational. They have no functional purpose. Addictions only seem to disrupt and destroy. Sober spouses and parents are amazed by the continued stupidity. “Why throw everything away for a baggie or a bottle?” A common assumption is that life must be too stressful, if the burdens were eased, then certainly, the addicted person would heal. This enchanting view grossly misunderstands the beast, (see Addiction—a Disconnection from Everything Good) and invites enabling rescues from potential consciousness raising experiences.
Addiction is an end point. The addicted person moves through stages that lead to a lifestyle built around the addiction. A contemplative evaluation (not necessarily conscious) weighed risks and benefits, pros and cons, leading to a decisional balance that created the addiction. DiClemente calls the final stage of change a well-maintained pattern of behavior. The change is complete. Whether an addicted person is a working alcoholic or a homeless intravenous drug user, the process has settled into a pattern. The person’s life may be chaotic but there is a pattern to the chaos. No one is carried kicking and screaming into addiction. Although, addiction isn’t consciously chosen; the lifestyle that created the addiction was embraced.
Friends and families often try to force contemplation. This is not simple. For the addicted individual, the evaluative process has been settled—the benefits of addiction won. Uninvited suggestions are met with resistance. The truth is, at least for the short term, remaining addicted is easier than trying to change. Remember, the first ominous action towards recovery is undergoing intense withdrawal. The drive to continue in addiction is intense.
Organisms spontaneously seek balance when disrupted. Since the disrupting consequences of addictions are severe, the challenge to balance this mess is formidable. The obvious action to rebalance is detoxing and moving towards maintained sobriety. However, the more likely response is escape with another high. For the observer the cure is simple—get sober. For the addicted, the cure is easy—drink, snort or shoot.
Defense mechanisms provide additional relief. Mental gyrations that deny, justify, or blame soothe mental disturbances for self-harming acts. The addicted person’s adaptations neutralize any sustained contemplation. Defense mechanisms and environments chosen to minimize friction create a toxic cocktail that prevents penetrating thoughts that life should be different.
Unpleasant emotions in full force stimulate contemplations. Repeated hurt can jolt change by creating a crisis. Yet, when dysfunctional adaptations diffuse the pain, the lessons can’t be learned. “Defenses are mental operations that remove components of unpleasurable affects from conscious awareness.” (Blackman, 2003).
When addictions take hold, problems are resolved in ways that support the addictive behavior. Everything conforms to the addiction, including beliefs, relationships, and personality characteristics. The adaptive organism balances by minimizing problem awareness.
DiClemente warns, “the problem of denial is really nothing more than the conviction of addicted individuals that at the present moment it is not in their best interest to change.” (DiClemente, 2018, p. 65). Motivational events, when not denied, have the potential to encourage questioning of a continued involvement in a pattern. Experience has the power to creates a negative association with the established pattern. (Walters, 2000, p. 94).
According to the traditional twelve-step programs, such as Narcotics Anonymous, “the process of change begins when the subject becomes aware of the compulsive nature of drug use and the … inability to control the behavior” (Fanton, et al. 2013).
Recovery is messy. Surrounding the addiction is a complex and complicated web of problems. Some problems existed prior to the addiction; other problems are consequences. Change is filled with issues, hinderances and conflicts. The clarity of a sober mind is necessary to address these problems; however, the originating movements to clear the mind must take place while still handicapped.
DiClemente explains, “Addicted individuals often find it difficult to consider change long enough to make a good decision.” Many substance abusers reported that they felt inclined to quit, rushed into a plan, convinced they would be successful. A distraught substance abuser, recently discharged from his detox program, lamented, “I thought life would be easier sober.” The beginning movement into recovery only creates a new clarity of mind, newly detoxified we are rudely awakened to reality—problems patiently waited.
There is hope, even in addiction, helpful contemplation is possible. Perhaps, only basic ruminations at first; but these imaginations can evolve into sustained and substantiated thinking. DiClemente believes that, “precontemplators who are dependent on an addictive behavior are clearly capable of directed and self-regulated actions and thoughts.“ He continues, “Goal-directed behavior is not impossible for addicted individuals, and neither should be some consideration of the problems and consequences of the addictive behavior” (2018, pg. 120-121).
Successful contemplations aren’t simply entertaining dreams, but meeting defensive mechanisms head on, dismantling excuses and raising consciousness. Perhaps, the “rock-bottom” of the twelve-step program is equivalent to this acceptance of reality. The comfort of the well-maintained addiction is only disrupted through purposeful and sustained contemplation, challenging the decisional balance. Contemplation stirs motivation that leads to comprehensive plans and appropriate action.
Contemplation must evolve to see the reality of the problem, perceive the risks of continued use, recognize the consequences, and see the potential for change. When contemplations penetrate the defensive protections, the decisional balance shifts in favor of change. Contemplation is a foundational step. The work being done in the mind brings attention to details that has been habitually denied. The major task of contemplation is moving from denial to responsibility. This movement marks a readiness for change.
Picture an old-fashion scale, slightly weighted to one side. The balance is tentative. The new balance favoring change is easily disrupted. The beginning movement has a decisional balance only slightly weighted for change. Success of the recovery is still in jeopardy. Significant lifestyle changes always encounter problems with each disruption throwing another stone to the other side of the scale.
Proper contemplation prepares for these challenges, building a safety net. DiClemente warns, “contemplators who fail to gather enough data about both benefits and negative consequences do not have a complete picture of the pros and cons of the addictive behavior.” He continues, “. . . part of the vulnerability for relapse may lie in failure to create an adequate decisional balance in the Contemplation stage. Firm and well-founded decisions support action better than less-considered ones” (2018, p. 146).
Our decisional balance strengthens through honest evaluations, pondering negative expectancies of continued drug use. We add additional weight, strengthening the decisional balance, by contemplating realistic positive expectancies of the change. Contemplation must find the seeds of discontent and cultivate them, not to magnify guilt but to shift the decisional balance. Only acceptance of the harsh consequences, taking responsibility for actions, can the balance adjust. Contemplations that include hope for a better future create a two-pronged approach that pushes and pulls.
Contemplation, when examined in the context of the stages of change, is more than what it is we are thinking—it’s how we think. Change contemplations represent a maturing of the thought process, embodying Lawrence Kohlberg’s “mature morality” of predicting long-term consequences, preferring future rewards over lesser immediate gratifications, and an expanding ability to predict. “Kohlberg observes that moral conduct may be regulated more by capacity for mature reasoning than by fixed guilt feelings” (Vaillant, 2012, Location 4358). This maturing embraces complexity, not fixed labels and simple remedies. Glenn Walters explains in his fabulous book The Self-Altering Process that, “cognitively complex adults are more flexible, open-minded, and receptive to new information” (2000, pg. 110).
Consciousness raising contemplations doesn’t thrive under a strict taskmaster, defining how and what to think. Parents, doctors and therapist can’t fill the mind with a list of contemplations and expect that the material will transform the soul. Readiness for change flourishes with a Socratic teacher who encourages individual journeys, leading to insights into personal conflicts and desires (Krebs, et al. 2018). Under these conditions the thought process begins to mature and embrace complexity.
As for our old friend Mark, He still has much to accomplish. He has begun an intense and exciting journey. The scales are falling from his eyes. Light of his potential is penetrating his soul. Slowly, Mark can escape the shackles restraining him from change. His new vision will expose vulnerabilities and open him to previously denied miseries. From this crisis of clarity, he can move forward with courage and strength, like millions have done before him. He is now ready to courageously plan his recovery.
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