The Stages of Change before Hitting Rock Bottom
Rock bottom. I hear it, read it, everyday. The phrase has become gospel in many recovery circles.
“She has to hit rock bottom before you can help her.”
“Wait till he hits his bottom.” Or something similar.
But here’s the thing. The whole notion of having to wait till someone hits “rock bottom” in order to change, specifically when it comes to substance use, is an urban myth. A very popular one granted, but still, a myth.
It’s simply not true that someone has to wait to hit “rock bottom” before they can change.
It’s okay if the second you read that sentence your whole body rebelled, tightening in resistance as you struggle to hold onto a strongly held belief. I get it. However in order to change your perspective and the way you act, you will have to go through stages of change, just like your loved one in addiction.
Change has been well researched and documented. It’s rarely a zero to 60 occurrence. It’s a process.
The Stages of Change
The first stage of change, called precontemplation, is actually the place where nothing is happening because there’s no buy-in that a problem exists.
During this phase the most important thing is developing or maintaining a healthy relationship. In terms of counseling this is what is referred to as a therapeutic alliance.
Wanting someone to be in the active phase when they’re in the precontemplation phase will cause a lot of frustration, probably yelling, and little positive moment. See my website for information and videos on how to engage someone in addiction to move them forward.
The second stage is called contemplation. Here an individual acknowledges that there’s a problem, but the hallmark feature is ambivalence. Understanding that a substance user has some positive reasons for using, even if all you see are the negative ones, will build that collaborative alliance that is necessary to move to the next phase.
Preparation. This is probably the most important phase, but often family members when they see the first sign of progress in contemplation want to zip right into action and bypass preparation.
In the preparation phase the ambivalence is normalized, values are explored and the individual although ready to change, may not be confident of the steps he needs to take. Small steps towards change are made such as tapering or sobriety sampling.
Often people engage in harm reduction techniques as part of the change process. Harm reduction is meeting the person where they are (not where you want them to be) but not leaving them there. Engaging and understanding the process of change helps move someone to the next stage.
An inconvenient truth about harm reduction is that people are more likely to come to, and maintain sobriety if they are allowed to work through the stages of change, making a temporary stop in harm reduction land.
Action. In this phase an individual is taking concrete steps and is committed to a new behavior or letting go of one that no longer serves them. This might look like going to AA, seeing a counselor, or a higher level of care such as residential or PHP.
In this phase it’s tempting for a family member to breathe a huge sigh of relief and take the foot off the collaborative gas. But here you want to continue your active support and understanding, and help them into the next stage of change.
Maintenance. In this stage the individual’s main concern is continuing the progress made in the active stage. During this stage life will show up, so it’s important for the individual to develop new coping skills as well as new activities (or restart old favorites) to take the place of substance use.
However as one might expect life doesn’t always follow a text book. A relapse can occur (or “lapse” if it’s very short). Also it’s not uncommon for individuals to move backwards temporarily, say from preparation to contemplation. Engaging the individual with effective communication skills can help move them forward again.
Rock bottom: a different perspective.
Before going into private practice I worked, and eventually ran the clinical program, at a residential treatment center for homeless men.
You might think being homeless, i.e. exhausting all family resources, would be rock bottom. But yet people still relapsed, and yes for some their situation got even worse. What I learned was that as long as an individual is alive things can always get worse.
Everyone finds different reasons to change. What many people don’t realize is that family members are in a unique position to help move those stages of change forward.
Learning effective communication skills, based in part on a therapeutic technique called motivational interviewing, can help people change before things get really bad.
If you would like help moving through the stages of change, or learn how to help someone you love, let’s talk. I would often tell counselors I supervise about different ways to approach and work with their clients.
When they resisted, and they often did, I would remind them, “wait a minute, you want your clients to make major changes, but you aren’t willing to change?” That would get their attention.
If you’re a family member in addiction, consider asking yourself the same question. Addiction is a family disease and there are no spectators. Like it or not, everyone has to change.
If you’re ready to take the next step towards learning how to change, or helping someone you love change, please reach out to me through my Mental Health Match profile.