Any substance misuse worker worth their salt will use the Cycle of Change in their practice. Although it may make absolutely little sense to you at the moment, it’s easy to understand once explained. Better still, it has been successfully used to support people to change unhealthy or unfavourable habits since its development in 1982.
What is it?
James Prochaska and Carlo Di-Clemente developed The Transtheoretical Model /Wheel of Change in order to help people to make habitual behaviour changes in their lives such as with drug and alcohol use. It recognises that change doesn’t happen instantaneously. It’s not a one step process. In order to successfully change our behaviour, we need to go through certain stages.
Prochaska and Di-Clemente identified these stages. Stages 1-5 can be seen as a wheel or a cycle that people naturally go through several times before the change is seen as permanent, which is where they have maintained their change for a long period of time and have managed any temptation successfully. Why not buy their book, “Changing for Good”.
Principles of the Cycle of Change
- A lapse can occur at any stage of the cycle.
- People can go through it several times before making sustained change.
- The cycle is a learning process and with each lapse or relapse comes a better understanding for all involved of what has worked and what hasn’t and what to focus on next time.
- Lapse or relapse is a natural part of the process and is not to be seen as failure.
- Identify where you think your loved one is at on the cycle and you can use certain techniques to move them onto the next stage of the cycle.
- There are many stages to change and it will not happen overnight.
How does it work?
As a family member who is living with a problematic drug or alcohol user, the Cycle of Change will be invaluable to helping you recognise what stage your loved one is at and what you can do to help. What better person to help move your loved one through the cycle is there than you? You are living with their substance use and although very skilled professionals use this model, there is no harm in you trying it out too.
Firstly, let’s talk about lapses AKA a “slip/blip”. What we mean by this is “a temporary failure”. Note the word “temporary”. In the Vesta Programme I teach how you can communicate with your loved one to influence their behaviour. Let’s be honest, the feelings of disappointment, anger and frustration probably haven’t allowed us to react productively to our loved one’s letting us down AGAIN! I hear you! Your reaction to a lapse is crucial to your loved one not having an excuse to go out and get intoxicated beyond recognition. Respond, don’t react. It is normal for anyone making a change to lapse. Check out the section about me below! What we need to try to do is accept it as a learning curve and prevent it from becoming a relapse, where they revert to their old behaviour.
Pre-Contemplation (not ready to change)
This is where your loved one has absolutely no intention of changing their behaviour. They may not have even considered that their substance use is causing problems or they may be burying their head in the sand and have gone back to square one. They do not intend to ta any action.
Trying to get your loved one in treatment at this stage is pointless as they are not ready to change.
If we were to put a timescale on this, they are probably not going to take action for the next six months.
What can you do to move them to Contemplation?
At this stage, you can acknowledge that your loved one doesn’t seem to be ready to change their behaviour. What you can do is speak to them about their current behaviour. It is important that this is done by them thinking about their own behaviour. Conversations like “I feel worried about your substance use sometimes. That time when you came in and I thought you had overdosed was scary for me to see. Maybe you could think about how to keep a bit safer when you’re using.” Let them know the decision to make any change is theirs.
Contemplation (thinking of changing)
This is the stage where your loved one is thinking about changing their behaviour. There is a lot you can do here. It is important though to avoid the temptation to push too hard
We would say here that your loved one is “ambivalent” about their change which means they are in two minds or 50/50. Tipping the balance here towards change being positive is your goal.
The timescale here is that they may be considering change within the next six months but definitely not considering change within the next month.
What can you do to move them to Preparation?
Discussions about benefits and costs of their drug and alcohol use is ideal at this stage as what we need to do is make sobriety more appealing than substance use. You could ask what they like about their substance use and what they don’t like. Ask them if the things they do like (positive reinforcers) about it are worth the negative consequences.
Preparation (Ready to Change)
This stage can be seen as an experimental stage where they are trying to change. They may have already made some small changes within the last 12 months.
They are planning to act within 1 month.
What can you do to move them to Action?
Encouragement and positivity is the key! More discussion about what they feel life would be like without their substance use. Encourage them to cut down just a little if they can and see what the change is like. Small steps are vital. It is imperative that along with the positivity, your loved one has realistic expectations. If change has happened before, think about what you learnt from it and what you will do this time if they have a lapse. Remind them that a lapse is not a failure but that you can both have a positive attitude towards lapses and move on from it. Encourage openness, honesty, trust and support.
Please note, your loved one is unlikely to achieve their goals by stopping substances on their own. On top of this, for substance such as alcohol or opiates, it can be extremely dangerous to do this without medical support. Look out for help available in your area.
It is worth looking at the options available for treatment and support at this stage.
Action (making changes)
This stage is where the magic happens! Your loved one will start to make changes around their substance use, including the environment. The environment is something that you influence yourself. I teach this on the Vesta Programme. For example, when your loved one is sober, it is time to make them realise that they are missing out on so much when they are using. Reward them with affection, love, their favourite meal. A day out with the children. Obviously, this needs to be within your means but you can make a list of what they like, what you used to enjoy doing together and do them! The idea here is to show your loved one how good and enjoyable life can be without drugs or alcohol.
What can you do to move them into Maintenance?
Usually at this stage, significant changes have been made over the last 3-6 months. Look out for potential relapse triggers such as them wanting to associate with drug or alcohol using peers. They may think they have the confidence to say no to their substances but certain people in certain environments can be triggers. Talk this through with them. Remember though, it is not your responsibility to make choices or police them. You can only influence them and remain realistically positive!
Increasing social recovery capital here is really beneficial. This can include reconnecting with family and old friends and also, through recovery networks such as AA, NA or SMART Recovery. This goes for you too! I have plenty of support for family members supporting their loved ones through recovery.
Maintenance (sticking with the change)
Your loved one has maintained their change for a long period of time and has avoided relapse. They may have lapsed but they have been in tempting situations and have not relapsed into their own behaviours. Their confidence has increased and they have other interests in their lives other than drugs or alcohol which they enjoy.
What can you do to make the change permanent?
They may have completed any specific treatment for their substance use at this stage, but if possible, it is great for people in recovery to continue with follow up support where possible. The same discussions can be had around relapse at this stage and a continuation of support, praise and positivity will now be coming more naturally to you!
If you can, discuss with your loved one about potentially using again and the fact that if they ever choose to, to be aware that they will not require the same dose as what they have used before. A long period of time off drugs or alcohol means their tolerance will be low or non-existent so they will need much less of the same drug or drink.
People can be in this stage for 6months to 5 years before the change is permanent. Some people are here for longer.
This stage of the cycle has been added in at a later date but basically means that your loved one has returned to their old substance using behaviours. This is a likely part of the cycle so try not to be disappointed! People will often relapse several times before they create a permanent change.
It is important at this point to recognise what stage they are at on the cycle and work with them again to encourage them back to action. Remember to take each stage at a time and remind them frequently about how well they have done before and that when they are ready, they can use the brilliant learning they have to do even better next time.
You can review why they relapsed and what the triggers were and plan in the future how they can do even better to prevent themselves from relapsing.
Applying the model to ourselves!
The good thing about the cycle of change is that we can usually apply it to a change we have made ourselves and this is the best way to understand it. For example, I think I’ve been dieting on and off now for 15 years (no joke!). I have been through this cycle many times! So…
– could be the run up to Christmas where I think, “Ah forget it!” and stuff my face with whatever’s going.
– is Boxing Day where I think, “Right, well I’ll continue stuffing my face but I might be up for stopping at some point”. “Then again, I might not”.
– is where I’m standing on the scales on New Year’s Day and I’m like, “Oh man, I need to do something about this. I’m ringing Karen from Slimming World immediately. Tim will have to put the kids to bed so I can go to group next week”.
– It’s Wednesday night and I’ve psyched myself up, I’m here. Let’s face the music and get on those scales. Ooh! I’ve put 9 pounds on in two weeks. Right. That’s ok. I’m here now so I’ll plan my meals, go shopping and stick to my meal plan. I will make sure my environment at home is right and I train myself to say no to temptation. I’ve done it before so I know tiredness and stress are my triggers (other than celebrations) so I’ll make sure I go to bed on time and get 7.5 hours sleep. I’m also going to do my mindfulness app and walk the dog every morning as exercise sets me up for the day.
– Yes! My 2 stone award I’m doing well! I’ve been great for ages.
– Oh dear. I’ve been really tired and craving sugar so I ate 10 biscuits and now I’m worried I won’t stop! Am I going to carry on eating sugar and relapse or am I going to stop???
So, let’s just remember that we have our own experiences with change. This model is fantastic to apply to any change we want to make, as long as we remember that change takes time!
I can help you!
I teach this and more in my Vesta Programme.
My service, The Vesta Approach, supports families affected by a loved one’s substance use. You can access confidential support from me wherever you are in the world. I will help you to get your loved one into treatment and lead a better life. I offer face to face sessions in the Manchester (UK) area. Skype sessions are available and an online group therapeutic programme.
Sign up to my mailing list here to keep up to date with Vesta news and get my free 10 Steps to Family Recovery download.
See you next week,