May 2024
Addictions are gripping but are not necessarily permanent fixtures. We can change our behaviour. We have choices.
James Prochaska and Carlo Di Clemente, in the 1970s studied the processes of change and came up with what is known as an integrative theory of therapy. This assesses a person’s readiness to act on a new healthier behaviour and provides strategies, or processes of change as well as that person’s decision making capacities. They identified the stages of change in this way:
Precontemplation (an unreadiness for change) where people are not intending to take action to change and don’t see their behaviour as problematic but may be required to attend therapy to please the courts or families or employers. In this case, exercises in self awareness as well as realizing addictive behaviour is risky to health and relationships. Alcoholism and drug taking, gambling, porn addiction, digital media addiction, etc have dramatically negative consequences on good health, work, and maintaining healthy relationships. Addiction makes it hard to maintain trust, respect and open communication with others and the life of addicts revolves around obtaining and using the drug of choice. This may lead to neglecting responsibilities or the needs of significant others and burning themselves out.
Addiction saturates the brain with dopamine and people become dopamine junkies. Dopamine is less about giving us pleasure per se, rather it motivates us to do things we think will bring pleasure. We experience a hike in dopamine in anticipation of doing something as well as when we do the thing itself, which makes us want to continue doing it. As soon as it’s finished, we experience a comedown or dopamine dip. That’s because the brain operates via a self-regulating process called homeostasis, meaning that for every high, there is a low. Interestingly though, if a person can do something else interesting enough for 12 minutes, the addictive craving subsides.
Contemplation (preparing for change) where people are starting to recognize that their behaviour is problematic and are starting to look at the pros and cons of their continued actions. They are also ambivalent about change. On the one hand they may be hoping to change their behaviour, but can also be unwilling to actually take action to make those changes. This is when they are likely to be the most influenced by prompts from others.
Preparation (ready for change): here people are intending to act to make changes in their lives and are starting to take small steps towards this. This period typically lasts about 30 days. In this time they are telling friends and family about what they plan to do, which is great because it’s then that support is critical. They are realizing that the better prepared they are, the more likely they will succeed in life long change.
Action: people have made specific overt modifications in their behaviour. This is when they are most receptive to learning techniques for keeping their commitment to change. They are also realizing that they have to avoid certain people and situations that perpetuate the unhealthy behaviours of their old behaviour (for example, not going to the pub and drinking with friends when trying to stay sober).
Maintenance: people are able to sustain these new behaviours for at least six months and are working to prevent relapse. During this phase, it’s recommended that people spend time with others who engage in healthy activities such as exercise particularly during times of stress. Group meetings of former addicts are helpful for many.
Completion (termination): people are no longer tempted to return to their old behaviours. If relapses occur, the process of change is likely to be easier than previously.
Change is possible. We don’t have to be chained to old behaviours. When we stop doing what we have habitually done, we find ourselves living in the world quite differently. We can obtain pleasure in less destructive ways and we can live life abundantly.
Preparing others for a lifetime of change is what counsellors do best. We help people through the first phases of addictive behaviour, for instance, and give them tools for maintaining and strengthening what they have learned and gained. It’s beautiful work.
