Changeology For Addictions

By John C. Norcross, PhD, ABPP

Changeology For Addictions

Changeology For Addictions, changing addictive behavior is a journey. Trite as that may sound, those who have traveled the road to sobriety know it to be painfully true. Obtaining sobriety typically takes multiple attempts over years.

For 30 years now, colleagues and I have tried to understand the structure, the DNA if you will, of behavior change. We have discovered that the journey of change is amazingly similar across diverse addictions. People progress through identical stages for each of the fifty-plus problems now researched. And they use the same core catalysts within each stage to speed their progress. Of course, the techniques within those change catalysts will differ depending on the particular goals—smokers are reducing cigarette consumption, problem drinkers dealing with alcohol cravings. But the step-by-step journey to the goal is virtually the same.

In practically every lecture or talk I deliver, someone immediately raises the challenge: But isn’t there a big difference between changing a bad habit, such as quitting smoking, and trying to become sober? I was convinced that modifying a long-established addiction was fundamentally different from treating other problems.

I was wrong.

Here’s how the science of behavior change—Changeology—works for virtually all addictions and here’s how it can help you get unstuck.

The journey begins with precontemplation or, as most people in recovery call it, denial.

Precontemplation is the stage at which there is no intention to change the addiction in the foreseeable future. Most individuals in this stage are unaware or under aware of their problems. Families, friends, neighbors, or employers, however, are often well aware that the pre-contemplators have problems. When precontemplators present for treatment, they often do so because of pressure from others. Usually they feel coerced into changing by spouses who threaten to leave, employers who threaten to  ire them, parents who threaten to disown them, or courts who threaten to punish them. Resistance to recognizing the addiction is the hallmark of precontemplation.

Contemplation is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it, but they have not yet made a commitment to take action. The change catalysts here are to acknowledge the addiction, get ready for change, and psych yourself up. This is where you specify realistic goals and define the new you. Start counting and measuring the behavior you will modify. Think about the
consequences of your problem and imagine a new life without it. Harness the awareness and emotions that will propel you into action.

Preparation combines intention and baby steps toward sobriety. This stage is all about prepping. Build your commitment and then make your goal public—tell people about it. Pick your start day and identify people who will comprise your support team. Take a few small initial steps…and prepare for liftoff.

At some point you jump from preparing to perspiring—the work of not using the substance. Action is the stage in which individuals modify their behavior, experiences, and/or environment in order to overcome their addictions. Action involves the most overt changes and requires considerable commitment of time and energy. In this stage it’s essential to develop healthy alternatives to problem behaviors and build new ones. Reward yourself for a job well done. Cultivate your environment and support team to keep moving forward.

Getting to sobriety is wonderful, but keeping you there entails persevering through slips and persisting for years. Maintenance is the stage in which people work to prevent relapse and consolidate the gains attained during action. For addictive behaviors, this stage extends from six months to a lifetime. All of us are vulnerable to lapses, so we can expect to fumble on occasion. The trick is to manage slips and prevent them from snowballing into a reversion to the old addiction. Learn to say “No” and develop a plan for recovering after a slip. Avoid high-risk triggers, resist the urge, and keep a positive outlook. Slips need not become falls.

It would be delightful if we humans could move through these stages of change in linear fashion only once; however, the cruel reality of addictions is that we move through these stages several times. Behavior change is rarely simple and linear. Rather, most of us move through the stages in a spiral pattern.

People progress from contemplation to preparation to action to maintenance, but most individuals will relapse. During relapse, individuals regress to an earlier stage. Some relapsers feel like failures—embarrassed, ashamed, and guilty. These individuals become demoralized and resist thinking about their addictions. As a result, they return to the precontemplation stage and can remain there for various periods of time. Approximately 15% of relapsers in our research regressed to pre contemplation. Fortunately, most relapsers—85% or so— move back to the contemplation stage and eventually back into action. That’s why it is not unusual for genuine sobriety to take years of tears and rehabs.

At this point, most people listening or reading will ask something along the lines of “Well, it’s helpful that you have outlined the cycle of change and discovered the structure. But how will that help me exactly?” In three concrete ways:

1. Your stage of change predicts the probability of your reaching sobriety

Our recent analysis of 39 published studies, involving 8,238 patients, demonstrated that the further along you are in the stages, the more likely you are to succeed. Moving an addict, for example, from contemplation to action doubles that person’s chances of sobriety. How far you advance in the stages will foretell your success or failure.

2. Your stage tells you what is most likely to work.

Knowing your stage is vitally important to your success. Once you can identify it, you can complete the tasks and exercises appropriate to that stage. We call this stage matching. For instance, if you’re already moving toward action, you won’t need the work of the contemplation and preparations stages—you’ll have already done that work. In fact, using
those change catalysts can actually send you reeling backwards. What works for someone getting psyched to change will not work for someone trying to persist in their sobriety. The science of change tells you what is most useful for that particular stage; what works for a person thinking about change certainly differs from someone trying to remain changed.

3. The stages guide you on the messy, infuriating journey to sobriety
Instead of blindly walking the path, let the stages give meaning and structure to your recovery. Trial and error is lengthy and costly; learning from the tens of thousands of research participants and clinic patients in our studies is far more efficient and effective.

It would be unfair for my colleagues and me to claim credit for discovering the stages. In our earliest studies done decades ago, when we tried to determine what methods were used to successfully change, our research participants kept saying “it depends.” “On what?” We wanted to know. Well, it depended on where they were in the change continuum. At different points they employed different strategies, some of which were only useful during certain stages. It sounds so obvious in retrospect, but researchers and psychologists before us didn’t know this. Now, however, we have the knowledge and the experience to back up what we know is true of successful change: it follows a well-defined, predictable pattern. And thousands of people we’ve counseled have benefitted from this knowledge.

One thing is for sure: change presents a challenge, but it needn’t prove impossible. Let Changeology guide you through the precontemplation, contemplation, preparation, action, and maintenance steps to a lifetime of sobriety. The science can show you a more efficient and effective path through the torturous journey of addictions.

In the words of Teddy Roosevelt:
“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly; …. who knows the great enthusiasm, the great devotion, who spends himself in a worthy cause, who at the best knows in the end the triumph of high achievement and who at the worst, if he fails, at least he fails while daring greatly.”

John C. Norcross, PhD, ABPP, is Distinguished Professor of Psychology at the University of Scranton, Adjunct Professor of Psychiatry at SUNY Upstate Medical University, a board-certified clinical psychologist in part time practice, and the author, most recently, of Changeology: 5 Steps to Realize Your Goals and Resolutions.