What are the 5 Stages of Addiction Recovery?
Stages of addiction recovery, also known as the transtheoretical model, is a model that can be used to illustrate the change from active addiction in to long term sobriety. Understanding the 5 stages can help you to navigate your way to sobriety from all substances and addictive behaviours.
What is the transtheoretical model?
The transtheoretical model is a framework for behavioural change first created by James O. Prochaska and Carlo Di Clemente in 1977. It says that there are five stages of change: pre-contemplation, contemplation, preparation, action and maintenance. Each stage is associated with different thoughts, emotions, and behaviours.
The model can be used to create individualised addiction treatment plans, as it takes into account where the person is in their journey of recovery. It can also be used to identify which interventions will be most effective at each stage.
In the first of the stages of addiction recovery, you're actively drinking or using and not considering quitting your substance use. You may be in denial about having a problem or think that your substance abuse isn't affecting your life negatively.
Someone in this stage may have friends or family who have told them that they have a problem, but they are unwilling to admit it. It is often only by understanding the ramifications of substance abuse that someone reaches the contemplation stage.
For example, someone addicted to cocaine may start having chest pains that lead them to question whether continuing to take the drug is the correct course of action.
In the contemplation stage, you realise you have a problem and understand that you are causing yourself harm. You're starting to think about making a change but haven't yet committed to sobriety. You may be considering options for treatment and recovery but aren't sure if you're ready to take the plunge.
During this stage, you will be more likely to listen to what the people around you say about your addiction. You consider taking action, but at some time in the future.
In the preparation stage, you're getting ready to take action and make a change in your life. You may have already decided to quit and be taking steps to overcome your substance abuse problem.
While someone in this stage may be close to getting treatment for their addiction, it is still a fragile step on the journey to recovery. If triggers or difficult emotions arise at this time, the addicted person may go back to the contemplation or pre-contemplation stage.
This stage is often also referred to as a window of opportunity, whereby the person concerned becomes open to change.
In the action stage, you're actively working on quitting your substance use. This stage can be hard work, as you're working to change how you think and feel about basically everything. You will also be seeking to connect with family and healthy friends again. This might take a while, as it can take a while to build trust back up when it has been broken. You may have some amends to make, and this action stage is the perfect time to do them, provided you are sober.
During the action stage, you may also:
If you are heavily addicted to benzodiazepines like Xanax or Diazepam or are a heavy drinker you must detox under the care of a trained professional. This is because these substances can cause death during detox. While it is technically possible to do a home detox if you are addicted to other substances, you have a greater chance of long-term sobriety if you detox at a rehab centre.
Go to rehab
After detoxing, you may consider a rehab programme. At rehab, you will gain the information that you need to live a life of sobriety. This aspect of the action stage is recommended, but it is not essential. If you do not have the time or money to go to rehab, you can choose to put more focus on other parts of your programme.
Participate in a recovery programme
Recovery groups such as 12 Step fellowships and SMART Recovery can help you deal with almost all aspects of recovery. Going to meetings, getting a sponsor/mentor and working a programme of recovery are all great activities to do in the fourth stage of the five stages of addiction recovery.
Everyone who has been through addiction should go to counselling. While recovery support group programmes are great, there are some aspects of recovery, like trauma, that is not usually covered within these groups. Past, unresolved issues need addressing so that you can have a happy life in recovery. Some people only choose to go to counselling during rehab, while others decide to get counselling for much more extended periods.
In the maintenance stage, you're working to keep up your sobriety. You may be continuing to attend support groups or see a therapist. As you shape both your internal and external environment, life continues to get better and better. What you are doing appeals to others, and may encourage others to access sobriety. You are deeply in gratitude for the things that you have achieved.
While this may not be as challenging as the action stage of recovery, it is still essential that you continue to work on recovery, as relapse is possible at any stage. That being said, your risk of relapse decreases significantly after the first couple of years (as long as you have developed a solid recovery programme).
Activities that you may do during the maintenance stage of addiction recovery include:
Assist other people with their sobriety. Helping others achieve sobriety can help you increase your understanding of addiction and helps to keep you sober. You can do this as part of a twelve-step fellowship or in any other way.
Help in your community. Service is not limited to helping people with their sobriety. You can be of service to anyone.
Practice self-care. It can be easy to do too much during the maintenance stage. Beware of this, as burnout can lead to depression and ultimately relapse. Make sure that you regularly take time out to do things for yourself that you enjoy. If you are someone who tends to overwork, schedule regular downtime.
Helping a loved one move through the stages of addiction recovery
Seeing a loved one wallow in the first three stages of addiction recovery can be painful and frustrating. However, there are ways that you may be able to help them along. Remember that people with addiction problems sometimes fall back into previous stages. This is all part of their learning process.
Here are some ways in which you can help them during each stage:
In the pre-contemplation stage, the aim of the game is to help your loved one to see that they have a problem. Now is the time to tell them that you think they have an issue with addiction. You can also ask other people who know them do the same. An intervention can be a good idea at this point.
You might also talk about the damage they have caused themselves and their relationships due to their substance abuse. By doing this you may be able to plant a seed that will help them to see the reality of their situation.
Now that your loved one has admitted that they have a problem, they will probably be more open to listening to your input on their addiction problem. When you feel like the time is right (they are as sober as can be), you can try discussing treatment options. As with all the other stages, don't push them too hard to get help, as this can be counter-productive.
If you are around a loved one who is addicted to substances, now is the time for you to help in earnest. You can help them look for rehab centres or suggest a recovery group that they can go to. Ultimately, they have to want to engage. This is the part that you cannot do for them.
During this stage, your loved one should be fully engaged in recovery. Support them when they need it and ask for it. If they feel disheartened about how their plans are progressing, remind them that long-lasting change takes time. However, if they have reached the action stage, they have already made much progress.
At this point, your loved one has built a good life in recovery. Remind them of how far they have come. If you see them faltering and not doing anything recovery-related, you might encourage them to go to a meeting or talk with their sponsor.
Sometimes the best way to support a loved one during stages 4 and 5 of addiction recovery is to allow them the space to do what is needed. Whilst they focus on this, you can start to focus on yourself. Most people that are close to a person with addiction need to undergo healing themselves. You might want to consider attending a support group or seeking counselling yourself.
What causes relapse into previous stages of addiction recovery?
People in the action and maintenance stages of addiction can unfortunately relapse and slip back into the first three stages of addiction. There are a few things that can cause this:
Stress. While a bit of stress is not bad, and can sometimes even help you work effectively, having high stress for an extended period of time can cause relapse. This is why it is so crucial to manage stress effectively in addiction recovery.
Unresolved relationship problems. If you have any unresolved relationship problems in your life that are causing you grief, you may relapse. This might be bad blood with an old friend, a toxic current relationship, or a problematic relationship with parents. While you should not take on too much at once, tackling relationship problems in your life can help to reinforce your sobriety.
Mental health problems. If you suspect you have mental health problems, it is vital to get diagnosed. Having a mental health issue that has not been treated opens you up to an increased chance of relapse.
Being around triggers. Encountering one of your triggers can cause relapse. This might be seeing an old using buddy, going to a place you used to use in, or even seeing paraphernalia that you used to use with, like tin foil. While it is difficult to eliminate all the triggers from your life, keeping them to an absolute minimum is essential, especially if you are in early recovery.
Using the five stages of the addiction recovery model for other addictions
The transtheoretical model is not just used for substance abuse addictions. You can use it with any other addiction, to help see where you are, and how to get to the next step. For example, you could use it with a gambling addiction or an addiction to sex.
In the pre-contemplation stage of gambling addiction, you may not know you have a problem, or you might be in denial about it. People close to you might have been telling you that you have an issue with the way you gamble, but you ignore them.
You have come to an awareness that your relationship with gambling is not healthy. In this stage, you begin thinking about changing your relationship with gambling sometime in the future.
You're preparing to take action to deal with your gambling addiction. You might speak with friends who have had issues with gambling, or you may check out if there is a Gamblers Anonymous group in your area.
This is where you get to work and start examining why you have this unhealthy relationship with gambling. You may try and reduce the amount of gambling you are engaging in each day. You might decide that the only viable option is for you to stop gambling completely.
This stage is when you may go to a support group for people with gambling problems, and you might see a mental health professional who has experience helping people with problematic gambling.
During this stage, you continue to carry out your recovery programme and abstain from all forms of gambling. You will continue to work through your problems with professionals and support and continue to grow in your recovery.
Using the five stages of addiction recovery
Everyone who has long-term recovery from addiction has been through the above five stages. If you are in one of the earlier stages, rest assured that recovery is possible. Use the tips from this guide to help you move on to the last two stages.
If you have a loved one in active addiction, use this guide to support them on their path towards recovery. Remember that it is ultimately their decision to move through recovery.
- Application of the Transtheoretical Model of Change: Psychometric Properties of Leading Measures in Patients with Co-Occurring Drug Abuse and Severe Mental Illness -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2583262/
- 5 stages of treatment - https://www.ncbi.nlm.nih.gov/books/NBK64208/