Understanding the Role of Stages of Change in Addiction Recovery

It can be confusing to watch an addict make choices that seem self-destructive, continuing in patterns of behavior despite major consequences, unwilling to stop and make a significant change in their lives.

It’s even more bewildering to be in the midst of addiction yourself, facing fluctuating layers of willingness to change within yourself.  Some days you might feel ready to tackle whatever’s necessary to experience freedom from the addiction.  But a few hours later, you might find yourself justifying your behavior and explaining to yourself why it isn’t really that bad.  What gives?

The Transtheoretical (Stages of Change) Model

In 1970s and 1980s, James Prochaska and Carlo DiClemente developed the transtheoretical model to explore the mechanisms of change in problematic behavior patterns, including addictions.  Their model seeks to understand resistance to behavior change in many areas, ranging from eating habits to addictions.

The transtheoretical model has formed the foundation of a new approach to targeting addiction.  Often addicts are aware of a need to change and have begun to confront themselves, which can create shame surrounding their behaviors that backfires. Toxic shame creates lack of motivation and hopelessness.  Motivational interviewing, on the other hand, is a type of therapy that focuses on these mechanisms of change to help an addict in recovery understand how to take steps to move forward.

This shift in strategy involves a more personalized approach in treating addiction.  It helps you understand the effects of the addiction on your personal life and identify what needs to change from that perspective within the context of a vision for the future, rather than just making changes out of shame or a belief that you “should” change.

The Six Stages of Change

The transtheoretical model covers five main stages of change: precontemplation, contemplation, preparation, action, and maintenance.  When discussing addiction, we can add a sixth category, relapse, as an optional stage that often characterizes these attempts to change.  These stages are not necessarily linear, meaning you might jump forward and backward in the progression, but the path to recovery involves working through each to get to a place of long-lasting change.

Precontemplation

In this stage, you do not consider your behavior to be a major problem.  Instead, you are more focused on the benefits that come from engaging in the behavior.  Denial is running the show, characterized by shifting blame for problems onto others.

You are likely resistant to any confrontation or advice about changing your behavior in this stage.  Individuals in court-ordered therapy or rehab recommended by a family member or spouse often begin here.  Usually, an experience of consequences to behavior is what propels someone into the next stage.

Examples of Precontemplation Thoughts:

• “It’s not that big of a deal.  I’m not hurting anyone.  I deserve this.”

• “If my spouse/family member/friend just were more open and let me do my own thing, everything would be fine.”

• You may not notice any thoughts about the behavior at all.

Questions to Ask Yourself in Precontemplation:

• What problems am I experiencing in life?  How might my substance use/problematic behavior be contributing to these problems?

• What are the pros and cons of my behaviors?

• If I’m not experiencing consequences currently, what are possible consequences I could face in the future?

• What long-term negative outcomes could come from this behavior?

Contemplation

In the contemplation stage, you likely have begun to think about changing the behavior.  Usually, this is precipitated by some negative experience, such as consequences (like a DUI or STD diagnosis) or cognitive dissonance about differences between your values and your behaviors.  Ambivalence is a hallmark of this stage: you’re feeling strong desires both toward staying in the problematic pattern and changing the behavior.

Learning, gathering information, and understanding the addictive process are important in contemplation.  To move into the next stage, you need to increase your knowledge about addiction and recovery, even if you aren’t willing to make any major changes yet.  The shift into the next stage occurs when you begin to solidify your vision for the future.

Examples of Contemplation Thoughts:

• “I can see that this is a problem, I’m just not sure I want to change.”

• “Why stop something that feels this good?”

• “I’ll change someday, but I’m not ready to right now.”

Questions to Ask Yourself in Contemplation:

• What personal values am I violating by continuing in this behavior?

• How are the consequences I’m facing now affecting me and my future?

• What am I learning about addiction and recovery that fits with my experience?

• What are the costs and benefits of my behavior?

Preparation

The preparation stage involves planning an approach to change.  You are getting ready to implement the strategies you learned about in the contemplation stage, even though you might still not be ready to act on that plan.  Ambivalence is still present, but you are more willing to consider the work required to make a lasting change.

In preparation, you create a specific, structured plan for how you could change.  Even if you still have misgivings, you are beginning to rehearse in your mind the actions it would take to leave behind your pattern of behavior.  In recovery language, this is where you begin to “trust the process” and learn more about steps involved in recovery.

You might test the waters by attending a 12 Step meeting or support group, purchasing recovery-related books and resources, sharing your desire to change with others, seeking accountability, getting into individual or group therapy, or attending an inpatient or intensive treatment center.

Examples of Preparation Thoughts:

• “I can see that it’s possible to change, and I’m beginning to want it, but I’m not sure yet how I’m going to do it.”

• “I need a plan of action if I’m going to make any lasting change.”

Questions to Ask Yourself in Preparation:

• What kind of change would I like to make?  What are the steps to get there?

• What resources or social supports might I need to help me in this change?

• What are the triggers that influence me to use my substance/engage in my behavior?  How might I need to change behavior to limit these?

Action

Real change begins to happen in the action stage, as you put plans created during preparation into action.  This change may be drastic, or it can involve smaller, incremental changes.  While the first three stages are more internal and often don’t affect external behavior, others can see the change in this stage.

The action stage can be a stressful experience, so preparation must be done beforehand to address triggers with new, healthy coping mechanisms.  There is a distinct shift away from using addiction as a method to cope with stress or pain, instead choosing alternate ways of coping.   

Examples of Action Thoughts:

• “I have a plan, and I’m choosing to move forward even when I don’t feel like it.”

• “I am learning new ways to handle my stress.”

Questions to Ask Yourself in Action:

• What is my relapse prevention plan?

• What are alternate ways I can deal with stress?

• What’s working from my plan, and what do I need to adapt or change in my approach?

• What skills do I need to strengthen to maintain sobriety/change?

Maintenance

The maintenance stage is a continuation of the progress achieved in the action stage: regularly implementing your plans over time to create long-term change.  It requires reflecting back on the two previous stages (preparation and action) to clarify what’s working and what isn’t.  Without maintenance, the likelihood of relapse increases significantly.

Stress can arise in this stage, highlighting the importance of the stress management components of the action stage.  Other challenges come when you’ve had a period of abstinence or moderation of behaviors, as this can put your guard down and lead you to reduce supportive behaviors.  You may begin minimizing the consequences, as the high of the early parts of the action stage has worn off.  Maintaining the behaviors committed to in the action stage is essential for staying sober and committed to recovery without relapse.

Examples of Maintenance Thoughts:

• “One day at a time.”

• “My recovery process works if I work it.”

• “I need to keep moving forward in my plan, even if sometimes I don’t feel like it.”

Questions to Ask Yourself in Maintenance:

• What routine behaviors do I need to keep in place to avoid relapse?

• Where could I be opening myself up to the possibility of relapse, and how can I close those doors?

• How can I stay connected to the original vision for the future that motivated me to change this behavior?

Relapse

Slips and relapses do occur in addiction recovery.  Instead of fearing the possibility of relapse and descending into a spiral of shame if it happens, instead recognize relapse as part of the process of recovery.  At the same time, know that this stage is optional – it does not need to be part of the process if action is maintained through commitment to the maintenance stage.

When relapse occurs, it can propel you back into the precontemplation or contemplation stage of your process of change.  To leverage relapse to benefit your recovery process, use the experience to solidify your understanding of what recovery means and your commitment to the process of change you’d like to make.

Examples of Relapse Thoughts:

• “Yes, I did the behavior I’ve been abstaining from, but was it really that bad?”

• “Acting out felt good, and I’m not sure I want to stop again.”

• “I don’t think this is a problem to do this, as long as I don’t do that.”

• “I can’t believe I did that.”

• “I’m back in my addiction, and I feel hopeless about getting out.”

Questions to Ask Yourself in Relapse:

• What do I need to review from the work in the contemplation, preparation, or action stages to remind myself of my vision for the future?

• What recovery-related behaviors do I need to recommit to?

• What wasn’t working about my approach that set me up for a relapse?

• What can I learn for the future as I continue to explore the impact of this behavior on my life?

Sources and More Information on the Transtheoretical Model:

• The Stages of Change Model of Overcoming Addiction - Verywell Mind

• The Stages of Change - Smart Recovery

• Brief Interventions and Brief Therapies for Substance Abuse - SAMHSA

Letting Go of Shame as Essential to Sex Addiction Recovery

Addiction is thorny.  Every addict knows this.  Once it has its claws in you, it can feel impossible to disentangle yourself from it.  The relief that comes from being discovered and/or finally taking the first step to get help is tangible.  Finally, you don’t have to be dealing with this by yourself anymore.  Finally, you have an excuse to make it stop and the motivation or resolve to do so.

But what happens when that motivation fades?  Sure, you’ll be committed early on, attending meetings or support groups, meeting regularly with your therapist, following the program…until it starts to get too hard.  Maybe the motivation you had to quit goes away, in the form of a separation from a spouse or consequences fading in intensity.  Maybe you lose sight of your reasons why for stopping.  Or maybe the pain of the recovery process becomes too great and you have to escape back into something that is self-soothing, comforting, familiar.

So you relapse.  And upon relapse, the shame you’ve been holding at bay with recovery work comes crashing down on you again.  And to avoid or self-medicate away from that shame (because it is impossibly painful) you act out again, continue to go back to your addiction because it’s what feeds you.  Maybe there’s a part of you that desperately wants to get out, that knows the destruction your addiction can cause, that it already has caused.  But then there’s another part of you that says you can’t live without your addiction.  That it’s the only thing keeping you sane, keeping you holding on, keeping you alive.

And so these two sides are at war.  Pulling back and forth, hoping to motivate you on one side, hoping to destroy you on the other.

“There’s another part of you that says you can’t live without your addiction. That it’s the only thing keeping you sane, keeping you holding on, keeping you alive.”

Add in additional shame because you can’t stop, further consequences to your behavior that result from your relapse, and the dopamine and adrenaline rush that feel more intense because you haven’t acted out in a long time, and it’s a recipe for disaster.

In early recovery, I often hear vestiges of the war: wanting so desperately to stop but feeling completely unable to.  The addict part of you convincing that it isn’t all that bad, or that you’re hopeless and without strength to stop.  Or the reality that you really just don’t want to stop because it feels good and offers relief from the pain of daily living.  These admissions are often then followed with shame-based beliefs about yourself: I’m a horrible person, I’m never going to get better, There’s something wrong with me, I’m disgusting, I’m worthless, I’m weak.

What’s the quickest remedy for shame?  Escaping into addiction.

Addiction feeds off of shame. So before we can truly bring addiction to an end, live in recovery and achieve sobriety, the shame needs to be addressed as well.  Otherwise you just end up as a dry drunk.

Here’s where acceptance comes in.

Acceptance?  What?  So I’m just supposed to accept that I’m a lost cause and act out as much as I want to?  The addict part of me really likes that, but the healthy part knows that’s not good.

“Before we can truly bring addiction to an end, live in recovery and achieve sobriety, the shame needs to be addressed.”

True, if you look at acceptance as a free license to do whatever you want, that’s a problem.  That’s typically where addicts get entrenched in self-aggrandizement and self-deception as a way of denying and avoiding the reality of their addiction.

Acceptance is an important step in releasing yourself from shame, but it doesn’t stop there.  We’ll get to the next part in a moment, but for now, let’s start with acceptance.

How does it feel to say to yourself: I’m a horrible, disgusting person who doesn’t deserve good things?  If this is the language you use to describe yourself, no wonder you want to run away into addiction, into something that helps you feel better.

But what if, instead of beating yourself up for your addiction, you sought to make sense of it?

Hear me out: addiction doesn’t develop out of nowhere.  Research has shown that sex addicts often carry stories of sexual, physical, or emotional abuse or neglect.  Neglect, in particular, is hard to see because it’s the absence of something good in our upbringing.  Because we consider our own upbringings to be “normal”, we don’t see it as neglect. 

Even if you don’t have abuse or neglect in your story, the world we live in offers pornography at the ready with the few clicks of a button.  Pornography is designed to draw you in, flood your brain with dopamine and keep you coming back for more.  It’s an industry, after all, and they want to make sure you continue to “buy” their product.  Never mind the fact that regular use affects the neurocircuitry of your brain to make real-life partners less attractive, sexual desire harder to drum up, and creates a pattern of dependency on the images for sexual release.

Examine the origins of your addiction story.  Where did it start?  What was going on in your life at the time?  Were you experiencing pain or distress?  Even what you might consider “normal” pain like a breakup, a parental divorce, teasing at school, feelings of loneliness – what did the sexual behavior help you avoid?

When you pick up a habit that helps you cope, you tend to repeat it in adult life even if it’s not working anymore or its hurting you.  Sexual behavior, beyond just a habit for coping, is self-reinforcing as it alters your brain to offer such a potent rush of feel-good neurochemicals every time you engage in it.   

No wonder you keep going back to something that feels that good.  You learned it worked, and so you’ll repeat it. 

“When you pick up a habit that helps you cope, you tend to repeat it in adult life even if it’s not working anymore or its hurting you.”

And you aren’t the only one who’s had this experience.  There wouldn’t be books written about sex addiction, research articles on the effects of porn on the brain, and 12 Step and support groups about this issue if you were the only one who struggled with it.

Allowing the addictive behavior to “make sense” releases the stigma of shame.  It’s not that you’re a horrible person – you’ve (in essence) conditioned your brain such that you go to sex to give you relief from stress or pain.   

So now what?  Sure, it makes sense, but does that give me free license to do it whenever I want?

Not exactly.  See, realizing that it makes sense and acknowledging that for yourself is freeing.  It means that you’re not alone and that others have found a way out of this, even when they’ve been in the midst of an intense relapse or full-on addiction.

Remember earlier when I said there would be a next step beyond acceptance?  That step is commitment.

Commitment to change.  Commitment to recovery.  Commitment to carry out the life values that are important to you.  Commitment to people.  Commitment to yourself.

Understanding commitment requires a vision for your future.  Shame destroys any hope for the future, so it follows that vision is only established when you accept that you aren’t hopeless or a lost cause, because it makes sense why you would choose addiction. Knowing others have been able to get out of it bolsters that hope.

Why do you want to stop?  What has it cost you to stay addicted?  What have you lost?  What are you at risk of losing if you don’t stop?

Imagine your future if you don’t stop acting out.  What would that look like?  How does that make you feel?  Imagine your current or future marriage or relationships falling apart, your addiction escalating into behaviors that are illegal, your body ravaged by disease, the impacts on the women or men you objectify and treat as sex objects instead of people.  The addict part of yourself might say, “well that’ll never happen to me,” but anecdotal evidence says otherwise. 

Pause: do I need to remind you of the acceptance piece again to release some of the shame of recognizing the impact of your addiction?  It makes sense why you’re acting out, and there is hope for you to change.  Got it? 

Now envision your life without the addiction.  What matters to you?  What feels important to you?  What would you spend your time doing?  This may be morbid but - what do you want to be remembered for after you die?

Once you have that vision in mind, recognize that the vision you have will not happen overnight.  You can’t scale Everest in a day, and you’d almost certainly die without training.  Instead, you need to take each day at a time, each step at a time.  You need to “train” for your recovery journey by doing small, concentrated tasks that move you closer to your goals of sobriety and recovery.

Join a 12 Step group.  Choose to spend one day without acting out.  Start to exercise more or pick up a hobby that you’ve been meaning to do.  Reach out to a friend or 12 Step member when you’re feeling triggered.  Go to a therapy session.  Work on a workbook or book related to treating sex addiction.   

“You need to “train” for your recovery journey by doing small, concentrated tasks that move you closer to your goals of sobriety and recovery.”

And most important, don’t expect that you’ll be able to do this all at once.  Take it one step at a time: but be sure to take that step. 

And when you find yourself beating yourself up for not accomplishing your vision RIGHT NOW, take a step back and remind yourself of acceptance.

“My name is _______.  I am a sex addict.  I am in recovery.  I have ___ days/years/minutes/ hours of sobriety, and I choose to be sober in this moment.  I know the addiction comes from my story, and I know I am not alone.  I will focus on this task to support my recovery today: (going for a walk, reading my 12 Step literature, sending a text to my sponsor, staying focused on my work, installing a filter on my computer).  My addiction does not define me: it is not who I am.”