Why Don't They See it as a Problem

The Stages of Change

The Cycle of Change gives us some insight into the stages of change that people go through when they are using drugs and decide they want to change their drug-using behaviour. Researchers, Prochaska and DiClemente developed the stages of change model to describe the process that we often go through when trying to deal with an addiction.

The Cycle of Change gives us some insight as to why a person is at a particular stage of drug use at any given time.

It is very common for someone to make many attempts over time to change their substance use once they are dependent. They will learn something from each experience.

If your loved one is at the 'pre-contemplation' stage of drug use, they will not be ready to take action to reduce or cease their use.

For someone to make changes, they need to see that they have a problem and want to make changes.

It can be more effective to focus less on the drug use and more on setting good boundaries in the home, and having good times together.

The Cycle of Change

There are six stages in their Cycle of Change:

Pre-contemplation stage (person doesn't see use as a problem)

Contemplation stage (person realises that they may have a problem)

Preparation stage (getting ready to make changes)

Decision/Action stage (start to do something to make changes, such as try to control, reduce or cease drug use, or seek help)

Maintenance stage (keep the changes going over time)

Relapse stage (return to use and pre-contemplation or contemplation stages).

A person may move around the cycle, or go from any point, back to relapse

This diagram adapted from Prochaska and DiClemente (1982) which shows the different stages a user typically goes through during their substance using.

1. Pre-Contemplation:

the substance user has no desire to change. They do not see their using as problematic even if others do.

How to help in the pre-contemplation stage: As the user doesn't see there is anything to change, the most appropriate support is limiting the impact and harm of their substance use to them and to everyone else. Also help the user to become aware of the consequences of their use and associated behaviour.

2. Contemplation:

at this stage the substance user starts considering their situation and whether they want to change. They are more aware of their situation and may want to get out of it. However, they are still using at this stage.

How to help in the contemplation stage: support at this stage continues to be about minimising the impact and harm of substance use. In addition support can be given by helping to motivate the user to change, such as exploring with them the choices they have and offering them information to better inform their choice.

3. Preparation:

the user makes a decision to change their substance using behaviour and starts to prepare themselves to do so.

How to help in the preparation stage: appropriate support involves helping and encouraging the user to make the changes they want to make, whilst acknowledging their anxiety about changing.

4. Action:

the user takes practical steps to bring about a change to their substance using behaviour.

How to help in the action stage: appropriate support is about encouraging the positive changes the user is making in their behaviour.

5. Maintenance:

When someone reaches maintenance they have achieved a change in their substance using behaviour. A substance user may have either stopped using drugs or alcohol, or moved to a more controlled, less harmful way of using and is maintaining that change.

How to help in the maintenance stage: supporting the changes that have been made by the user, such as removing triggers to use from the home. It is important also to adjust to changes in family life and in the relationship with the user, which are likely to have resulted from the user’s changed behaviour.

6. Lapse and Relapse:

a lapse is when the user briefly returns to their old substance using behaviour. It is possible for them to go from lapse back to any stage of the cycle. However, a relapse is when the user fully returns to their old substance using behaviour and then needs to go through the Cycle of Change again.

How to help in the lapse and relapse stages: appropriate support to the user is about reducing harm from substance use and helping the user re-engage with treatment, so a lapse doesn’t become relapse.

Note that the suggested ways you might be able to help change with each stage of the Cycle. Therefore, if you offer information to someone about treatment when are at 'pre-contemplation' they are unlikely to use it, however, this would be appropriate when they are at 'decision' and 'action'.

Understanding a substance user’s cycle and the support friends and families can provide is very important. The above is just a brief outline of how to help. There are many more ways that you might be able to help at each stage. Channah suggests that you get help and support with exactly how you can do this.

Of course, drugs and alcohol can cause problems even when a user is not at a stage of dependency. There may be strong feelings of disapproval about their lifestyle, worry about what might happen to them, or concern about their health and well-being. Where illegal drugs are involved, there is also the worry that the user will be caught, or that the wider community will perceive the whole family as ‘criminal’.

It is normal for a person to have mixed feelings about their drug use, to sometimes want to keep using and to sometimes want to give up. It is very common for someone to make many attempts over time to change their substance use once they are dependent.

It is helpful to think that each time a person tries to make changes, they learn something from the experience, and they may be one step closer to sustained recovery. With each try, people may learn to stop using sooner, or to stop before their use gets quite so problematic.

If your loved one is at the 'pre-contemplation' stage of drug use, they will not be ready to take action to reduce or cease their use. They will first have to start to consider that there may be a problem with what they are doing now.

Why they don't think they have a problem