Breaking Down Stages of Change
Our team breaks down the Stages of Change and how this model can shed light on better understanding an individual’s willingness to accept addiction treatment help.
- 1st Stage of Change – Precontemplation
- 2nd Stage of Change – Contemplation
- 3rd Stage of Change – Preparation
- 4th Stage of Change – Action
- 5th Stage of Change – Maintenance
Getting people to make changes is a process. What we are trained to do in our field is to make changes 1 degree at a time to get all the way to 180. It’s way too easy to say, ‘quit using drugs, start taking your medications, just change, stop it, 180 degrees right now’. But what the Stages of Change model is saying is that there is actually a process for getting people to make changes. Sometimes people can work through that process rather quickly, but sometimes it’s just about planting these little seeds of doubt to have them think, ‘well maybe this isn’t working for me’.
hello everybody welcome back to another episode of finding peaks uh joined today by your favorite host brandon burns chief executive officer for peaks recovery centers and we’ve had a day here at peak so we’re we’re just emotionally regulating at this moment with jason friesma chief clinical officer peaks recovery chief operating officer clint nicholson everybody so welcome back i’m going to carry the internet i’m going to pull these guys out of the rut that is their operational nightmare for the day things happen in addiction treatments so we’ve been navigating that beforehand but we’re going to roll into stages of change we’re going to pipe it up a little bit here okay yeah all right so i’m ready yeah all right i am guys are into it jason’s ready so which means he goes first so jason always goes first go first so i have to be ready you go first yeah say something got it so i was talking to a friend of ours in addiction treatment who works on our behalf and we were talking about um you know a situation in which uh you know individuals as they go through uh using abusing drugs and alcohol she called it high hopes that there’s this moment when you’re using math heroin or otherwise and you think you know what i don’t want to do this anymore i’m going to change my life tomorrow and i’m going to stop and i’m going to get my job and get my life back together and all those sort of things so kind of a silly little set of language there called high hopes and in the stages of change that feels like the pre-contemplative stage of that yeah so i hope i delivered that i was hoping for a little bit of a smile maybe from you on that but you expect clint to smile i’m sorry i lost my
so high hopes is pre-contemplation right and from that clinical lens because it’s superior to my philosophical lens at least in navigating addiction treatment is that accurate is high hopes the pre-contemplative sort of phase of that or would you describe it in another way yeah i mean i think high hopes uh is a really nice way to put the old term denial like hey i’m just i can solve this on my own or things aren’t that bad or um everything’s going to be okay or yeah so it is a hopeful tone i’m not sure i think it feels hopeful very fleetingly would be my guess yeah i think that makes sense the i mean pre-contemplation is i’ve always understood it um this moment of um maybe there’s a problem you know maybe i do a little too much heroin you know but i still got it under control there’s still that feeling of um that that sense of efficacy that you have in act that you’re holding on to that you start to recognize there may be a little bit of disruption but it’s not a level of disruption that really requires any immediate sort of response so that would be the kind of pre-contemplation moment i don’t i mean it may be a situation in which right you’re sitting down you’re having coffee with somebody and you’re like hey maybe i have an issue and you’re talking out loud but it seems more of an internal sort of struggle pre-contemplation right is that is that accurate yeah i mean i don’t think it i think if if anybody’s having a problem with you or your behavior it is definitely not you yeah like that like it’s other people’s issue and they are too sensitive or not understanding me or too conservative or whatever it might be like it’s not me it’s it’s them yeah absolutely yeah it’s definitely still the world’s fault yeah that moment what is a what is a general way somebody comes into you know peaks recovery and they’re pre-contemplative like well my mom said i got to do this or i have to be here what is the first sort of clinical strategy to support the individual to go into the next phase of the stages of change oh great question um so actually literally the strat the clinical strategy for dealing with pre-contemplation is to raise doubt that’s it right like it isn’t necessarily to get into an argument it’s just to simply begin to find little cracks in in the thinking which you would appreciate brandon and begin to like whittle away a little bit like how’s that working for you or you know you’re kind of you’re kind of saying that um
maybe your addiction isn’t out of control but um you also just told me that uh you haven’t paid rent in two months and you might get evicted like that doesn’t quite match so it’s just a little subtle opportunities to kind of point out some discrepancies basically in the thinking yeah developing discrepancy that’s really what you’re doing when uh you know when i so sometimes you know i i’ve been on the phone or discussions with families and they you know their loved ones in treatment and they’re pre-contemplative and the parents sometimes say the same things to us or to the individual pre-treatment that we say to them and then we’re talking to them and um they’re like oh yeah yeah you know you’re right there is an issue here and i got this going on then we share that with families and families turning like i’ve been telling them that for years um as what is it about that as a scenario in that pre-contemplative stage it it’s you know that you guys are familiar with in the clinical setting uh you know for me kind of to expose i guess the direction of my thinking about it is that um the individual in those moments is no longer able to hear the parent and the way even if the information is obvious you know don’t do drugs heroin whatever that somehow we’re able to bring that to light in a new and sort of meaningful way
um as a parent um i do think uh my my my kids god love them because you know hi um i do think they had can uniquely uh ignore a parent voice at times right like you you were once a kid i think clinton was once a kid too and like you you do figure out a way um to be able to just ignore people that have been saying the same things over and over to you and and um and sometimes you just need to hear things from somebody outside your chain of command if you will you need somebody outside um objectively looking in and offering a new perspective and also offering likely just different words um and i can certainly understand parents being frustrated about that um and i’ve heard that same feedback too of like i’ve i’ve been saying this over and over and um and of course they have but you know and your kids have been ignoring you forever and ever too like i mean that’s just kind of true and so i think it there’s just can be so much more weight and power and i i think there’s an objectivity too of like you know i do think we are trained to really fully listen to people and i think our admissions department does a great job of listening um to people and their problems all the way through so when somebody feels all the way heard yeah and then on the back end of that they’re like man i’ve heard all of that and i don’t have any of the baggage i never changed your diaper or anything like i’m just hearing all this for the first time and you have a problem like it does carry a different weight and i think that we approach maybe from the clinical perspective you approach with a bit more curiosity it’s uh and i think that element of curiosity helps people like jason say feel heard and feel to a certain degree validated like being able to recognize that i under i see this is your reality i see that this is these are your beliefs and that this is kind of your perception of the situation and i’m going to offer you something a little different i’m going to just flip that a little bit and i’m curious what it looked when i when i show you it your life this way what does that do and rather than trying to tell somebody that they’re living their life wrong you’re you’re being more curious about sort of why they’re living their life the way they are and what it would look like to live life a little bit differently so there’s a softer delivery and then i think it’s why jason and i have beards because people take people’s beards more seriously yeah so thanks that’s a huge difference yeah yeah sure obviously they take jason very very seriously very seriously yeah the grays help too absolutely it really does yeah and so would it be a you know uh obviously there’s a well obvious to us i think that there’s a skill set right and being curious from a clinical standpoint but would we like to make a recommendation that you know you see your loved ones struggling with you know drugs and alcohol and x y and z behaviors look you know really you know devastating and are frustrating the situation um you know not necessarily to put on like the clinical lens but just to be more curious about that you know what you know okay i hear you that you’re going through those things but just walk me through it you know like what’s going on with you you know that how can i support you this type of language rather than stop doing that and you’re going to ruin your life and you’re going to die and that sort of telling aspect what i really i think that’s a great point what i think about i i mean we’re kind of introducing this topic of stages of change um which is implying that getting people to make changes is actually a process right and i think what we are trained to do in our field um is to change to make changes sometimes one degree at a time to get all the way to 180. you know and and i think it’s way too easy to be like quit using drugs or start taking your beds or whatever it might be just change stop it um 180 right now but like i think the stages of change model is saying you know what well actually there’s actually a process for getting people to make changes and sometimes people can work through that process relatively quickly and sometimes it’s just about um you know just planting these little seeds of doubt in their mind of like maybe this isn’t working for me i mean i’m actually surprised you haven’t broken down the word pre-contemplation i’m not sure that’s actually an english word um until stages of change came about but like it’s literally before you think about something right like that’s what that word means right pre-contemplative would be probably more appropriate yeah yeah yeah i try to keep it really high level you know we only have so much time the deep dives they can get distracting pretty soon we’re wondering whether
or whether or not he was delivered by storks yeah sure so we got the individual in you know maybe the parents got them to go from pre-contemplation to contemplation the next stage of change right they go to a treatment and they say you know what i kind of recognize i got a problem you know stealing from mom whatever the case might be or they get into treatment mom doesn’t know what she’s talking about okay jason you’re a guru you got me i think there’s probably something to look at here now we’re in this contemplative stage um what is what are they contemplating like like reasons for change or should i change at all or cause there seems tones of pre-contemplative in contemplative as a stage of change how do we break those apart okay
so uh i mean i think strictly the contemplative would be when people begin to think maybe i have a problem maybe i don’t pre-contemplatives i you know at least as i understand is i just don’t have a problem and obviously you know there’s some gradations between those thinking but like contemplation is where people land when it’s like okay i’m in treatment now you know maybe i can admit that things aren’t going great for me now and and so our job kind of when people are contemplating maybe have a problem maybe i don’t is again it’s it’s the same method though like you keep asking you maintain your curiosity um because the contemplation is about you know do i have a problem basically that needs some sort of solution or intervention still really people people in contemplation are still not entirely sure they need help of any type and so that’s what the contemplation is about and um you know i think in motivational interviewing your job in contemplation tends to be to tip the scales like to try to get them to weigh their options and then likely the need for change or adjustment will then tip the scales toward you know the next stage of change um is how it plays out but like really what it’s about is just helping somebody explore this and again i think you know if you’re not professionally changed to do that trained to do this like you don’t you it’s hard to be in that ambivalent state you know and i’ve had i mean i’ve had um somebody with a heroin addiction being like i only shoot up twice a day i know people who shoot up six times a day i’m not sure i have a problem right whereas you know if you’re a parent of somebody that’s shooting up here when that’s shocking just a problem of course that’s a problem absurd but but but they’re thinking um uh well if i want to back up even further like i do think people are constantly resolving their cognitive dissonance right like if if
people don’t end up shooting up heroin twice twice a day um overnight it’s been a series of decisions they’ve made and somewhere along the way those decisions have made sense and then the next decision made sense and then the next and then the next and so there’s a lot of cognitive distortions that are in there a lot that have that have been put in place to resolve their cognitive dissonance and so now they get to walk it back and be like it doesn’t just go away automatically a lot of times for a lot of people it’s like no we get to walk this back is this really okay um and it is surprising maybe that to to help people walk that back may be surprising it may seem self-evident to a lot of but it but it’s a caring aspect to just be like no i’ll help you walk this back and like you can actually look at you know some of these lines that you know maybe it isn’t usually um in these ways and i think you know especially like when people are suffering with some alcohol use issues i find that you know people have a lot of ability to be like well i don’t drink that much or i drink less on the weekend or less on the weekdays and i always make it to work like they have all of these stories um that they tell themselves and it’s just our job to kind of help them unpack some of that and then and maybe point out uh some some things that are in disparity with them i talk a lot we do yeah i think i think that was very thorough uh my sort of simplistic way when i’m doing coffee dates with clients i think about when they’re in that contemplative state to couch it into terms of responsibility and sustainability and it becomes pretty difficult to couch like fentanyl use or you know heroin or meth use into any sort of responsible framework and then even if we could get it there you know to say well i have pain you know then we can go right into the sustainability you know side side of it and most of the time there’s no sustainability it gets awkward of course in conversations you’re an addiction treatment sometimes you want to promote abstinence based on the individual you know that you’re speaking with and you know sort of the the you know american narrative is somewhere in there that there’s responsibility and sustainability at least into drugs namely pot and alcohol in that regard um and that way of things so i don’t know if i’m gonna prompt a question from this but that’s i’m listening for because you promoted what he was saying i’m just hopeful that you can promote now what i’m saying you’re saying about responsibility and sustainability as a contemplative what i said
i think if you’re looking at uh responsibility and sustainability through like a contemplation lens you’re basically again trying to draw um dissonance right like well so you you’re telling yourself a narrative right or a story about how you are living a responsible and sustainable life but then you’re also saying that you know maybe when you uh you’re you’re picking up your kids from school while you’re intoxicated right so there’s a there’s a dissonance there right there the narratives aren’t aren’t meeting like you’ve uh like jason was saying when you’re using it’s any sort of substance there’s a process of sort of calibration where you’re constantly recalibrating your reality to make sense of your behavior and when you can pull back a little bit and show somebody their behavior from a more objective standpoint and say well here you’re saying this but then i’m but you’re also but you’re doing this like help walk me through how how those two things make sense then you actually the dissonance starts to be created in the in the disruption of the narrative yeah so and that’s in that kind of is speaking to what you’re talking about but i think that yeah you’re that sustainability and responsibility fall apart pretty quickly when you highlight the dissonance and narrative and again yeah the title of your book that you should write uh from this would be the philosopher’s guide to stages of change because because i do think you you’ve created really with un unknowingly created really um helpful questions to help kind of tip those skills and get people into action by causing them to think really deeply about the sustainability of their lifestyle yeah yeah well and for our viewers out there if you caught it there’s a slight talking down happening about like that is adorable language brandon with responsibilities did you miss you were doing so well did you miss jason’s point on dissonance because there’s a better word you guys would never we can’t because you’re our boss i appreciate it i appreciate it but i caught it so now we move from contemplation to preparation what is preparation because i don’t even have alleged to walk off there in that direction i don’t i don’t even know how to approach that from a questionnaire standpoint yeah this brute force what is preparation i’m ready yeah that’s really i mean that that is a great question it’s just saying that there is um a brief transitional period of time when somebody says okay i have a problem to when they’re fully ready to take whatever actions they need so it’s just it’s this step that maybe clinton can talk to more because it’s a more of a pragmatic thought process of like okay you have a problem there is a solution how do we bridge the gap between your problem and a solution so pragmatically take it away yeah no so that we’ve uh accepted dissonance at that point right you’re like you’re right like the way the way that i’ve calibrated my reality versus the uh the way that i’m living my life are incongruent with one another and there’s an acceptance of that it’s like yes i have basically i have a problem and uh and in preparation there is this moment of and i’m ready to do something about it um what am i going to do and so preparation is figure is answering that question what am i going to do to resolve this issue that i’ve accepted is real and problematic um and you begin the state the steps of i don’t know the probably the first step would be a google search right like treatment like i need help i need support um i’m gonna um figure out the the path that is going to best support me in sort of resolving this um dissonance that i i have created in my life and that i’ve identified and accepted is there that’s really what preparation is yeah i mean i think it right like if you know some people uh may come into peaks in denial that they have a mental health issue right maybe like a bipolar um issue and so they won’t take meds maybe or they you know can’t see how they’re affecting other people’s lives and through these processes we get them to be like okay i i think i’m i may need some help okay well then let’s then now now we’re in preparation here’s what help looks like you’re gonna have to take medications because this is a mental health issue and it requires there’s a there’s an imbalance of chemicals in your brain and we we need to address that um it’s also gonna likely require um some psychotherapy and here’s how you utilize individual therapy and group therapy like it’s just kind of laying out kind of the plan yeah basically it’s a treatment plan and then at the very end of that there’s a commitment to the plan yeah right and so that’s sort of like when preparation becomes action it’s like all right i agree like i commit like i’m putting my stamp on that and now i’m ready to move forward so uh that preparation piece is just getting that plan organized and and every sort of everything laid out and then at the very end there’s the commitment that all right i’m ready i’m going to go do this now is this in the you know you guys have uh obviously brought us to this step this next step in stages of change that is the action item when maybe this is where you know we’ve kind of uh jabbed at holistic models of care but this is really where that holistic approach comes in right that this is your unique action plan versus somebody else who’s in treatment you know alongside you and we have these action plans and then we create them for the individual or support the creation of it with the individual so that they can best succeed because it’s you know their plan is something that’s meaningful for them uh and now we’re kind of maybe we’re creating awareness through like deep dives into you know clinical work um that expose you know ways of informing the action item but it seems like we’re kind of in that sort of behavioral modification or how are we going to get this right and be consistent with it um to succeed yeah i think that’s a good way to put it i think some of those behavioral uh like i look at some of the behavioral things you described as kind of the scaffolding and i think some other things can be going on underneath that some of that deeper um clinical work is part of that action phase um and i in well i think that’s all i had to say about what you said yeah i think action is it’s it’s both of those things it’s those deep dives to figure out motivation why do i do these things and then there’s that exploration of and sort of practice of like how do i do it differently like um and collectively that is the action stage um it there it’s it’s a hefty hefty stage i think that sometimes people um think oh action boom it’s like it lasts 30 days because that’s how long treatment lasts that’s actually no that’s that’s a small part of the action process action is because action requires a level of integration and practice that requires repetition right um so but it’s uh it’s where the work is done that’s that’s where you really you put in the blood sweat and tears and it’s um it’s it’s a heavy lift really it’s the heavy lift part of the stages of change so the the sort of fifth stage of change here is maintenance the kind of like the the difference between pre-contemplation and contemplation um it seems like through the action items through the repetition we’re already engaged with maintenance yeah absolutely so i guess if we can kind of parse those out how are they different than one another i mean that is pretty tricky i mean it’s kind of like maintenance is just less action yeah it’s kind of a lot of the same things you just don’t need to do as much like if you think about it as a weight change uh metaphor like the action phase would be losing weight or gaining it i guess is that if that’s what you need to do and then the maintenance phase would be maintaining the same weight like what do you have to do you still can’t eat maybe how you were eating before right um but you don’t you don’t have to be as aggressively uh trying to lose weight or whatever like you just get to kind of maintain so it doesn’t it isn’t a return to old behavior but it is like i have the the things i need and and um i think a lot of times too maintenance phase to me is when um you both will roll your eyes at this a little bit but like where people have access a lot to their intuition and they can trust it again where they they know what they need to do to keep um on the path that they’re doing whereas a lot of these other things require some outside input a lot of times to help guide and all of that and then once people are in maintenance phase they’re usually well attuned to okay i know i know what i need to do to kind of keep the weight off if you will for sure yeah i think it’s a level of integration into your life and where it’s it’s less about practice and course correction and more about um like you you’ve started to fully integrate like a healthy lifestyle right like working out just becomes part of your day you know a healthy diet just becomes part of uh it’s just how you eat it’s not even a diet anymore right it’s just how you’ve chosen to start eating um yeah it’s it’s a that maintenance is really the moment in which it just becomes your life yeah and it’s it’s not really even a matter uh it’s kind of like trying to parse out though at what point does practice become not practice anymore and you’re actually just doing it so but yeah that’s that’s pretty much on point well stage is a change everybody uh you know what to me it just you know it feels like you know what the stages have changed are are really like you know the the building’s burning down and you know we got to put the fire out and it’s really becomes like the foundation sort of scaffolding for sort of putting it all back together and even though the scaffolding is up all the work that goes into it whether it’s clinical whether it’s medical whether it’s brute force action whether it’s the meetings the rooms uh all of the things that sort of follow suit for getting uh you know the home restored in that regard um seems to start with the stages of change in that regard just kind of as like the brick and mortar of it um and that way of things so i think it’s important to get familiar with this language for how it operates within you know treatment episodes for the individual as they go through it um you know but at the end of the day uh it is more of a scaffolding and that um there’s a ton of work that goes into that so uh at the end of this we’re not trying to simplify recovery journeys they’re quite complex and uh require deep dive but you know the the stages of change in that regard really give us a foundation to work from in that way of things so uh appreciate you guys told you we would get through this together yeah we did it we had a rough day today and so hopefully all smiles now at the end of this absolutely and yeah uh thanks for everybody for opening our phones until we open our phones again 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