The 5th Stage of Change - Look Ma, No Hands!
5th Stage of Change
Written by and for people with Lived
Experience - Port Alberni Community Action Team - Families Helping Families
Today’s Learning Moment – 07 19 21 Issue: The 5th
Stage or Change; Maintenance or “Look Ma, no hands!”
In the last article on the 4th
stage of change, I ended with success is not a place, it is the small steps we
take in the journey. I have also
repeated that the stages of change are not linear processes but rather circular
processes. They are sort of like a
pinwheel spinning in the direction of the wind, back and forth, one way then
the other, at least during the early stages for sure. The 5th stage, maintenance, is a
little more stable.
A person is considered to be in the maintenance stage of change after achieving initial goals. That might be having completed an inpatient or outpatient program. Having learned some strategies and developed some skills and comfort in using those strategies. The main objectives in this stage are to keep doing what works, be curious about what else works, and continuing to move forward in whatever direction seems to fit best and is desired the most. It is certainly a time for increased hope and a rebuilding of trust in relationships. It is a time to celebrate all of the steps that have been taken so far and all of the little and not so little victories that have been achieved so far.
We have explored all of the work that it takes to get here so I am not going to repeat anything from the last 4 steps. Except maybe the most important:
Judgment is the hope killer. Never forget that. We as supports know exactly what it feels like to be judged, especially with the stigma that unfortunately exists with substance use disorder. We as people who have used drugs, definitely know what it’s like to be judged. All it really gets any of us is an all-expense due trip to shame and guilt resort where people wallow and are consumed in the mire of muck that is judgement. Remember Support, Compassion, not punishment. So on that fun note, let’s get into “so what do we do then?”
This:
Help your loved one identify and sample drug-free sources of pleasure.
·
This is a continuation of what your loved one has been doing in
the action stage. They have developed
some strategies that are transforming or have transformed into healthy
habits. There is always more. Some people get stuck in just a couple of
helpful strategies which can later become boring and monotonous. I have always helped people develop a “menu”
of options. Some were quick fixes aka
short term and others were more drawn out or long term strategies that required
ongoing attention. Exercise is a great
example of both a short term and long term strategy. Being stuck in just one thing can be a
potential risk factor. Here’s a quick
story to illustrate what happens:
One of my clients was seeking some support after successfully stopping his use
of cocaine and alcohol. He came in to
see me weekly. I asked him what he was
doing to help him stay abstinent. He
stated that he loved ball hockey as a kid and joined a league now. He was really enjoying it. He stated that he had experienced little to
no thought of using and no cravings. He
came in week after week and told me about his ball hockey experiences and
identified that as his mainstay strategy.
I would ask him what are you doing to stay healthy and he would tell me
ball hockey.
Then one week he came in and stated he was struggling and had slipped. We started to explore what happened and we
arrived at the fact that he was bored of ball hockey and had stopped
going. We then began exploring other
activities he could do and came up with some short term and long term
strategies that he had forgotten about while he was initially working on
getting abstinent. Once he started
mixing things up a bit, he was back to feeling confident with little to no
thoughts or cravings to use.
Support lifestyle changes.
·
This is really just a continuation of the last point. All of the strategies and activities,
thoughts and attitudes that are developing will help form meaningful lifestyle
changes. Remember, this is at your loved
one's pace and not at yours. Given that,
you may have to set some boundaries re: progress based on your needs. For instance, “I know you want to be more
independent, I think I need that
too. We should start looking for a place
for you to live soon”.
Also, remember that your lifestyle will experience some change as well and this
change can feel uncomfortable and unfamiliar at times. While you are keeping one eye on your loved
one, keep the other on yourself and all of your own coping and lifestyle
habits. Make sure you are as safe and
healthy as you want your loved one to be.
Affirm your loved one’s resolve and self-efficacy.
·
There is nothing like validation to affirm motivation,
determination, tenacity, and to affirm how capable a person is. And validation helps to humanize your
experience along with your loved one’s experience. Even if things go sideways, it is important to
always come back to successes, victories, achievements and to build on those
rather than focusing on the negative. At
this point, your loved one has demonstrated plenty of skill-building and
capacity to do what needs doing. And
there will be times when you or your loved one will feel less than capable or
successful. Again this is the time to
rebuild, not to tear down.
One huge reward for both of you at this point is the trust that is slowly
rebuilding. A very effective way of
validating trust is to identify and ‘catch’ your loved one doing something
healthy and comment on how that is rebuilding your trust: “Wow, you have a job
interview, that’s really encouraging”; “I’m glad to see you have been going to
your appointments”; “I really notice that you smile so much more these days.
That warms my heart, I know this hasn’t been easy but I’m relieved that you are
working it”….. You get the idea. There
is so much motivation, compassion and trust being built in any statement that
validates your loved one and makes it easier and more important to continue
with what is healthy for them.
Help your loved one to practice and use new coping strategies to
avoid a return to use.
·
Again a continuation of the last points. I will add here that at the maintenance
stage, your loved one should be practising and choosing healthy habits and
strategies on their own. Your help
should be more along the lines of encouragement and listening. It doesn’t hurt to make suggestions but as I
have said in the past, always ask permission before giving advice or
suggestions.
Let your loved one know that you are there to listen and support.
·
Always have very clear boundaries with this of course. Remember that you need to care for yourself
first and foremost. Doing so will make
it easier for you to be there for your loved one.
Develop a "fire escape" plan in case of slips and
relapses.
·
So this brings us to the last stage of change which I will talk
about in more detail in the next article.
For now, I will say that offering to sit down and both of you coming up
with a tangible relapse prevention plan should be easy to do at this
point. However, in saying this, there
should have been a plan put in place back in the action stage. If so, then review it and adjust the plan as
needed. Identify any new triggers or any
rough spots along the way. If your loved
one feels more comfortable with another supportive friend or counsellor in
reviewing their plan, that’s okay too.
Be flexible and willing to support what works best for your loved one.
Be curious on occasion about your loved one’s long-term goals.
·
Remember that you are not responsible to decide these for
them. Being curious is just a way to
open conversation about wants, needs, desires, realities and downfalls, you
know, normal stuff.
As I mentioned, I will be writing about the final stage of change
which really in all respects is something that occurs all throughout the cycle
of change. Regardless, always be
prepared for slips, falls, setbacks and some disappointment. Remember that these are not failures, they
are rather, opportunities to learn more for stronger growth, not just for your
loved one but for you as well.
All our
past articles can be found here:
https://ptalbcat.blogspot.com/
The link
to this specific article is: https://ptalbcat.blogspot.com/2021/07/the-5th-stage-of-change-look-ma-no-hands.html SHARING is best done
by copying and pasting this link everywhere you want:
Author: Ben Goerner— Ben is a retired counsellor. He advocates for people with
substance illness or mental illness.
Families Helping Families is an initiative of the Port Alberni Community Action
Team. We send out “Learning Moment” articles regularly to help folks understand
substance illness. Knowledge is vital in understanding the illness of our
family members. You may copy, distribute or share our articles as long as you
retain the attribution. You can be added to our distribution list by dropping
us a note at - albernihelp@gmail.com
Resources:
Miller, W. R., & Rollnick, S. (1991). Motivational interviewing:
Preparing people to change addictive behaviour. The Guilford Press.
Prochaska, J. O., & Norcross, J. C. (2001). Stages of change. Psychotherapy: Theory, Research, Practice, Training, 38(4), 443–448. https://doi.org/10.1037/0033-3204.38.4.443
Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 35.) [Table], Figure 2-2: Appropriate Motivational Strategies for Each Stage of Change. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64963/table/A62587/
https://addictionrehabtoronto.ca/smart-goals-for-substance-abuse-recovery/
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