How the six steps of behavior change play a role in the road to recovery

SALT LAKE CITY — For many who struggle with addiction, replacing negative habits with positive ones is the first step towards positive behavior change.

By using the Transtheoretical model developed by James Prochaska and Carlo DiClement in the late 1970s, Dr. Matt Woolley, a licensed Clinical psychologist at the University of Utah, is gaining a better understanding of addiction and how relapse can affect change.

He spoke about their relationship in the latest episode of the Project Recovery podcast.

The first stage of change — Precontemplation

While in the early stages of addiction, many are unaware that they have a problem according to Dr. Woolley.

“Precontemplation is a stage where you are deep in the behavior that is unhealthy,” he described. “You have really no insight that this is a problem.”

Whether it’s an eating addiction or an addiction to alcohol, the concept of being addicting to anything is typically unknown. This, in turn, causes many of those whom suffer from a substance abuse disorder to dive deeper into their addiction. Until they are forced to look at their own actions.

“It’s probably not quite rock bottom yet but something will happen,” Dr. Woolley said. “If it’s a person who’s overweight because they have an eating addiction, they go in for a check-up and the doctor says you’re not healthy.”

It’s not until the consequences begin to build up in your addiction when you can shift into the next phase of the cycle — contemplation.

Contemplation

In stage two of the cycle, many begin to recognize that their behavior may be problematic. Dr. Woolley describes this period as the period of change where thoughtful and practical consideration of their behavior takes place

“There’s no intention yet to change,” Dr. Woolley said. “Nobody in contemplation is thinking about changing and going to rehab but they’re starting to have consequences.”

An addict’s life is heavily affected by their addiction at this point and they are beginning to see how their actions are conducive to negative behavior. And yet, they still are not in a position to actually make a change. “They’re talking in a way that sounds like they’re making changes but they’re not really,” Dr. Woolley explained.

He also notes that this period is right before someone hits their rock bottom and is forced to make a change.

The steps of preparation

Preparation, the third stage of behavior change, is often met with said rock bottom. It could be a health scare, an accident, or even an ultimatum from friends and families. They have finally realized that it’s time to make a change.

“In preparation, you still haven’t done anything yet but now a person might be reaching out, asking for help, looking for what is available to them,” Dr. Woolley said. “Ultimately, they have to be committed in that stage. It’s not until the person really internalizes [that change] that they’re really in preparation.”

Dr. Woolley also explains that this stage should be as brief as possible in order for positive behavior change to take effect.

Beginning to take action

Once the person suffering from substance abuse has moved on from preparation, they are ready to start moving towards recovery. They begin to attend rehab or hire a nutritionist — they begin to take action. 

“Action is some sort of active modification of your negative behavior,” says Dr. Woolley. “It’s when we’re learning new behaviors.”

When a negative behavior is replaced by a new and positive behavior, this is when real change is starting to take place according to Dr. Woolley.

Why maintenance is so important

Once the new positive behaviors override the negative behaviors, that’s when an addict is in the maintenance phase. In this phase, someone is approaches decision-making in a healthy manner and with a positive mindset. They are no longer active in their addiction and their actions are only to the benefit of their lives says Dr. Woolley.

“You’re continuing actions that keep your behavior successful,” Dr. Woolley said. “And you’re doing it over a period of time.”

But for many, this is where they are drawn back into their addictions after years of work.

“A lot of times people are in maintenance for a short period of time or a long period of time,” Dr. Woolley says. “They’re doing great and then something happens — they relapse.”

How relapse leads to behavior change

Most of us have to go through a cycle multiple times according to Dr. Woolley but he insists that it should always be a hopeful process. 

“These stages are hopeful. They’re not one dimensional. It’s actually an upward spiral,” Dr. Woolley described. “Most of us have to go through a cycle multiple times. So, it’s hopeful.”

Once relapse occurs, the cycle begins all over again but it should never be a negative as we are constantly learning and growing Dr. Woolley says. “Think about a spiral that moves upwards that gets tighter as it goes [up]. People tend to spend less and less time in those relapse moments. They learn something from that so that the next time they get all the way back to maintenance, [they’re] a better, stronger person.”

In the world of addiction, relapse is looked at very negatively, but Dr. Woolley hopes that can change as we become more educated on behavior change and addiction.

“That’s my hope for people. Instead of looking at relapse as a failure … relapse is part of a cycle that moves us upward,” Dr. Woolley explained. “It’s important for people to understand if you can identify where you’re at in the cycle, get some help to keep moving through and try and stay in that maintenance phase.”

Listen to the podcast to learn more about the behavior change cycle

For more information on addiction or if you or someone you know is struggling, you can find more information on Facebook, KSL TV, or from Use Only as Directed. To hear more from Casey Scott and Dr. Matt Woolley, you can listen below or subscribe to the ‘Project Recovery’ podcast on Apple Podcasts or wherever you get major podcasts.