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Addiction and Change: How Addictions Develop and Addicted People Recover
The stages-of-change model has become widely known as a framework for conceptualizing recovery. Less well known are the processes that drive movement through the stages or how the stages apply to becoming addicted. From Carlo C. DiClemente, codeveloper of the transtheoretical model, this book offers a panoramic view of the entire continuum of addictive behavior change. The author illuminates the common path that individuals travel as they establish and reinforce new patterns of behavior, whether they are developing an addiction or struggling to free themselves from one, and regardless of the specific addictive behavior. The book addresses crucial questions of why, when, and how to intervene to bolster recovery in those already addicted and reach out effectively to people at risk.
318 pages, Paperback
First published April 2, 2003
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138 people want to read
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Displaying 1 - 10 of 10 reviews
March 23, 2008
Nice book by a co-developer of the very important "Transtheoretical Stages of Change". The stages are usually used when someone is changing towards sobriety, but the neat thing is he applies it towards people changing toward addiction as well. A problem is we all appear to be in the precontemplative stage of change for various addictions (like heroin, overeating) as there do not appear clear criteria to separate these folks from those that are not in the stages of change at all. Some highlights:
I. Understanding Addictions in Terms of Change
1. Models of Addiction and Change
- an addiction is 1) a solidly established, problematic pattern of an appetitive behavior 2) with psychological and physiological components that create dependence 3) and therefore the behavior is resistant to change.
- alcohol, nicotine, and heroin produce classic dependence features of tolerance and withdrawal, but cocaine, amphetamines, and hallucinogens don’t
- traditional models for understanding:
(a) Social/Environmental (societal influences, peer pressure, social policies, availability, and family systems)
(b) Genetic/Physiological (placebos working show that social contexts and expectations matter too)
(c) PersonalityIntrapsychic (impulsivity, nonconformity, antisocial behavior, independence, and hyperactivity are traits that tend towards alcohol abuse; AA: alcoholism as deficit in character and will)
(d) Coping/Social Learning (inability to cope with stress can lead to and reinforce addiction as coping repertoire narrows)
(e) Conditioning/Reinforcement (slot machine’s “variable/ratio reinforcement schedule creates a stable, hard to extinguish pattern of behavior”; situational cues like “needle high” of heroin user and reaction to white powder by cocaine addicts)
(f) Compulsive/Excessive Behavior
2. The Process of Human Intentional Behavioral Change
- stages of change:
(a) Precontemplation
(b) Contemplation
(c) Preparation
(d) Action
(e) Maintenance
- processes of change:
(a) Cognitive/Experiential (consciousness raising, emotional arousal, self-reevaluation, environmental reevaluation, & social liberation)
(b) Behavioral (self-liberation, stimulus generalization or control [creating/altering/avoiding cues & stimuli that trigger or encourage addiction], conditioning or counterconditioning [new cues/behaviors or substituting new behaviors to cues], reinforcement management [using positive & negative reinforcement], & helping relationships)
- cognitive/experiential is more important in beginning, behavioral processes are more important further along in change stages
3. The Well-Maintained Addiction: An Ending and a Beginning
- definition: “addiction represents the final Maintenance stage of the process of change, and this explains why it can be so difficult to dislodge”; a regularly occurring pattern of behavior, dependence (under poor self-regulatory self control/out of control, continues despite negative feedback, & has become an integral part of the person’s life and coping).
- behavioral processes: repeated behaviors makes it become a habit and integral to the person; stopping an addiction once generalization has occurred often involves avoiding access to the places, situations, and persons with whom the individual has engaged in the behavior; positive reinforcements and negative reinforcements, including avoiding withdrawal (hair of the dog) and loss of the addictive behavior, add to the costs of giving up the behavior; relationships become a normative group against which to measure oneself
- context of change: addictions can make life crappy, so one copes with addictions, which make life crappier, etc.
- the end-state of the process of addiction becomes the beginning state for the process of recovery
II: The Road to Addiction
4. Exploring the (Pre)contemplation, and Preparation Stages of Becoming Addicted
- adolescents move into contemplation most often and this is assisted by positive experiments/if context of change is right; negative experiments/other context of change can make person stay or go back to precontemplation
- positive decisional balance and experiments move things toward preparation and vice versa
5. Repeated and Regular Use: Preparation to Action
- abusers are in action stage (3-6 months) cuz still have self-regulated (controlled with few negative consequences) and abstaining periods; otherwise, the person is maintaining an addiction and is dependent
- quantity and frequency are important (even infrequent binging)
- negative emotions often trigger relapse; narrowing behavioral and environmental repertoires
- disinhibition & impulsivity help addiction
- people can stay in action phase (abuse) for some time without moving into addiction
III: Quitting an Addiction
6. Precontemplation for Recovery
- not seriously considering change in the foreseeable future (6 months)
- decisional balance against change, self-efficacy not important now (except considering temptation too).
- confrontation/nagging can stop change
- families that allow natural consequences may feel less used and the abuser can learn responsibility
- the individual must see the problem, perceive the risks, experience & digest the consequences, and see the potential for change.
- self honesty is important; marital problems often bring an addict into treatment
- person may be at different stages at the same time for different changes
- task: discovering any consequences & concerns about the behavior that arouse consideration of change
- processes and markers change, don’t let context of change distract focus on addiction
- foot in the door/ door in the face can move a person
7. The Decision to Change
- addicts tend to have low frustration tolerance so thinking about change can be hard
- defensive avoidance can be better than rushing into change
- need to include pros and cons of change (as well as status quo)
- feedback from multiple sources is powerful (when person is sober), but don’t overstate
- ask for client’s personal (as well as social) evaluation of problem, provide frequent summaries of decisional balance,
- speak from a position of “concern”, use natural consequences (don’t let drive when drunk)
- context of change can help or hurt
8. Preparing for Action
- need commitment and consideration of life circumstances
- plan needs to consider person’s weaknesses and strengths, specific date(s)
- elements: a) Changes, b) most important reasons for change, 3) steps for change, 4) how other people can help, e) plan is working if, f) possible roadblocks
- stimulus control (avoiding bars and drinking buddies), counterconditioning (desensitization, relaxation training, distraction, and constructive self-talk); if needs stimulus control than may need more social supports
9. Taking Action to Change an Addiction
- action/maintenance very different from previous stages
- tasks: changing behavior, commitment, revising plan, and managing temptations/slips (vs relapses); recycling is going through the stages again
- abstinence can be short-term or long-term goal
- turn attention to other problems as sobriety solidifies
10. The Long Haul: Well-Maintained Recovery
- abstinance becomes norm (after 3-6 months in action stage) and eventually person exits stages of change
- must: counter threats/temptations, monitor commitment, monitor decisional balance, create protective environment & satisfying lifestyle
- relapsing cognitions: “abstinence violation effect” (any slip is falsely thought to mean relapse) & “apparently irrelevant decisions” (its no big deal to reengage)
- self-efficacy is very important in maintenance and action stages; learn from the relapse
- maintaining change over time and situations
IV. Designing Interventions to Match the Process of Change
11. Prevention: Interfering with the Process of Becoming Addicted
- population-based (primary), populations at risk (secondary), and afflicted populations (tertiary) are kinds of prevention; first are (pre)contemplators, second are planners/actors, and third are actors/maintainers
- goal is to stop them from moving along stages of addiction and hopefully reverse them
12. Designing Interventions for Recovery
- stage of change and treatment tasks:
a. precontemplation (increase concern and hope for change)
b.contemplation (tip the decisional balance)
c. preparation (commitment and effective plan)
d. action (problem solving; support self-efficacy)
e. maintenance (prevent relapse; resolve context problems)
- “right thing at the right time”
- consequences and concern can motivate; need patience and persistence
13. Research on Addiction and Change
- Stages of Change are relevant across cultures
- meds can screw with self-efficacy (both ways), start “action” without a commitment, etc.
I. Understanding Addictions in Terms of Change
1. Models of Addiction and Change
- an addiction is 1) a solidly established, problematic pattern of an appetitive behavior 2) with psychological and physiological components that create dependence 3) and therefore the behavior is resistant to change.
- alcohol, nicotine, and heroin produce classic dependence features of tolerance and withdrawal, but cocaine, amphetamines, and hallucinogens don’t
- traditional models for understanding:
(a) Social/Environmental (societal influences, peer pressure, social policies, availability, and family systems)
(b) Genetic/Physiological (placebos working show that social contexts and expectations matter too)
(c) PersonalityIntrapsychic (impulsivity, nonconformity, antisocial behavior, independence, and hyperactivity are traits that tend towards alcohol abuse; AA: alcoholism as deficit in character and will)
(d) Coping/Social Learning (inability to cope with stress can lead to and reinforce addiction as coping repertoire narrows)
(e) Conditioning/Reinforcement (slot machine’s “variable/ratio reinforcement schedule creates a stable, hard to extinguish pattern of behavior”; situational cues like “needle high” of heroin user and reaction to white powder by cocaine addicts)
(f) Compulsive/Excessive Behavior
2. The Process of Human Intentional Behavioral Change
- stages of change:
(a) Precontemplation
(b) Contemplation
(c) Preparation
(d) Action
(e) Maintenance
- processes of change:
(a) Cognitive/Experiential (consciousness raising, emotional arousal, self-reevaluation, environmental reevaluation, & social liberation)
(b) Behavioral (self-liberation, stimulus generalization or control [creating/altering/avoiding cues & stimuli that trigger or encourage addiction], conditioning or counterconditioning [new cues/behaviors or substituting new behaviors to cues], reinforcement management [using positive & negative reinforcement], & helping relationships)
- cognitive/experiential is more important in beginning, behavioral processes are more important further along in change stages
3. The Well-Maintained Addiction: An Ending and a Beginning
- definition: “addiction represents the final Maintenance stage of the process of change, and this explains why it can be so difficult to dislodge”; a regularly occurring pattern of behavior, dependence (under poor self-regulatory self control/out of control, continues despite negative feedback, & has become an integral part of the person’s life and coping).
- behavioral processes: repeated behaviors makes it become a habit and integral to the person; stopping an addiction once generalization has occurred often involves avoiding access to the places, situations, and persons with whom the individual has engaged in the behavior; positive reinforcements and negative reinforcements, including avoiding withdrawal (hair of the dog) and loss of the addictive behavior, add to the costs of giving up the behavior; relationships become a normative group against which to measure oneself
- context of change: addictions can make life crappy, so one copes with addictions, which make life crappier, etc.
- the end-state of the process of addiction becomes the beginning state for the process of recovery
II: The Road to Addiction
4. Exploring the (Pre)contemplation, and Preparation Stages of Becoming Addicted
- adolescents move into contemplation most often and this is assisted by positive experiments/if context of change is right; negative experiments/other context of change can make person stay or go back to precontemplation
- positive decisional balance and experiments move things toward preparation and vice versa
5. Repeated and Regular Use: Preparation to Action
- abusers are in action stage (3-6 months) cuz still have self-regulated (controlled with few negative consequences) and abstaining periods; otherwise, the person is maintaining an addiction and is dependent
- quantity and frequency are important (even infrequent binging)
- negative emotions often trigger relapse; narrowing behavioral and environmental repertoires
- disinhibition & impulsivity help addiction
- people can stay in action phase (abuse) for some time without moving into addiction
III: Quitting an Addiction
6. Precontemplation for Recovery
- not seriously considering change in the foreseeable future (6 months)
- decisional balance against change, self-efficacy not important now (except considering temptation too).
- confrontation/nagging can stop change
- families that allow natural consequences may feel less used and the abuser can learn responsibility
- the individual must see the problem, perceive the risks, experience & digest the consequences, and see the potential for change.
- self honesty is important; marital problems often bring an addict into treatment
- person may be at different stages at the same time for different changes
- task: discovering any consequences & concerns about the behavior that arouse consideration of change
- processes and markers change, don’t let context of change distract focus on addiction
- foot in the door/ door in the face can move a person
7. The Decision to Change
- addicts tend to have low frustration tolerance so thinking about change can be hard
- defensive avoidance can be better than rushing into change
- need to include pros and cons of change (as well as status quo)
- feedback from multiple sources is powerful (when person is sober), but don’t overstate
- ask for client’s personal (as well as social) evaluation of problem, provide frequent summaries of decisional balance,
- speak from a position of “concern”, use natural consequences (don’t let drive when drunk)
- context of change can help or hurt
8. Preparing for Action
- need commitment and consideration of life circumstances
- plan needs to consider person’s weaknesses and strengths, specific date(s)
- elements: a) Changes, b) most important reasons for change, 3) steps for change, 4) how other people can help, e) plan is working if, f) possible roadblocks
- stimulus control (avoiding bars and drinking buddies), counterconditioning (desensitization, relaxation training, distraction, and constructive self-talk); if needs stimulus control than may need more social supports
9. Taking Action to Change an Addiction
- action/maintenance very different from previous stages
- tasks: changing behavior, commitment, revising plan, and managing temptations/slips (vs relapses); recycling is going through the stages again
- abstinence can be short-term or long-term goal
- turn attention to other problems as sobriety solidifies
10. The Long Haul: Well-Maintained Recovery
- abstinance becomes norm (after 3-6 months in action stage) and eventually person exits stages of change
- must: counter threats/temptations, monitor commitment, monitor decisional balance, create protective environment & satisfying lifestyle
- relapsing cognitions: “abstinence violation effect” (any slip is falsely thought to mean relapse) & “apparently irrelevant decisions” (its no big deal to reengage)
- self-efficacy is very important in maintenance and action stages; learn from the relapse
- maintaining change over time and situations
IV. Designing Interventions to Match the Process of Change
11. Prevention: Interfering with the Process of Becoming Addicted
- population-based (primary), populations at risk (secondary), and afflicted populations (tertiary) are kinds of prevention; first are (pre)contemplators, second are planners/actors, and third are actors/maintainers
- goal is to stop them from moving along stages of addiction and hopefully reverse them
12. Designing Interventions for Recovery
- stage of change and treatment tasks:
a. precontemplation (increase concern and hope for change)
b.contemplation (tip the decisional balance)
c. preparation (commitment and effective plan)
d. action (problem solving; support self-efficacy)
e. maintenance (prevent relapse; resolve context problems)
- “right thing at the right time”
- consequences and concern can motivate; need patience and persistence
13. Research on Addiction and Change
- Stages of Change are relevant across cultures
- meds can screw with self-efficacy (both ways), start “action” without a commitment, etc.
July 7, 2017
A solid overview of the stages of change model. Really does a good job of explaining this model in depth and providing lots of access points for creating shifts in work with clients. I love that any theoretical outlook can easily be overlaid on top of this model. Well written, very clear!
June 26, 2018
While informative, I had a hard time reading and comprehending. The book has a dry, technical feel but is worth reading for the content.
September 4, 2020
Mükemmel bir kitap ama çok ağır ve terimler çok fazla.
September 29, 2014
This is an essential book on addiction. The author proposes a transtheoretical model that incorporates many other addiction models, such as bio-psycho-social, compulsive, social-environmental etc., in order to address addiction in a more holistic way.
This book is focused specifically on the stages of change, as an individual is both entering and attempting to recover from addiction. The stages are the same for each, which is interesting and actually pretty helpful. Each stage is extensively articulated, which makes it easier to grasp what stage a client might be in at a particular time, with the associated interventions that will be more effective at that stage.
I will definitely continue to use this as a resource in the future. As I work with clients who are struggling with addiction, I will be able to continually reference this to determine where individuals are in the stages of change, as well as create specific interventions based on that information.
I would also say that this text focuses particularly on behavioral change, so it is important to use this in conjunction with texts that look at the narrative of the addiction as well.
This book is focused specifically on the stages of change, as an individual is both entering and attempting to recover from addiction. The stages are the same for each, which is interesting and actually pretty helpful. Each stage is extensively articulated, which makes it easier to grasp what stage a client might be in at a particular time, with the associated interventions that will be more effective at that stage.
I will definitely continue to use this as a resource in the future. As I work with clients who are struggling with addiction, I will be able to continually reference this to determine where individuals are in the stages of change, as well as create specific interventions based on that information.
I would also say that this text focuses particularly on behavioral change, so it is important to use this in conjunction with texts that look at the narrative of the addiction as well.
September 19, 2015
Seminal book in the field, this is a must read for all.
August 24, 2015
Great for anyone who doesn't understand addiction or the steps necessary for change (in addiction) to be successfully maintained. I would recommend it.
December 15, 2013
read for grad school. A bit laborious at time but good information.
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April 26, 2019616.86 D5543a 2018
Displaying 1 - 10 of 10 reviews