Utilizing The Transtheoretical Model or ‘Stages of Change’ to Better Understand Your Addiction

By Concentric Counselor Charles Weiss, LCPC

If the dopaminergic receptors in my brain didn’t make me feel so good when stimulated and weren’t so intertwined as well as interwoven with my serotonin levels and that my GABA receptors didn’t inhibit my nerve transmission leading to my brain activity level to be depressed, I would have never used in the first place.  Do people who suffer from addictions really think like this?  Do they really understand the intricacies on how drugs affect the brain and other physiological aspects of their bodies?  If they had that insight or answers, would they still want to get high, continue rationalizing the reasons in which they use or actually seek out help?

For the change process of the individual to be effective and impactful, it is helpful to better understand how certain drugs affect the brain.  Different drugs when taken affect different aspects of our brain functioning.  For example, alcohol is a depressant, which slows down or depresses our Central Nervous System, which helps reduce anxiety and inhibit relaxation in our body.  It slows down brain activity through binding with GABA receptors to help with minimizing racing thoughts, rapid breathing and quick pulse.  Substances like opioids and stimulants, that target the pleasure center in our brain, which involves the Dopamine neurotransmitter, provide us with that “feel good response” that makes it more difficult for people who are addicted to want to quit.  Let’s not forget the cannabinoid receptors that are naturally occurring neurotransmitters that our brain produces, which Tetrahydrocannabinol (THC) and cannabidiol latches onto.  When this occurs, we often experience a more euphoric feeling and our sensory perceptions are often enhanced, which also increases the level of dopamine that is being produced in our brain.  This list is just to name a few of the more widely used substances individuals can become addicted too. 

Substances have the propensity to be both psychologically and physiologically addicting, meaning either the body and/or our mind needs the drug to avoid potential withdrawal.  Not everyone who tries a substance for the first time will become instantly addicted, however, it can increase their risk of them wanting to try it again because of how it made them feel. 

It is not just the neurochemistry in the brain that makes a person struggling with addiction want to use, but the stages of the change they are in can have an impact and effect into the chronicity of their use.  Prochaska and DiClemente postulated a Transtheoretical Model or what many might know as the “Stages of Changes” that people can experience when it comes to their understanding their addiction and their willingness to cease it. 

This model has 5 stages that an addict can experience, with a sixth called Relapse, which I will discuss later, that indicate the individual’s willingness of wanting to continue or cease the use of the substance(s). This model can also apply to a wide range of other behavioral challenges that individuals are having an arduous time in overcoming, not such substance use, abuse, or dependence. 

Stage 1- Precontemplation

Pre-contemplation is when an individual doesn’t think they have a problem with the drug and/or substance they are using and aren’t willing to change their behavior.  Oftentimes these individuals are in denial that their addiction is a problem, they have not connected the experience of the negative consequences of their addiction or understand the severity of their addiction at this time.  They are currently enjoying and appreciating the positive and pleasurable effected of their addiction, the “high” and positive aspects of the substance they are using due to neurotransmitters that substance targets to cause this affect.  It often isn’t until the individual begins to experience more of the negative aspects of the substance (i.e.: withdrawals, negative consequences from their addiction), will the individual begin to consider they might have a problem and move from pre-contemplation to the contemplation stage.

Stage 2 - Contemplation   

Contemplation stage typically occurs when individuals have the self-talk about the challenges and struggles in wanting to make a behavior change, yet are unable to pull the trigger at this stage and follow through with their thoughts of wanting to change or cut down their use.  Individuals are typically open to listening to advice on how they can change their behavior, to gain a bit more insight into their addiction, understanding the consequences of their addiction, but have not established and/or developed a specific plan on how they would like to change their behavior.  Utilizing a non-judgmental attitude and motivational approaches to encourage change, such as beginning to teach individuals a harm reduction approach, can help propel the individual towards the preparation stage of change.

Stage 3 – Preparation

During this stage of change, individuals are starting to become more committed into wanting to change their behavior and develop plans on how they can begin minimizing the frequency and occurrence in which they are using substances.  Individuals start to gain more insight into the impact and effects the substances have on their level of functioning and the dysregulation of neurochemistry in their brain through collecting and gathering resources either provided to them or investigating these resources for themselves.  They become more cognizant of their triggers and begin learning more effective strategies to minimize the occurrence of them as well as seeking out and developing healthier support systems to aide in their recovery.  Individuals begin to gain more insight into the consequences their addiction is having on their level of functioning.

Stage 4 – Action

As the insight and introspection into their addiction becomes more “front and center”, individuals are able to begin developing plans to implement to aide in their recovery.  Now all the preparation that was exerted and exhibited in the previous stage can be put into motion.  As stressful as this stage can be, it is the best time when interventions such as seeking out a Certified Drug and Alcohol Counselor (CADC), licensed therapist or going to a substance abuse or detox center can be most impactful and continue to move as well as guide the individual towards their recovery.  With a trained and licensed professional, appropriate and realistic goals can be established to be addressed gradually as well as developing more adaptive over maladaptive coping skills that are taught to help move the individual towards the maintenance stage.

Stage 5 & 6 – Maintenance/Relapse

After the strenuous time it takes into in acknowledging, accepting and putting into motion plans that become action, maintenance follows.  This is time in which the individual is able to maintain sobriety for at least 6 months of implementing everything they have learned in treatment and progress on the goals they have developed for themselves.  During this time, individuals might begin to feel complacent or feel like there is some plateau they have reached with their progress, that defaulting into their maladaptive habits might be inevitable.  However, with the continual commitment and support to their recovery, maintenance can be an obtainable long-term goal. 

Part of any recovery can be relapse, although not everyone experiences relapse(s).  When an individual relapses, they don’t necessary default back to Stage 1 - Precontemplation.  If the individual is committed and with ongoing positive support they have created for themselves, they might only fall back a stage to Action and/or potentially Preparation Stage.  It unfortunately might take an individual several relapses before they are fully committed to the change process.  The goal is never to give up and continuing reinforcing yourself of your commitment of wanting to make the behavior change in being able to abstain from one’s substance of choice, such as alcohol or illicit substances.

If you or a loved one is struggling with any addiction, please seek out professional help. There are countless resources available that can help and aide you in your recovery.  Change doesn’t happen overnight, but understanding as well as acknowledging that you might have a problem is the first step in your journey to change and living a healthier and more fulfilling lifestyle.  This Transtheoretical Model or Stages of Change by Prochaska and DiClemente might not be applicable to everyone, but it can be applied broadly to anyone who is willing and wanting make the necessary change to improve their overall lifestyle and to be a better you. 

Finding Balance Between Healthy and Unhealthy Anxiety

By Concentric Counselor Charles Weiss, LPC

There are 10 seconds left of the clock in the state championship game and your team is down by 2 points.  You have the ball and the fate of the team is in your hands on what will you do next, either pass or take the game winning shot.  Sweat is protruding down your face, your heart is beating a thousand miles a hour, your mind is racing with a million and one different case scenarios on what you should do and then your anxiety starts to take over.  However, you realized that your anxiety has allowed you to think quicker on your feet and make better decisions, because you don’t let it control and consume you.  3, 2, 1 and throw up a prayer of shot from about 35 feet away from the basket, knowing that being vulnerable to your anxiety, you can live with the consequences…  Swish!  Game over and you have just won the state championship for your team.

Anxiety… What is it and what does to mean to us when it begins to take control; do we let it control our consciousness or embrace it as an opportunity of growth and self-discovery?  According to dictionary.com, anxiety is defined as “a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.”

When outcomes are uncertain to us in which we want to control, but can’t, anxiety can consume our every decision, thought and feeling.  It leads to panic, fear and vulnerability to the unknown, having us over-analyze every decision we make, postulating those “what if” scenarios.  Anxiety can so debilitating to someone when it’s severe and impacts our day-to-day activities.  Plain and simple, anxiety can suck!  Nobody wants to constantly live a life of panic, fear, worry and dread, wondering all the time, “What if?” When you let anxiety take control and inhibit your ability to just be “you”, it becomes unhealthy.

Is there a way to gain back that control over anxiety before it begins to consume us, crippling our sense of self and being vulnerable to “What if…?”  Anxiety is your body’s indication that something isn’t right, like a built-in warning system indicating that your homeostasis might be out of balance.  When we listen to our body as it talks to us and yes, our body does speak to us, you can begin to prepare and embrace for its impact and figure out how to manage it. Certain symptoms to be mindful of that can alert us when something “isn’t right” and anxiety begins to manifest itself within us, are the following:

·        Racing thoughts

·        Irritability

·        Headaches

·        Nausea/upset stomach

·        Disturbed sleep

·        Muscle tension/tightness

·        Shortness of breath

·        Mind going blank

·        Difficulty concentrating/focusing

·        Fatigued

·        Palpitations

When we are able to listen to these symptoms we experience, then we can to things to keep these symptoms in check before they exacerbate. Taking the time to do a body scan, deep breathing exercises, mindfulness exercises, progressive muscle relaxation techniques can all help keep the heightened level of anxiety at bay.

Can anxiety be healthy?

Anxiety can also be a way to motivate yourself to reach your goals and achievements that you have established.  It can better help prepare yourself to face as well as overcome challenges. When we approach anxiety as a hindrance, it can become unhealthy. You can instead capitalize on it as more of a way to inspire your self-growth and to live a more authentic life.  According to Katharina Star, Ph.D., anxiety is another way people can be more empathetic towards other people’s issues and concerns, and help with how they interact with others. She also stated that individuals who struggle with anxiety are often more cautious thinkers, problem solvers and decision makers because they are often building-in “back-up plans” for when things go wrong. 

Bottom line, anxiety isn’t always bad and unhealthy when individuals experience it, it can be a way people thrive if they are able to recognize it, understand it, and know how to cope and properly channel the healthy aspects of it. People can still live fully authentic lives when experiencing anxiety, it’s when it takes control and we begin to panic, that derails aspects of our lives.

If you are experiencing at least 3 symptoms of anxiety, that have been affecting your ability to function on a day-to-day basis in a variety of settings (i.e.: school, work, home) and those symptoms have been occurring for at least 6 months in which you find it very difficult to control that worry and anxiety, please contact your local mental health provider and schedule an appointment with a professional who can help you learn how to regain control over your anxiety and transform it into a healthier form of anxiety for you.