Alcoholism does not occur overnight. It’s a disease that typically develops gradually over time as a person drinks more and more regularly, which causes chemical changes to occur in the brain. It stands to reason that alcohol recovery is also a gradual process with no set timeline.
While recovery from alcoholism can take weeks, months or even years, most people progress through six stages of change as they overcome an alcohol addiction. Understanding these stages, first described in the 1970s by psychologists James Prochaska and Carlo DiClemente, can help you better understand where you or someone you know is at in the recovery journey and what might be standing in the way.
During this stage, people are experiencing the negative impacts of their alcohol addiction, but they have no intention of changing their behavior.
At this stage, defense mechanisms are in high gear, and people are reluctant to even acknowledge they have a problem. They may try to avoid the topic of their drinking or minimize the negative impacts of their alcohol use.
They may also rationalize, or make excuses, for their behavior. For example, they may say they are drinking a lot because they are stressed because of work. Or they could claim that it’s common to drink to relax and say that it’s no big deal.
Alcoholics may even lie and blame others, rather than their addiction, for their problems. They usually resent suggestions that they should seek help or change their behavior.
Others in the precontemplation stage may feel hopeless and helpless about their situation or overwhelmed by the energy required to make a change.
Sometimes people in this stage do show up for addiction treatment, but it’s not by their own volition. Typically, it’s because family, friends, an employer or perhaps a court has forced them into treatment. Unfortunately, treatment is often ineffective at this stage because individuals simply don’t believe they have a drinking problem. It’s unlikely that a person in this stage would even be interested in information about alcoholism.
Because people in the precontemplation stage are resistant to getting any kind of help for their alcohol addiction, it can be helpful for others to raise their awareness of the risks and problems associated with drinking.
Engaging in subtle and sympathetic conversations and getting alcoholics to explore the pros and cons of their own behavior, for example, can help to lay the groundwork for the second stage of recovery.
By the time people reach the contemplation stage, they’ve begun to recognize they have a drinking problem and may want to get help, but they’re often on the fence about it.
Individuals may waffle back and forth between wanting and not wanting to change. Procrastination, or stalling, is common in this stage. They may decide, for instance, that they’re going to seek treatment sometime in the next six months but won’t set a definite date.
It’s also common for people in this stage to attempt to curb drinking on their own or to make plans to cut down on their alcohol intake.
People can remain stuck at this stage for a long time — knowing that they need to make a change but not feeling ready to act on it.
Doing a cost-benefit analysis to weigh the benefits of alcohol use against the cons and costs can sometimes help a person find clarity at this stage.
Contemplation can be an uncomfortable process, and feelings of guilt, shame, hopelessness and desperation are common as people reach this crossroads in their addiction journey.
Once people in the contemplation stage shift away from just thinking about their alcohol problem and begin focusing on a solution, they’ll move toward stage three of recovery.
At the preparation stage, alcoholics have decided to make a change, and they are planning to take meaningful steps toward recovery in the near future.
At this point, people are committed to change and are preparing to take action within the next several days or weeks. Although they are still drinking, they’ve likely begun telling friends and family members about their plan to change their behavior — but they may still feel some ambivalence about their choice.
While it may be tempting to rush into recovery at this point, experts actually caution against this sort of sudden action. In their book “Changing for Good,” psychologists James Prochaska, John Norcross and Carlo DiClemente warn that those who “cut short the preparation stage” are more likely to fail.
A better bet is to use this time to develop a detailed action plan and identify strategies that will help them conquer their alcohol addiction. This might include examining the sort of lifestyle changes they’ll need to make or researching types of treatment and treatment facilities. This is a good time for setting goals — an activity that helps to strengthen their commitment to change.
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In the action stage, people have chosen an approach to sobriety and they’re executing it.
For many alcoholics, the first step of this stage involves going through a detoxification, or alcohol detox, process. Because alcohol withdrawal can be life-threatening, detoxing in a medically managed environment is advisable.
Once detox is complete, people can begin work on the psychological, social and behavioral problems that accompany an alcohol addiction. Many types of addiction treatment programs are available, including long-term residential treatment, short-term residential treatment, outpatient treatment programs, individualized counseling, group therapy and 12-step programs.
For many, the action stage is both physically and mentally taxing — and individuals at this stage face a risk of alcohol relapse. The action stage typically lasts from three to six months and sometimes as long as 18 months, but it does not mark the end of the recovery process.
After completing a program at a treatment center, recovering alcoholics move into the maintenance stage, which generally lasts from six months to several years or longer. At this point, the individual is enjoying the benefits of quitting alcohol while focusing on sustaining the achievements made in the action stage.
During this stage, the behaviors people learned during the action stage become second nature, and they develop new skills to help avoid relapse, such as adopting healthy coping strategies, avoiding triggers and identifying alcohol-free ways of having fun.
Prolonged abstinence along with healthy eating and exercise during this stage can also allow people to begin recovery from liver damage.
The sixth and final stage of recovery is termination. It’s also a somewhat controversial one. Theoretically, at this stage the addiction is conquered completely. The alcoholic is sober and has no cravings for alcohol, and there is no threat of relapse.
Many in the addiction arena, however, argue that alcohol addiction is a chronic disease that never completely goes away. They believe that the risk of relapse always remains and that the disease requires lifelong treatment.
Some people who achieve long-term sobriety continue to display the same impulsive and dysfunctional behaviors that they did when they were drinking. This is sometimes referred to as dry drunk behavior. Because dry drunks have a high risk of relapse, they are not in the termination phase.
While some alcoholics progress through the first five stages of recovery in a linear fashion, many do not. It’s more common for people to move back and forth through the stages of change as they tackle addiction.
Relapse is a common feature of substance use disorders, and it is more the rule than the exception. In fact, 40 to 60 percent of people recovering from substance addiction relapse at some point according to the National Institute on Drug Abuse — but this doesn’t mean their treatment has failed.
Approximately 15 percent of those who relapse regress to the precontemplation stage, and approximately 85 percent return to the contemplation stage before progressing to the preparation and action stages. Most people recovering from addiction will cycle through the stages of change three or four times before completing the cycle without a slip.
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