The 'Cycle of Change' provides a helpful way of understanding how different ways of helping a substance user are appropriate at different times
This diagram adapted from Prochaska and DiClemente (1982) which shows the different stages a user typically goes through during their substance using.
1. Pre-Contemplation:
the substance user has no desire to change. They do not see their using as problematic even if others do.
How to help in the pre-contemplation stage: As the user doesn't see there is anything to change, the most appropriate support is limiting the impact and harm of their substance use to them and to everyone else. Also help the user to become aware of the consequences of their use and associated beahviour.
2. Contemplation:
at this stage the substance user starts considering their situation and whether they want to change. They are more aware of their situation and may want to get out of it. However, they are still using at this stage.
How to help in the contemplation stage: support at this stage continues to be about minimising the impact and harm of substance use. In addition support can be given by helping to motivate the user to change, such as exploring with them the choices they have and offering them information to better inform their choice.
3. Preparation:
the user makes a decision to change their substance using behaviour and starts to prepare themselves to do so.
How to help in the preparation stage: appropriate support involves helping and encouraging the user to make the changes they want to make, whilst acknowledging their anxiety about changing.
4. Action:
the user takes practical steps to bring about a change to their substance using behaviour.
How to help in the action stage: appropriate support is about encouraging the positive changes the user is making in their behaviour.
5. Maintenance:
When someone reaches maintenance they have achieved a change in their substance using behaviour. A substance user may have either stopped using drugs or alcohol, or moved to a more controlled, less harmful way of using and is maintaining that change.
How to help in the maintenance stage: supporting the changes that have been made by the user, such as removing triggers to use from the home. It is important also to adjust to changes in family life and in the relationship with the user, which are likely to have resulted from the user’s changed behaviour.
6. Lapse and Relapse:
a lapse is when the user briefly returns to their old substance using behaviour. It is possible for them to go from lapse back to any stage of the cycle. However, a relapse is when the user fully returns to their old substance using behaviour and then needs to go through the Cycle of Change again.
How to help in the lapse and relapse stages: appropriate support to the user is about reducing harm from substance use and helping the user re-engage with treatment, so a lapse doesn’t become relapse.
Understanding a substance user’s cycle and the support friends and families can provide is very important. The above is just a brief outline of how to help. There are many more ways that you might be able to help at each stage. Adfam suggests that you get help and support with exactly how you can do this.
What to do if you have tried all this and the family member continues to use substances.
It’s usual to feel helpless and frustrated in these situations. First of all, there are many people who have been through the same kind of problems as you, and come out of the other side. Finding help for yourself is the best thing that you can do for your family.
Remember:
A user can only stop if they want to. It may be that a user has become dependent; if this is true, then it will be very difficult for them to stop and they will probably need treatment.
However, with the right help and support a dependent drug/alcohol user can stop using. There is support and treatment available.
The family can be a vital avenue of support for users.
But often, the family cannot do it alone. There are support services dedicated to helping the families of substance users.
Families feel embarrassed, often ashamed, to reveal to others what is happening and their need for help. People who work families know this and won’t judge you; indeed they usually admire the courage that families show in asking for help.
Make sure that you are getting the help, support and advice you need – both to be able to help them and to live your life as best you can. You can try and help a substance using family member, but coming off drugs/alcohol is a very difficult process - ultimately someone will only seek treatment or help if they want it.