How to help a loved one with a drug or alcohol problem: stages of change

Frustrating is an understatement to describe how it feels to watch your loved one destroy themselves and be powerless to do anything about it.

It can be confusing and hard to understand why they would continue to drink or take drugs when it's causing them and the people around them so much harm.

This blog will outline a psychological model for behaviour change. Hopefully understanding what stage of change your loved one is in, will demystify some of the confusion and help you to be as supportive as you can to your loved one (if that is your aim) as well as look after yourself. 

Like a broken record, I will mention (as I often do) that we can't change another adult's behaviour for them. They need to be motivated to change. We can encourage and support them and we can learn to change the way we respond to their behaviour. 

The stages of change model (developed by Prochaska and Declemente) helps us to understand the stages people go through when faced with the prospect of changing their drinking or drug use. 

©Dr Fiona Dowman, Clinical Psychologist, Adapted from: Prochaska and Diclemente (1986)

People don't necessarily move through these stages in order as depicted in the image, they can move back and forth between different stages and may go through the stages a few times before achieving lasting change. However, the stages of change model provides a useful way to remember and understand the process of change.

If we use a journey across a bridge as a metaphor, precontemplation is like being at home and not making any progress on the journey. Contemplation is like stepping outside. Preparation is like planning your route. Action is like crossing the bridge and maintenance is reaching the other side (let’s call it abstinence Island). I will shine a spotlight on each stage, in turn.

Precontemplation (staying at home)

Although you may have noticed your loved one has a problem with drugs or alcohol, in the precontemplation stage they may not acknowledge a problem. Or they know they have a problem but don't have any desire to change in the near future. 

They are therefore more likely to be defensive and less open to any suggestion of change. They know that other people see their drinking or drug use as a problem which can lead to secrets and lies to cover up the extent of their drinking or drug use.

You might feel worried, anxious, frustrated or angry that they won't seek help.

If you decide to talk to your loved one about their behaviour, be prepared to revisit the topic several times. Try to listen and be genuinely curious about their reason for not wanting to change (i.e. the perceived benefits of drinking or taking drugs)  rather than jumping straight to why you think they should stop or cut down. The former is more likely to open a conversation up. The latter is more likely to close it down.   

It can be incredibly difficult trying to help someone that doesn’t want help. If you find that you aren’t getting anywhere with encouraging your loved one to consider change, this means they are not ready. However, despite there being no obvious change, you might be planting seeds for them to consider change in the future. 

Contemplation (stepping outside)

In this stage, your loved one has acknowledged a problem with their current behaviour and is considering making a change but they may be ambivalent and not quite ready to commit to taking steps towards a change. 

It's a good time to ask your loved one to consider the pros and cons of their drinking or drug use as they are more likely to be open to discussing it. They are also more open to reading, watching or hearing about the harms of drinking or drug use. 

Your loved one might stay in this stage for a long time, going back and forth between the costs and benefits of drinking or taking drugs. 

It might not be easy for you to have patience, and that’s ok. Don’t forget to consider your needs in this situation and what you need to do to nurture your well-being.

Preparation (planning your route)

When your loved one has identified a reason or reasons to change and can see that the costs of their current behaviour outweigh the benefits, they are motivated and ready to take action.

They will begin to weigh up their options. However, just because someone is motivated to change does not mean that all of their ambivalence is resolved, once they have expressed their motivation for change, it might help if you remind them of it.

Your loved one might have tried to make a change in the past and can make use of what they learnt from these past attempts to sustain change in the future. 

Your loved one can increase their chances of success by getting a realistic idea about the various self-help or support options and making a plan for how to manage challenges along the way. For example, if your loved one uses drugs with their friends and they make a plan to stop using but don’t make a plan about how they will resist using when they are with their friends, they are not fully prepared to take action.

Action (crossing the bridge)

In this stage, your loved one has taken steps towards changing their drinking or drug use. E.g. they don’t go to the pub anymore, they don’t have alcohol in the house, or they attend AA meetings. You will probably notice changes in your loved one and start to feel more hopeful. 

This can be a vulnerable time because the change in their drug or alcohol use often comes with lifestyle changes like changes in how they spend their time or who they spend time with. If your loved one was using drugs or alcohol to cope with mental health difficulties, these can get worse in the absence of alternative coping strategies. This is the time to put all the previous planning into action, to deal with these challenges. If you are supporting your loved one, it would be a good time to check in with how they are coping. 

Maintenance (arrived at Abstinence Island) 

Achieving abstinence, sobriety or a reduction in drinking or drug use is a significant achievement. Maintenance is a period of continued change. Motivation is high, and if your loved one experiences benefits associated with reducing or stopping their use, they will be more motivated to keep it up. 

Lapses (a detour) are always possible when moving through the stages of change. It can help if people acknowledge their personal triggers for having a lapse so they can prepare for how to reduce the risk of another lapse. Some common triggers include: particular people or places, difficult emotions and withdrawals.

When someone has a lapse, it’s hugely disappointing, stressful and confusing for those who care about them. However, whilst it might seem like it's game over, perception is everything. Slips and lapses are not a sign of failure. Coming back to the bridge metaphor, think of it as a delay or detour in your journey. 

Our thoughts and feelings affect our behaviour. If we view a lapse as the end of the road and think that we might as well give up, we are likely to feel deflated, unmotivated and slip back into old habits. However, if we view a lapse as a slip-up, an opportunity to learn and evidence that we CAN be successful, we will be more likely to feel motivated and to try again. 

Take care of yourself 

The stages of change can feel like a rollercoaster ride for loved ones. Whether you are there for the ride or watching from the sidelines, you don't know what direction it will go, there are twists and turns, ups and downs. 

With the adrenaline rush comes a range of emotions from anxiety to excitement, hope, laughter and anger. It's natural to feel a range of emotions.

As hard as it is to focus on yourself when you're concerned about your loved one,  your own well-being is important too! 

Self-care has become somewhat of a buzzword but put simply it means remembering to pause every now and then to do something good for your mind and body e.g. rest, food, exercise. Self-care can also mean setting boundaries in your relationship.

If we neglect our needs, we are more likely to experience anxiety, stress and burnout and are less able to support a loved one. 

Dr Fiona Dowman, Clinical Psychologist

If your loved one wants to seek help for their drinking or drug use, you can search for your local drug or alcohol service here or find a list of drug and alcohol support groups and organisations here.

I offer psychological therapy tailored to people affected by their loved one’s drinking or drug use. You can learn more about my therapy services by clicking here.