Understanding addiction

Supporting a substance user is not easy - getting up to speed on key issues like the cycle of change may help.

In order to provide support for a drug/alcohol user, it helps to understand their behaviour and the motivations behind it. A popular model for explaining the stages a user goes through is the Cycle of Change. A user typically goes through the cycle several times as part of their recovery journey; the model helps explain that lapse and relapse are a common part of the journey for people trying to give up any substance.

The cycle of change also shows how family members should understand which stage the user is at and not attempt to provide inappropriate support - for example providing information on rehabs too early. See the diagram below for ways you could help in the different stages of the cycle.

1. Pre-Contemplation

In this stage 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. You can also help the user to become aware of the consequences of their use and associated behaviour.

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

Here 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

At this point the user takes practical steps to bring about a change to their substance using behaviour, such as using less or deciding to give up completely.

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. As we all know, sticking to the changes we make in our behaviour can be the hardest part of the process.

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. Some families can be tempted to blame drugs for all the problems they've experienced, so when there are still relationship difficulties without drugs, this can be very distressing and confusing. In this case it is important to maintain open and honest dialogue about problems, feelings and aspirations and try to work through them.

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 all the way 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.
