A couple of weeks back, I got a call from a client, let’s call him Joe. Joe is on disability and has dealt with chronic pain for most of his life. If you saw him walking down the street, you’d think Joe was a regular guy. He dresses well, has a gym membership and a part time job working just enough hours to supplement his disability income without jeopardizing it. Joe is also dealing with addiction, though it was only a few days ago that he would agree to use the word.
When he called, Joe told me he needed to talk. He had made some bad choices, and fell into a pattern of behavior that he wanted some help with. Joe admitted to misusing his prescription medications, drinking too much alcohol, and supplementing on occasion with cocaine. If we refer to the Stages of Change, this call represents Stage 4: Preparation. In this stage we transition into having active conversations about the problem as a way of exploring. Think of it as dipping your toe in the pool to see if it is too cold before you dive in. We talked a little more and made arrangements to meet later that week.
When Joe showed up at my office on Friday last week, he had a nervous smile on his face. We sat down to talk and a few minutes later he reached into his bag and tossed his prescriptions on the desk. “I’ve never done this before, but I need you to help keep me accountable.” We had a long chat before he pulled out two weekly pill holders and explained the scenario he had worked out during Contemplation and Preparation.
In the end, we agreed to meet twice a week. On Mondays I give him a holder with 3 days of medication, and on Fridays he returns the empty one in exchange for the second holder and 4 more days. Throughout the week, Joe checks in by phone as-needed for support and encouragement. In this conversation Joe acknowledged the need for addressing the alcohol and cocaine use, but we agreed that at this point the most important step is returning to compliance with his prescribed medications. Once he is steady with his footing in that area, we can return to the conversation about the others.
There will come a time when Joe no longer needs my assistance. When he works through the trauma that led to his addiction, he will begin to become more self-sufficient. He will build a strong social and support system of his own, and our professional relationship will have run its course. This is the final stage in the Stages of Change model, but that isn’t the end of the process, because the Transtheoretical Model isn’t as easy as “start here” and “finish here”. Not only is it a cyclical process, you can start and/or stop at any one of the steps, at any time, and for any reason.
This is a complicated topic, and one that can be terribly polarizing because this is where the misunderstandings about relapse and recovery comes into the picture. Relapse is absolutely a part of the Stages of Change cycle unless the individual holds fast to their decision to break that cycle successfully. If relapse occurs, the cycle continues, that much is indisputable. The issue arises when people say that “relapse is part of recovery” and some strongly disagree with that assessment. Perhaps a more appropriate way to state that problematic phrase might be that: RELAPSE IS PART OF THE CYCLE OF ADDICTION. This statement is more empowering because it is a reminder that breaking the cycle is the ultimate goal of recovery.