How We Grow: The Stages of Change

stages of changeThis month was the 25th anniversary of the death of Nirvana frontman Kurt Cobain. I loved Nirvana as a teenager (sorry Mom) and still enjoy “Heart-Shaped Box” whenever I hear it over the airwaves. I remember his tragic end after a long bout with heroin use. It had been quite a while since I’d thought about his story.

 

Now, after all these years and working so closely with addictive behaviors and substance use, I felt sad as I read stories like this one about how loved ones tried to help him. They did their best, as we all do, in a difficult situation, and they were listening to the professionals guiding them.

 

Still, they can’t help but wonder today: What might they have done differently? How could they have reached him? How could they have helped? Could his story have ended in another way?

 

Of course, everyone affected by addiction—including those struggling with addictive behaviors and substance use themselves—asks similar questions not in retrospect but every day they live with their using or acting out.

 

Those struggling with substance use or problematic, compulsive sexual behaviors want to understand how they could possibly return to their addictive behavior of choice, sometimes even after a long period of abstinence. “Why do I keep doing this?” they ask. “And how can I change?”

 

Family and friends want to understand helpful ways to support their loved ones. They’re often desperate to help the loved one find healing and become hurt, angry, frustrated, and exhausted trying to understand his or her behavior.

 

A sound understanding of how people change can provide the foundation for answering both of these questions. If we understand the stages of change, we can give ourselves a bit of grace as we struggle with our addictive behavior. And family members can learn how to better support their loved ones and promote their healing.

Understanding Addiction, Part 1: The Disease Model

understanding addiction“Why? Why do I keep doing this?” I get this question a lot, especially from new clients who are struggling to comprehend why they keep engaging in an addictive behavior they don’t want to keep doing. They struggle in understanding addiction.

 

I get it. I’ve been there. I wondered the same for a long time. I couldn’t understand why I continued to drink when I felt as ashamed about it as I did. Eventually, I came to understand why I started to drink and why I continued to need to drink.

 

Eventually, I came to understand that I drank to alleviate my own shame and anxieties. Understanding what alcohol was doing for me helped me learn to be more authentic and manage my feelings differently. When I didn’t need alcohol anymore, I spontaneously stopped when I got tired of how much it was taking from me.

 

Maybe you’re trying to understand your drinking, gambling, sexual behaviors, or other addictive behaviors. Really, you’re asking about what you don’t understand about yourself. That’s where looking at a few models of understanding addiction can help.

Treating Sex Addiction with Harm Reduction Psychotherapy

treating sex addictionThis week, I received the exciting news that I’ll be participating in a panel discussion about sex addiction, approaches to treatment, and how best to help clients needing support with these issues. I’ll be talking about treating sex addiction with harm reduction psychotherapy.

 

The conversation will take place at the conference for the International Institute for Trauma and Addiction Professionals in Phoenix in May. It’s going to be a great chance for mental health professionals on the front lines of out-of-control sexual behavior treatment to compare treatment options and philosophies.

 

Normally I don’t post too much about developments in the field of addiction, though I did give an update about sex addiction receiving a diagnosis last summer.

 

But this panel is so important and exciting because it’s evidence of a growing number of voices in the addiction field who think a bit differently about how to help those struggling with addictive behaviors, including sexual behaviors.

 

I thought I’d briefly compare the traditional approach and the harm reduction approach as I consider my remarks for the panel. I’m very much thinking out loud here as I continue to evolve and grow, so I invite you to be a part of the dialogue in the comments below.

How Alternative Addiction Treatment Can Work for You

Koorosh Rassekh, MMFT, is a licensed therapist and founder of Evo Health and Wellness in Venice Beach, California. His mission is to break the stigma around mental health and create a world of healthier people, families, and communities.

 

I recently connected with Koorosh and invited him to share about how he helps his clients change their addictive behavior. Read more about my collaboration with him about sex and porn addiction here.

 

1) Evo’s website states that you respects “where you are and where you want to go.” What does this mean for how you think about and treat addictions?

 

Taking inspiration from one of my mentors and one of Evo’s key advisors, Dr. Gabor Maté, I would say that Evo understands that addiction is never the primary issue. It is a secondary response to something deeper happening for a person – trauma, marginalization, the impact of being different, bullying culture, rape culture, etc. When people suffer, they turn to whatever is available to address their suffering. With substances, people often use as a coping mechanism, and this coping mechanism becomes a problem within itself.

Master Your Recovery Mindset

master your recovery mindsetIf you’re in trying to change your relationship with alcohol, a drug, sex, porn, or some other addictive behavior, you know it’s not a cakewalk. I want to walk you through an exercise today that will hopefully call attention to recurring thoughts that might be getting in the way of you reaching your goals.

 

I’m going to try something different here. I’m going to ask you to notice your first reactions to the statements that I’m going to give you. But in order for it to work, you have to promise to pause after you read each statement, taking note of what you’re thinking.

 

So don’t read on until you do that, okay? But first, a few words about why this is important. Let’s dive in.

Changing the Conversation with Your Addict

changing the conversation with your addictIf you’re in recovery, and especially if you frequent 12-step meetings, it’s not uncommon to hear about the “addict” in each person who struggles with addictive behavior. Often, using this term in this way refers to that part of the individual that wants to use, act out, or wreak havoc in some other way that is harmful to others.

 

I completely understand, then, why when I hear folks use this term in this way, they’re trying to prevent that damage from happening. They don’t want to lie anymore. They don’t want to hurt their partner with the “addict’s” hurtful words. And they really don’t want to use or act out.

 

So why am I about changing the conversation with your addict?

Navigating Family Gatherings When You’re in Pain

tips for navigating family gatherings when you're in painDuring my drinking days, there were holiday seasons when I was really struggling. I remember being so anxious about what was going on in my life and so ashamed about my drinking that I really didn’t feel like talking to anyone.

 

With the holiday season upon us, so are the joys unique to this time of year. But if you’re struggling with depression, anxiety, if you’re reeling from an intimate betrayal, dealing with an addiction, or whatever, the holidays can be a tough time of year.

 

Family gatherings can present challenges. How do you deal with your family, who may have contributed to your pain in the first place? How much do you tell about what’s going on for you? Let’s take a walk through some ways of navigating family gatherings when you’re in pain that might help, no matter what’s going on in your life.

A Tale of Two Selves: Leading a Double Life

leading a double lifeBy all appearances, Gary (who’s not real, by the way) is a successful businessman, a loving father and husband, even an elder at his church. He is respected in his social circles, esteemed in his business, and loved by his family.

 

Behind the facade, though, Gary leads a very different life. He watches porn, though far less than he used to as his interest in getting massages with happy endings at local parlors has taken off. He slips in visits with prostitutes at hotels in the area between meetings, skimming money from his business to hide it from his wife. He covers his tracks, making sure that his secret life stays a secret.

 

Gary comes to see me because afraid he may have an STD and he’s not sure what to do. More than that, he confides he’s getting tired of the effort required to maintain his double life. Gary is typical of the clients that I see that are struggling sexual behaviors that have gotten out of hand.

 

And, like many of my clients, he wonders how things got this far, why keeps doing what he does, and how he could live two such drastically different lives.

 

The answer? In a word, shame.

How to Find an Addiction Counselor

addiction counselorFinding the right help for an addiction isn’t easy. These days, there are quite a few options. Do you choose inpatient or outpatient substance abuse treatment? Intensive outpatient? An online recovery program?

 

And what do you do if you know you also have concerns about your mental health at the same time? How should you decide what you should do if you need chemical dependency treatment and also need help with your depression, anxiety, or some other mental health issue?

 

Navigating all of this can be tricky, but there are a few considerations that might be helpful as you find an addiction counselor to begin your recovery.