At all stages of Prochaska and DiClementes’ Stages of Change model, the values of
unconditional acceptance, destigmatization of relapse, and individuality of treatment are upheld.
This model has granted me a deeper understanding of the non-linear nature of addiction and
recovery. In my own process of implementing an exercise plan, I have already experienced
moving from contemplation to preparation to action and back to preparation again following
some physical setbacks. What has kept me from staying in the action stage is the occurrence of
heart palpitations after exercise, which are unsettling and keep me awake at night. To stay stable
in the action stage, I need to mildly adjust my goal to minimize the effects of my chronic illness
while still making gains in my fitness. Although there are simple ways to adjust my goal and
move forward, it was very tempting to sink into my disappointment and accept defeat. This event
has impacted my understanding of the psychological difficulty of relapse; where although it is
possible to re-enter the stages of action or preparation, the mental roadblocks of feeling hopeless
or like a failure are difficult to overcome. For me, this illuminates the importance of interpersonal
support for maintaining self-esteem and regaining motivation to move forward.
Learning about the Stages of Change has allowed me to reflect more accurately on my
interpersonal and intrapersonal experiences with addiction. I recognize how a lack of proper
support during the action and maintenance stages has led to relapse for several of my friends, and
how I have inadvertently pushed away friends in the precontemplation stage by urging treatment
rather than meeting them where they are at. On the intrapersonal level, I have learned the
importance of the preparation stage between contemplation and action, which I have often missed
whilst trying to implement changes.
One myth that I am unlearning is that maintenance medications are a steppingstone for people to
still get some “high” effects from a drug until they decide to quit fully. I have since learned that
in fact, drugs such as gabapentin, naltrexone and acamprosate work to block receptor sites,
restore balance to neurotransmitters and reduce cravings (Cavaoila et al., 2022). Rather than
acting as a reduced quantity of the previous drug of choice, these medications act as a treatment
for the chemical properties of addiction.
Stereotypes of personal weakness, dangerousness, unpredictability, and the media image of “the
addict” lead to reduced treatment-seeking behaviors, housing and employment discrimination,
and a public perception that “others” and criminalizes individuals with addiction (National
Library of Medicine, 2016). This systematic “othering” from society leads to anxieties around
seeking treatment because an admission of having a SUD may lead to this myriad of negative
assumptions and consequences. The media stereotypic image of addiction often shows
individuals as unhoused, unclean, violent, and erratic, sometimes as a comedic punchline at the
expense of those with an SUD. This stereotype dehumanizes and trivializes people who are
struggling in a similar manner and may lead individuals to believe that they are not “sick enough”
to receive treatment if they do not match this societal perception, or to fears around being
perceived in this way following disclosure of one’s substance use.
People in oppressed groups may experience a range of barriers when trying to access
treatment, including “high cost of treatment, limited availability of treatment, ineffective
interventions, public stigma, inaccurate information, inadequate training of mental health
professionals, acute rather than long-term care, and criminalization of addiction” (Cavaoila et al.,
2022, p. 431). To aid the process of breaking down these barriers, I can join Faces & Voices of
Recovery, an organization that seeks to “dismantle stigma, discrimination and injustice against
those with addictions” (Cavaiola et al., 2022, p. 431). To work effectively with multicultural
populations, I can align my counseling with the MSJCC, which urge counselors to “intervene
with and on behalf of, clients” on all socioecological levels, which leads to increased “cultural
competence and humility” within counselors (Cavaoila et al., 2022, p. 430).
To not “other” the client, I can act with empathy and actively expand my knowledge on
the science of addiction. During assessment, I can “spend time establishing rapport and making
the client feel comfortable” (Cavaoila, 2022, p. 119). When the client is acknowledged as a
partner in therapy rather than a “subject”, they can experience therapy as an equal participant
rather than an “other” and can collaborate to plan and adjust their treatment. As part of the 4 Rs
of trauma informed care, I must also “Realize the widespread impact of trauma” and “respond by
fully integrating knowledge about trauma into procedures” (Cavaoila, 2022, p. 64). With most
clients with addiction having at least one ACE, it is crucial to obtain a holistic view of the
individual to prescribe the best fitting treatment. I can also expand my knowledge on the concepts
of PAW, REM rebound, dopamine depletion and epigenetic changes (Cavaoila, 2022). By
understanding how neuroscience and trauma intertwine with addiction, I can work against the
moral model of addiction, which “others” clients by blaming their issues on moral failure.
(Cavaiola, 2022, p. 56).
The culture of addiction in the United States is one of stigma and secrecy, with only 10%
of people with SUDs receiving treatment in 2018 (American Addiction Centers, 2018). Although
neuroscience is making breakthroughs as to the biological processes of addiction, “the moral
model continues to influence public policy and legal sanctions in 21st century America”
(Cavaoila, 2022, p. 28). 54% of Americans believe that landlords should be able to deny housing
to those with addictions, and 30% believe that recovery from addiction is not possible (American
Addiction Centers, 2018). Additionally, People of Color are subjected to much higher rates of
incarceration and police violence for drug use, whereas White people are often granted
explanations of trauma and mental illness (war vs. epidemic semantics) (Cavaoila, 2022, p. 28).
Through this punitive and shaming culture of addiction, it is difficult for those with addictions to
seek help and to view themselves as worthy of recovery.