Step 1: Strengthen Your Motivation and Commit to Change
Have you ever wondered why it is that you can feel entirely convinced one day that drinking or using is something that has become toxic in your life, yet the next day, or even the next hour, you can find yourself coming up with reasons why it might be okay to drink or use just one more time? Believe it or not, there are theories in psychology about why this happens, because in reality, it happens to a lot of people—and not just people who are trying to quit using drugs and alcohol. This shift in motivation is something that people experience when they’re trying to make all sorts of life changes, whether it’s trying to eliminate a behavior that is not good for them (like overeating or overspending) or starting something new and healthy (like exercising, taking medications regularly, or eating right).
In this chapter, you are going to learn about why your motivation to change important behaviors might shift around from day to day, or over longer periods of time. You will be introduced to a theory of behavior change that explains the different stages of motivation to change your use of alcohol or drugs, and how these changes influence your recovery. Next, you will do a self-assessment to get a sense of where you are in your motivation and commitment to changing your drug and alcohol use, and you’ll complete exercises that help you to strengthen and sustain your motivation. You can revisit these exercises anytime you feel that you need a little psychological “boost” to remind you of why you are going to all of this trouble to cut back or quit.
Psychologists have spent decades trying to understand the process of behavior change. What has to happen inside of our minds to motivate us to change behaviors that have been habits for a very long time? One of the most well-studied theories about this is called the transtheoretical model of behavior change (Miller 1996). In the addiction treatment field, this model has been widely used to understand and improve motivation for recovery. According to this theory, there are five different stages of motivation for change, involving thinking about, planning, starting, and sustaining behavior changes. No matter where you are in the cycle, you can move back and forth between the stages, and every person moves through the stages and changes at a different pace. Let’s take a look at the different stages:
Of course, in the process of recovery from addiction, a slip or relapse can naturally interrupt your progression through this sequence of stages, but it doesn’t have to put you right back at the beginning. The way that you respond to a relapse makes a huge difference in your ability to regain momentum in your recovery. If you catch yourself early, and are able to prevent a slip from turning into a full-blown relapse, you can get right back into the action phase, rather than winding back to an earlier phase and feeling “stuck” there. Throughout this section of the book, you are going to learn skills that help you to understand and move beyond a slip before it gets out of hand.
Exercise 3.1: What Stage of Change Are You In?
Review the above descriptions of the five stages of change. Circle which stage you are in with regard to your motivation to change your alcohol or drug use:
Precontemplation Contemplation Preparation Action Maintenance
Now, circle the rating that describes how motivated you are to take the necessary steps to achieve abstinence, on a scale from 0 to 10, with zero being not at all motivated and 10 being the most motivated:
0 1 2 3 4 5 6 7 8 9 10
Not Motivated Somewhat Motivated Motivated Highly Motivated
Looking at your responses to these two items, there are a few things to keep in mind. First, if you circled Action or Maintenance, congratulations! You’re well on your way to a healthier new chapter of your life. Keeping your motivation strong will be important to sustain the changes that you are already making, so be sure to complete the exercises in this chapter. If you circled Preparation, this chapter is an ideal place for you to solidify your reasons for initiating a change and moving into Action. If you circled Precontemplation or Contemplation, then it’s great that you are getting educated about addiction by reading this book and considering whether making a change to your alcohol or drug use is something that you’d like to pursue further. On the rating scale, if you gave yourself less than a 5, you are probably in an early stage of change (such as precontemplation or contemplation). If you gave yourself a 5 or above, some part of you—whether it is just a small part or all of you—has already decided to take steps to change your alcohol or drug use.
Regardless of which stage of change you are in, take a look at your self-rating for motivation, and ask yourself this question: What would it take to move me up just one more point on the scale? If you don’t know the answer to that right now, don’t worry. As you consider the pros and cons of changing your alcohol or drug use, as well as the reasons why it might be worth changing, you will get a better idea of how to answer that question.
Ambivalence: It’s Normal in Recovery
No matter how motivated you feel about your recovery and its importance in your life right now, it is very normal to feel ambivalence, or mixed feelings, about the process of changing your behavior and lifestyle (Prochaska, DiClemente, and Norcross 1992). Even though your use of alcohol or drugs has caused problems for you that have led you to think about changing, there was a reason that you started drinking or using in the first place. The reason was, it was doing something that felt good or helpful to you—whether it was making you feel positive emotions or enhancing your ability to function in some way, or removing unpleasant feelings.
It is important to acknowledge that there were some positive rewards that you got out of drinking or using back when you started, and the hope to continue to get those benefits can lead you to have mixed feelings about giving it up, even if you haven’t experienced many positives from drinking or using for a while. Those memories are powerful, and your addicted brain will tempt you to seek out alcohol and drugs in attempts to repeat these positive experiences. As you examine your motivation for change, you will begin the process of strengthening the power of your rational brain to control your addictive behaviors.
If you’re anything like most people who enter recovery, you’ve been using alcohol or drugs for a while, so it may be hard to imagine life without it. You might even feel like you’re setting yourself up to fail, because you don’t believe that you can change successfully. These anxieties are completely normal. The good news is that they are not rational! Why is that good news? Because once you recognize that your thoughts or feelings are irrational, it’s easier to change them. The reality is, many people who have been drinking and using for a long time are able to give it up and turn their lives around. It’s not easy, but with a solid recovery plan—which you’re building with the help of this workbook—and the right support in place, it is entirely possible.
In the next section, you’ll consider some of the pros and cons of continuing to drink or use versus cutting back or quitting your use of alcohol or drugs. One thing to keep in mind as you complete this exercise is that the immediate or short-term benefits of drinking and using (such as improving your mood) are often the exact opposite of the longer-term effects, which come a little bit later. These can include depression or other mood disturbances, and the inability to get important things done. Being realistic about these short- and long-term effects is important so that you can take an honest look at the full range of benefits and drawbacks that come with each possible decision (such as continuing to drink or use versus changing your use patterns).
Exercise 3.2: Resolving Your Ambivalence
The best way to resolve any mixed feelings you might have about changing your use of drugs or alcohol is to give some serious consideration to the benefits of stopping your use and weigh them against the things about drinking or using that you will miss. In this exercise, you’re going to think about this in four different ways. First, you’re going to think about the reasons why you drink or use—the positives. Here are a few examples of things people like about drinking or using:
• It helps with anxiety.
• It helps with relaxation.
• It provides an escape from things that are difficult to cope with.
• It can be fun.
• It breaks the ice in social situations.
Second, you’re going to think about some of the negative things that happen when you drink or use. This will help motivate you to change your behavior, especially if you can keep this list in mind when you experience a craving. Here are some negative effects of drinking or drug use that you might experience:
• It causes health problems, including physical discomfort when the substance wears off, getting sick, and longer term effects of certain substances (for example, liver damage, heart disease, and oral health problems).
• It causes or worsens psychological symptoms or illness, such as anxiety and depression.
• It creates financial problems.
• It leads to relationship difficulties.
• It causes you to have difficulties meeting your obligations at work, school, or home.
Third, you’ll come up with a list of the benefits of reducing or quitting. Some of the benefits that you might discover are as follows:
• Feeling better physically
• Having more predictable and stable emotions
• Becoming more productive
• Improved relationships (this happens more gradually, usually)
• Feeling better about yourself
• Saving money
Fourth, you’ll spend some time thinking about the things you will miss about drinking or using. Some of the drawbacks of reducing or quitting your use of alcohol or drugs might include:
• Missing the immediate positive effects of drinking or using on your mood or your ability to do certain things
• Losing or distancing yourself from friends you like because they might tempt you to drink or use
• Feeling more limited in the range of social or work activities you can participate in comfortably
• No longer being able to lean on alcohol or drugs to cope with stress or problems
Now, complete your own matrix below of the pros and cons of reducing or quitting substance use versus continuing to drink or use drugs. Be as open and honest as you can when you make this list; the better you understand the sources of any mixed feelings you have about this, the more equipped you will be to talk yourself through them when the urge to drink or use comes up.
Benefits of Reducing or Quitting Drawbacks of Reducing or Quitting
1. 1.
2. 2.
3. 3.
4. 4.
Benefits of Continuing to Drink or Use Drawbacks of Continuing
1. 1.
2. 2.
3. 3.
4. 4.
To use the results of the matrix to help you in your recovery, find a place where you can jot down the drawbacks of continuing to drink or use, as well as the benefits of reducing or quitting your use. Some people like to store this in their notes on their cell phone, or even on their cell phone wallpaper for a more consistent reminder. For others, writing it down on a little index card or slip of paper and carrying it around (in a wallet or purse) can be useful. Pull out the card or look at the list on your phone any time you experience a craving, to remind yourself of what you are getting out of your recovery, as well as what you stand to lose if you slip or relapse.
Remember that your addicted brain will persuade you to drink or use by enticing you with memories of the acute, or short-term, positive effects of alcohol or drugs. The negatives and drawbacks of drinking and using typically come afterward. But if you start thinking about them before you make the decision about whether or not to drink or use, you will strengthen your rational brain and increase your chances of successfully overcoming a craving without relapsing.
Earlier in this chapter, you rated your motivation to reduce or quit drinking or using. You were also thinking about what it would take to move your rating up by at least one point, to make your motivation stronger. The exercise you are going to complete next will give you some things to think about that might help you answer that question. It will involve answering some questions to help you consider more carefully the concerns that you have about your drinking or drug use, the impact of your use on your life now and in the future, and your confidence in your ability to abstain from alcohol or drugs.
First, let’s look at an example.
Carrie Considers Change
Carrie has been smoking pot on a daily basis for the past eight years. In general, she’s been very functional for most of that time. She’s held down a few different jobs as a production assistant in the television industry, she’s had a long-term relationship (which she recently ended), and she has kept up a pretty active social life. Lately she’s been noticing that she has a lot of anxiety. She has found herself obsessing about past decisions (such as breaking up with her most recent boyfriend), and questioning whether they were right or wrong. She has also noticed that she’s been thinking a lot about her career and wondering why she hasn’t really advanced from the level of assistant to something a little higher up.
These thoughts have had a depressive effect, leading her to smoke pot more often than before. Since this cycle started, Carrie has felt less motivated to get out and do the things she normally enjoys, like socializing, exercising, and spending time with her family. She has noticed a connection between smoking pot and feeling depressed and anxious, which she wasn’t aware of before. Although smoking pot helps her to detach from a lot of the things she is unhappy about, Carrie has noticed that when she smokes more heavily, she enters a period of several days of not feeling like herself. On those days, she feels sad, irritable, and extra tired, and it takes a big effort for her to focus on things she needs to do at work and at home.
Carrie goes to see a psychologist for an evaluation, and one of the themes that they discuss is the connection between her use of marijuana and the problems she has been experiencing. When she comes to the appointment, Carrie is in the contemplation stage of change concerning her use of marijuana—she is starting to put together some thoughts about how it is affecting her, but she does not yet have a plan in mind about what she is going to do about it. She rates her motivation to change her marijuana use at a 5. She is somewhat motivated, but she has some ambivalence about it, especially since she’s been using pot for so long and doesn’t think it has affected her in many negative ways. Carrie’s psychologist suggests that she consider four aspects of her thoughts about marijuana that will help her explore her ambivalence and strengthen her motivation to make a change:
After Carrie completes this exercise, she finds that she has reached a new level of self-understanding about the ways that marijuana use has been affecting her life, her concerns about the effects it could have on her in the future, the things that could change for the better if she were to change her use of marijuana, and the reasons she has to be confident that she can change her marijuana use. After reflecting on all of these things, she finds that her motivation rating has changed from a 5 to a 7.
Exercise 3.3: Motivation for Change
Now it’s your turn to consider your thoughts about alcohol or drugs in the same four areas that Carrie did. This exercise will help you to explore your ambivalence about changing and express your motivation for change in your own words.
Consider whether alcohol or drug use is a problem for you.
What kinds of problems have you had in relation to your use of alcohol or drugs? Describe them here:
How has your use of alcohol or drugs interfered with, or stopped you from, doing things you wanted to do?
Think about what concerns you about your alcohol or drug use.
Is there anything that worries you about your use? Is there anything you can imagine happening to you because of it? If so, describe your concerns here:
What, if anything, are you worried will happen if you don’t cut back or stop drinking or using?
Think about how changing your alcohol or drug use will affect your life.
What makes you think that you might need to cut back or quit your use of alcohol or drugs?
If you change your use of alcohol or drugs successfully and things work out the way you want them to, how do you imagine your life will be different?
Think about the reasons that you can believe in yourself and your ability to change.
What inspires you to believe that change is possible for you?
Now that you have given more thought to your motivation to change your alcohol or drug use, let’s revisit the motivation rating that you completed earlier. Circle the rating that describes how motivated you are to take the necessary steps to change your alcohol or drug use on a scale from 0 to 10, with zero being not at all motivated and 10 being the most motivated:
0 1 2 3 4 5 6 7 8 9 10
Not Motivated Somewhat Motivated Motivated Highly Motivated
Did your rating change from earlier? If so, that is great news! You will find that keeping that rating as high as it can be is something you may need to work at during different stages of change—even the maintenance stage. The reason for this is that at every stage of change, those ambivalent or mixed feelings about drinking or using can (and naturally do) come up. Even when you’re completely stable in your recovery, you may find yourself tempted to drink or use occasionally, and then you’ll need to revisit the potential benefits and drawbacks of that choice, to take a realistic look at your motivation for sobriety.
If your motivation rating did not change from earlier in this chapter, that is perfectly okay; maybe it was high to begin with and these exercises were simply a reminder of your reasons for that. If your motivation was not so high to begin with and it did not change, then it is good that you are being honest about where you are, and you can revisit the exercises in this chapter any time you think that you might have some perspective to add to strengthen your motivation. Working with a therapist might also be helpful.
Finally, whether you moved up on the scale or not, don’t hesitate to push yourself further. By asking yourself what it would take for you to increase your rating by just one more point, you can continue to strengthen your motivation. Keeping the issue of your motivation on your mental radar is a big part of making it solid and maintaining it.
By now, you have a better understanding of the psychology of behavior change, the specific stage of change that you’re currently in, the strength of your motivation to change your alcohol or drug use right now, and your reasons for wanting to change. This understanding is the foundation for your recovery, but it is just the first layer. Next, you need a plan for how you are going to go about establishing the support that you need to succeed in achieving your goals. You also need skills that will enable you to plan for and get through difficult situations without drinking or using.
As you move through the next six chapters of this workbook, you will learn to apply cognitive behavioral, motivational, and mindfulness-based skills to the specific types of triggers, temptations, and roadblocks you face in your recovery. By the time you finish with section 2 of this book, your personalized relapse prevention plan will be in place and you will have mastered the tools that are the most helpful to you to achieve long-term recovery.