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From Action to Maintenance

Action is the stage of change where people believe they not only have the ability to change but are actively involved in taking steps to change their maladaptive behavior by using a variety of different techniques. The amount of time people spend in action varies. It generally lasts about 6 months, but it can literally be as short as one hour! Through Action and into Maintenance, clients remain aware that what they are striving for is personally worthwhile and meaningful. They should be patient with themselves and recognize that it often takes a while to let go of old behavior patterns and practice new ones until they are second nature to them.

Rewards provided to clients when they demonstrate a desired behavior, such as abstinence, can be very helpful for clients who are in Action and into Maintenance. Rewarding clients during sessions brings validation to positive changes. One reward that created behavior changes in my clients was a certificate of completion of early recovery groups and a small speech when receiving this certificate. It did many things for the client: it was visible and tangible, showed them success for that stage of recovery, provided motivation to not only that client but the whole group, made them desire to continue working and earn another, and also improved their selfesteem.

We also need to understand that relapse/recurrence is a part of the process. When clients relapse it is our job to help the client not get stuck at this point but to move the client back into preparation and action. Recurrence is accompanied by feelings of discouragement and seeing oneself as a failure. While recurrence can be discouraging, the majority of people who successfully quit do not follow a straight path to a life free of self-destructive habits. Rather, they cycle through the five stages several times before achieving a stable lifestyle change. Consequently, the stages of change model considers recurrence to be normal.

There is a real risk that people who have a recurrence will experience an immediate sense of failure that can seriously undermine their self-confidence. The important thing is that if there is a recurrence, they shouldn’t see themselves as having failed. Rather, help them analyze how a recurrence happened and use it as an opportunity to learn how to cope (you can be the key in this process). Recurrence is not a sudden event, it happens when a client is not being consistent in his treatment goals, not attending treatment, NA, AA, meetings, church, or other positive support groups. A recurrence identifies problem areas that need to be worked on but at the same time it will show tremendous growth and success. When these happen, be sure to help the client see the strengths from the recurrence: How long did they go before they relapsed, they came and told you about it after it happened, etc. Focus on the positives and help the client realign their sites toward action and maintenance again.

After Recurrence the Clinician Can…

  • Ask clients for their perceptions and reactions to resumed substance use

  • Review with clients their change plans and evaluate what worked and what didn’t

  • Elicit from clients selfmotivational reasons for change, the reasons to get back on track

  • Explore what can be learned from the experience; conduct a functional analysis

  • Normalize the experience of resumed substance use as a common and temporary part of the cycle of recovery

  • Assess client’s current stage of readiness for change

  • Encourage the client to talk about the advantages of abstinence

  • Use plenty of reflective listening, not just a string of questions

  • Explore the client’s values, hopes, purpose, and goals in life

  • Reframe the client’s “failure” as a partial success, emphasizing what the client did accomplish and learn

  • Ask a key question—what does the client want to do now—and move on toward a plan for renewed change.

Recovery is a lifelong process and if a client maintains long enough, the client will reach a point where they will be able to work with emotions and understand their own behavior and view it in a new light. When they reach that point in their process of change, they will know that they have transcended the old habits and that they are truly becoming a new person who no longer needs their old behaviors to sustain themselves. For more information and resources, please visit SAMHSA. gov, under the Treatment Protocol (TIP) 35.

By: Edward Garcia, ACTS Counseling

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