Action is the stage in which people begin to change their behavior in a way that is obvious and observable. However, not all changes of behavior change are effective. For example, if a cigarette smoker manages to stop smoking tobacco, but starts smoking crack cocaine then we can agree that that is not a very effective change of behavior. He has changed his behavior alright but now has a worse problem than the one he started with. Likewise, overeating every time he has cravings for cigarettes is less than ideal, because he is merely swapping one health issue for another.
To be effective the behavioral change must be one that has been shown to effectively treat the relevant health condition or disease. For example, with tobacco smoking the research and clinical guidelines are fairly clear. The most effective behavioral change for smokers is total abstinence (stopping completely). Cutting down on cigarettes is shown by the research data to be ineffective. This is because it eventually leads to smoking the same amount again. Similarly, with other forms of addiction, abstinence tends to be the ideal, and for the same reason.
So when it comes to the action stage of change, the real question is – what kind of action? Well, with addiction the answer is almost always …
- Abstinence
- Building a support network & being accountable
- Self-efficacy
Abstinence
The reason abstinence is often promoted in treatment is due to our current understanding of addiction as a learning disorder which affects the brains motivational circuitry (see ‘The Neurobiology of Addiction for Beginners’.) In particular, addicted people display very poor impulse control. This actually occurs on a neurological (brain) level and is not simply a matter of poor choice. Oftentimes, when someone displays poor impulse control around a person or thing, then staying away from that person or thing becomes the simplest course of action. When that thing (a drug in this case) also happens to impair their decision making, then the need to remove it becomes even greater.*
*NOTE: There are some potential exceptions to this rule of abstinence being the main goal of treatment. People who are addicted to opioids, alcohol or benzodiazepines (e.g. valium) may need temporary or even long term medicating due to risks associated with withdrawal and relapse.
Building a Support Network & Being Accountable
Addiction is a disorder in which you need to find other people (e.g. other recovering addicts in a support group) who can hold you accountable. During active addiction, our impulse control becomes compromised and so there is a need to run decisions by other people who understand your addiction. This helps you to bring your addiction into the light of day and give others the chance to challenge you when they think you are behaving addictively. If you don’t make yourself and your addiction transparent to others then the addiction will thrive in secrecy. Input from your peers in recovery will help greatly to rebalance the impaired decision making which is such a recognizable feature of addiction. It doesn’t really matter whether these peers come from a mutual aid group like Alcoholics Anonymous (AA), Narcotics Anonymous (NA) or SMART Recovery, or whether they are members of an inpatient, outpatient, or online therapy group. It will all help.
After getting a support network around you, you can turn your thoughts towards making the things you do on your own more effective. We call this – self-efficacy.
Self-Efficacy
Self-efficacy is a clinical concept central to the stages of change model. Self-efficacy in the context of addiction means becoming effective at things which improve your health and prevent relapse. This might mean; getting up and going to bed at the same time every day; eating healthy food; having meals at the same time everyday instead of snacking; taking regular exercise and making daily contact with people in your support network.
With consistent work addicted people can achieve a considerable amount of self-efficacy which means that after a number of months or years they are highly competent at maintaining their sobriety (but they still have to make themselves accountable to others of course).