Dan Mushens speaks to Eric, who is living with the effects of alcohol related brain damage

Prochaska and DiClemente’s Transtheoretical Model of Behaviour Change, is commonly used by practitioners in the field of addictions when helping people to make positive lifestyle modifications.

It usually relates to alcohol and substance misuse as well as smoking cessation and weight management. It can be applied to most situations where a health related behaviour change is desired, but proving problematic due to an addictive element.

A key component of the model is the stages of change concept which suggests that change is a ‘process involving progress through a series of stages’.

I work in the social care sector in Scotland supporting people with alcohol related brain damage (ARBD). Eric Jacobs is just one of the people I’ve worked with that the can have the stages of change applied to their journey with alcohol.

“I’ve just turned 65 and yes, it’s fair to say that I’ve drunk more than I probably should have for the best part of 50 years, some people have called me an alcoholic over the years, but I don’t like that word. I’m unsure if there is a problem or not, maybe I just can’t accept it”.

Eric served his apprenticeship as a painter with an engineering firm in Rosyth, and still has his indenture contract on display in his studio flat. “I’ve got memory problems due to the ARBD now, I often forget to eat my dinner or remember what I watched on TV last night, but my memories of my apprenticeship are still clear in my head”.

Now retired, Eric’s entire employment history was as a painter and decorator and he worked in a variety of unusual settings. “I used to paint the exterior of battleships and frigates when they were in the dry dock as well as painting the cranes that were used to build the actual ships.”

He also painted factories, shops, hotels and warehouses as well as the standard living room walls and ceilings. “Every day was genuinely different, but one thing remained the same, when 5pm arrived everyone would go to the pub, they were on every street corner in those days”.

Eric worked hard for many years and married his long term partner, bought a house and became a father to two girls. “Life was good” he says, “we had holidays every summer and the girls never wanted for anything”.

Eric says he drank alcohol every day, usually lager, but he never saw it as a problem. “After a while, my marriage broke down and I’ve not seen my girls since. It was around the mid 90s I think that things must have gone downhill because that’s when my memories fade away. I still struggle to piece together those years”.

Eric spent time in hospital after being found wandering in a state of confusion, several weeks in a homeless men’s hostel, supported accommodation for a couple of years, some months in detox wards as well as some time in various tenancies around Fife.

Eric has lived with a diagnosis of ARBD for around a decade now and has achieved some periods of abstinence when residing in a residential setting. Returning to the community to live independently however has coincided with a return to old routines involving alcohol use.

Currently, Eric is living in his own tenancy in a sheltered accommodation complex in Fife. He receives support from my service seven days a week, has a domiciliary service visiting daily as well as input from the local authority addiction services. As of now, Eric says “I’m still drinking at the moment, but that could change if I really wanted to stop, I’ve done it before”.

When helping the people we support to change their drinking behaviours, we often use the stages of change as a tool to help them identify where they see themselves at any given time in their recovery, as well as highlighting what stages to expect to navigate when making plans for their future journey.

It could be said that Eric is currently at the pre-contemplation stage of the cycle as he doesn’t feel that any problem necessarily exists. To those around him however, the negative consequences of his sustained alcohol use are clearly apparent with self-neglect evident.

Historically however, Eric has used his autonomous decision making abilities to decide to move into residential care home settings or to receive in-patient detoxification. This suggests that during some periods of his recovery he has successfully navigated the contemplation stage of the cycle and acknowledged alcohol use was negatively impacting his life.

Also, whilst on waiting lists for vacancies in supported accommodation and detox wards, Eric has clearly made plans for the preparation stage and showed his intention to address problems that were detrimentally impacting on his health and overall wellbeing.

Eric has spent several years in supported accommodation enjoying lengthy periods of abstinence and engaging with rehabilitation and recovery programmes. This action stage is where the real change is witnessed and although it can be stressful, it can also be exciting with opportunities for a new future becoming a real prospect.

Naturally, once the action or intervention has brought about a modified behaviour change, the goal is to maintain the change which itself can be a lifelong effort. For Eric, he has overcome the physical and mental addiction to alcohol several times by living in a structured residential environment with staff and peers on hand to offer support and guidance, as and when necessary.

Something we frequently see is when people leave the structure of a supported accommodation setting to return to live independently, relapse can occur soon after. Eric has returned to live alone on several occasions after remaining abstinent for sustained periods. Succumbing to temptation and returning to old behaviours can happen within minutes, as has been the case for Eric, and so the cycle continues.

The main benefit of the model is the simplicity in its application and the fact it can be applied retrospectively. It also recognises that nobody can really promote change by force, but occurs best and is most sustainable when it’s something the person really desires. In Eric’s case, it therefore offers hope that he can once more make the changes that will lead to abstinence and further recovery, when he is ready to do so.

Dan Mushens is a recovery practitioner for Scottish mental health charity Penumbra

*Eric Jacobs is a pseudonym and the location has been changed