Question 1

What are the stages of change in addiction recovery?

Accepted Answer

The transtheoretical model (Prochaska and DiClemente) describes five stages: pre-contemplation (not yet recognising the problem); contemplation (aware of the problem, ambivalent about change); preparation (intending to change, beginning to plan); action (actively changing behaviour); and maintenance (sustaining change and preventing relapse). Understanding where someone is in this cycle guides the appropriate approach — providing advice to someone in pre-contemplation is rarely effective; motivational interviewing meets people at their current stage and supports movement forward without confrontation.

Question 2

What is harm reduction and is it effective?

Accepted Answer

Harm reduction approaches aim to reduce the negative consequences of substance use without requiring abstinence as a prerequisite. Examples include needle exchange programmes (preventing bloodborne virus transmission), naloxone distribution (reversing opioid overdoses), supervised consumption facilities, and substitution therapies (methadone, buprenorphine for opioids). Evidence consistently shows that harm reduction approaches save lives, reduce disease transmission, and provide a bridge to treatment for people not yet ready for abstinence. They are not in opposition to recovery — they keep people alive to reach recovery.

Question 3

What is dual diagnosis and why does it complicate treatment?

Accepted Answer

Dual diagnosis refers to the co-occurrence of a substance use disorder alongside another mental health condition — most commonly depression, anxiety, PTSD, or ADHD. Approximately 50% of people with serious mental health conditions have a substance use disorder, and vice versa. Each condition can drive and maintain the other, making treatment of either in isolation less effective. Integrated treatment addressing both conditions simultaneously by clinicians trained in both produces significantly better outcomes than sequential or parallel treatment through separate services.

Question 4

How can family members best support someone with a substance use disorder?

Accepted Answer

Evidence supports a middle path between enabling (covering up consequences, providing financial support for use) and confrontation or ultimatums (which tend to increase defensiveness and shame without motivating change). CRAFT (Community Reinforcement and Family Training) is an evidence-based approach for family members that teaches positive communication strategies, how to reinforce non-using behaviour, and how to allow natural consequences without rescuing. Attending Al-Anon, Nar-Anon, or seeking therapy for oneself addresses the significant impact of a loved one's addiction on family members' own wellbeing.

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