Healthy Living in the North

Helping with change, one stage at a time

Stages of change

Stages of change

In my twenties, I worked in a bar. It was an upscale place near the Winnipeg Stock Exchange. A broker who worked there – we’ll call him “W” – was a regular customer at the bar. He would come in at 10:30 in the morning for a double Manhattan and called it his breakfast. At lunch he would be back for another. At around four he would have two or three more to “round out the day.”

One afternoon W’s wife came into the bar. She told us he was suffering from a serious illness and his doctor had told him to quit drinking, but she was afraid he wouldn’t. Later in the day, I spoke to him when he came in. He said he had never thought his drinking was a problem until the doctor told him he was in danger, and even then, he wasn’t so sure. He thought it was only an issue because of his illness. He convinced himself that if he drank a little bit less he would be okay, so he cut down to singles instead of doubles and limited himself to three drinks a day. This became his new routine. Some months later his health took a turn for the worse and he was away for awhile. When he came back to the bar weeks later he switched to coffee, no booze.

I often thought of W years later when I began working with people with problems related to substance use. Looking back, I can see the stages of change in what he was going through. When I met him, he was precontemplative, sure he was okay and didn’t really have a problem. The illness was a crisis that moved him to consider that there was a problem. Still, he was so tied to his drinking that he didn’t want to think it was as serious as it was. His relationship with alcohol skewed his contemplative stage to justify staying with his routine. He developed a plan, put it into action and came to believe he had dealt with the problem. His life went on as before with a reduction in the amount that he drank, and he returned to a precontemplative state until there was another crisis that he could not ignore.

When we try to help people, we need to get a clear idea of where the person is, because for each stage, we can help in a different way. The precontemplative person can be helped by a reality check to shed some light on what’s really going on. The contemplative person needs some help to make sure they are seeing things accurately and realistically, not colored through the lens of their fears and desires. The planning stage needs some problem solving support and some detail work to make sure the plan is doable and complete. The action stage needs support to help with adjusting to new ways of being. The maintenance stage is a time to reflect and see the positives so that the person does not relapse and go back to old ways. People often go through the cycle many times before really getting to the heart of their problems and making significant and successful changes. With “W” it was alcohol but the pattern holds for tobacco, drugs and for other behaviors as well.

People change when they see a need to do so, when the change is a move to something better and when they can see it as such. The more you can help people work through their beliefs about what change is necessary, what that change will be like, how to make the change, how to adjust to the change, to maintain new ways of being and to celebrate success, the more likely the changes are to take hold and survive.

Have you ever helped someone through the stages of changes as they coped with a difficult issue or addiction?

Andrew Burton

About Andrew Burton

Andrew is a Community Integration Systems Navigator for Northern Health’s HIV and Hepatitis C Care team and works to support healthy living practices in communities across northern B.C. Andrew is developing positive activity and diet practices for two reasons: to deal with his own health concerns, and to “walk the talk” of promoting healthy living. Building on his training and experience in creative arts therapy, Andrew founded and runs the Street Spirits Theatre program promoting social responsibility among young people. This work has been recognized nationally and internationally as a leading method of social change.


Poverty and health – an unbreakable bond?

I must remain a force for change

Local graffiti: “I must remain a force for change.”

World Poverty Day, which fell on October 17 this year, doesn’t spark fundraising walks or appeals for funds but it’s still an important health promotion campaign. As poverty is a major factor in determining the level of health that people can achieve, policies and actions that help to reduce or eliminate poverty will improve health. It’s so well recognized and understood that the World Health Organization declared October 17 as World Poverty Day in an effort to focus attention globally on the issue of poverty. This day is intended to give people living in poverty an opportunity to speak and act on the problems emerging from poverty and destitution.

Understanding the connection between social factors, such as poverty and health, challenges us to think outside of the health care box. We tend to think of our heath care services as the critical intervention that determines whether we are sick or healthy. Yet, many people are unaware that illness, disease and injury start outside of the health care system. Our health is shaped by the conditions in which we live, the levels of education and income in our families, whether our neighbourhoods and workplaces are safe. Poor families are often trapped in low-income employment and living in unsafe neighbourhoods. They live without many of the essentials of life that many of us may take for granted.

Seeing how poverty directly impacts the health of individuals also allows us to see the important role of health in building healthier communities that step outside of the health care services “box.” When people are exposed to increased health risks because of poverty, or when we lose them to premature death or to chronic diseases, we lose valuable community assets that could have made important contributions to our local economies and to a rich and vibrant social fabric.

Finding ways to reduce poverty is a challenge, in part because it can become a vicious cycle. For example, we have many children in our region who live in poverty, who go to school hungry. The capacity of children to learn and acquire the education that would help them escape poverty in the future is compromised by the poverty they live under in the present.

So, while World Poverty Day doesn’t ask us to contribute from our wallets, it is looking to collect something different, something equally valuable: our time and attention. Each of us can ask ourselves, what can we do to help reduce and eliminate poverty in the communities we call home?

For more information please visit the BC Poverty Reduction Coalition. This coalition consists of community and non-profit groups, faith groups, health organizations, First Nations and Aboriginal organizations, businesses, labour organizations, and social policy groups. They have 30 coalition members and 350 supporting organizations whose goal it is to work together for a poverty-free BC.

Theresa Healy

About Theresa Healy

Theresa is the regional manager for healthy community development with Northern Health’s population health team and is passionate about the capacity of individuals, families and communities across northern B.C. to be partners in health and wellness. As part of her own health and wellness plan, she has taken up running and, more recently, weight lifting. She is also a “new-bee” bee-keeper and a devoted new grandmother. Theresa is an avid historian, writer and researcher who also holds an adjunct appointment at UNBC that allows her to pursue her other passionate love - teaching.