The “stages of change” or “transtheoretical” model is a way of describing the process by which people overcome addiction. The stages of change can be applied to a range of other behaviors that people want to change, but have difficulty doing so, but it is most well-recognized for its success in treating people with addictions. It was developed from research looking at how change occurs in “natural recovery” from addictions and has been embraced by the move away from confrontational and pathological approaches, toward motivational and person-centered approaches, such as motivational interviewing.
Model of Overcoming Addiction
These stages can be represented as a cycle, and it is suggested that people go through these stages in sequence. In reality, people can jump about between stages, go backward and forward, and even be in more than one stage at a time.
The sequential model provides a useful way of understanding the process of change, and gives a structure to how changes in addictive behaviors can be encouraged and managed.
behaviors can be encouraged and managed.
The Precontemplation Stage
Precontemplation is the first stage in the "stages of change" or "transtheoretical" model of addiction and behavior change.
When people are in the pre-contemplation stage, they typically do not consider their behavior to be a problem. This may be because they have not yet experienced any negative consequences of their behavior, or it may be a result of denial about the negativity or severity of the consequences they have experienced.
When people are at the pre-contemplation stage, they are often not very interested in hearing about negative consequences or advice to quit their addiction.
They usually experience their addictive behavior as a positive or pleasant experience at this point. However, negative consequences do eventually affect people engaging in addictive behaviors, either as a result of an addiction developing (which, by definition, impacts on other areas of life), or as a result of other harms as a consequence of a single occasion of engaging in addictive behavior. These negative consequences can push the individual into the "contemplation” stage.
The Contemplation Stage
The word contemplation essentially means to consider or think about something deeply. In the context of the “stages of change” model of addiction and behavior change, contemplation specifically refers to the stage at which the person engaging in the addictive behavior begins to think about changing, cutting down, moderating or quitting the addictive behavior.
In the stages of change or transtheoretical model, the contemplation stage is separate from the preparation stage or the action stage, so someone at the contemplation stage is generally more open to receiving information about the possible consequences of their addictive behavior. They may be open to learning about different strategies for controlling or quitting the addictive behavior, without committing to a specific approach or even to make a change.
People with addictions may be in the contemplation stages for many years. They may move forward to the next phase, the preparation stage, or they may move back to the pre-contemplation stage.2
Contemplators typically benefit from non-judgmental information-giving and motivational approaches to encouraging change (rather than confrontational methods).
The contemplation stage concludes with the decision to change the addictive behavior.
The Preparation Stage
The preparation stage of the stages of change (transtheoretical) model means a person has moved forward to planning and preparing for carrying out changes they contemplated.2 With substance addictions, thorough and thought-out preparation can be important to success.
Examples of the kinds of things a person might plan, do or decide about during the preparation stage include:
- The kind of change to be made: Do you intend to cut down, reduce harm, or quit completely?
- How to make the change: For example, if you intend to cut down on cigarette smoking, how much should you reduce your smoking by?
- Obtaining necessary resources: For example, if you intend to use nicotine patches, you will need to research the most suitable type of patch, discuss with your physician the most suitable dose (many people do not use strong enough patches, and end up experiencing cravings); and actually, purchase supplies of patches. If your intention is to reduce the risk of STD transmission, you will need to purchase or obtain supplies of condoms.
- Getting rid of triggers: Triggers are reminders of your addiction that are likely to cause cravings and make it hard for you to fight going back to your addictive behavior. Triggers could include stashes of drugs or drug paraphernalia for a drug user; bottles of liquor for a drinker; ashtrays and lighters for a smoker; pornography for someone with a sexual addiction. Letting go of these reminders can be a difficult process in itself, but going through the process can harden your resolve to overcome your addiction this time.
- Putting support in place: Support can include every kind of social support, from informing friends and family who want you to overcome your addiction to booking a place in detox and/or a treatment center, to finding a support group. It can even help to inform your addiction buddies (other drug users, drinkers, etc.) of your plans, asking them to respect your process and to not engage in the behavior around you.
There may be many other preparations that need to be made in your specific circumstance, such as finding a clean, safe place to start your new life. If you need help from a counselor or social worker, this is the time to get it. He or she may also be able to help you with other preparations.
It is important to remember not to rush the preparation stage. It will be different for everyone.
For some people, such as those whose family and friends have been pleading for them to quit for years, all the support required might be readily available. For others, such as those leaving the sex trade, a whole new location and identity might be required.
Once the necessary preparations have been made, a person is typically ready to move onto the action stage.
The Action Stage
The action stage is the focus for many people attempting to overcome addiction. This is the stage at which real change – change of behavior – starts happening. The action stage is typically stressful, but with good preparation, it can also be an exciting time that gives way to new options.
For many people, the action stage starts in a detox or treatment center, where there are trained professionals on site to support you through the early phases of discontinuing an addiction. For others, particularly those whose goals are around moderating or controlling behavior (rather than quitting completely), it can be similar to your normal life, but with greater restraint and perhaps a greater need for support and other ways of coping with stress.
Depending on the goals you set in the contemplation stage, and the plans you made in the preparation stage, the action stage can occur in small, gradual steps, or it can be a complete life change. It may feel strange and even empty to be living life without the drama of your addiction. It takes time to get used to life without an addiction, even if your support and alternative ways of coping are good.
Identifying and developing effective ways of coping with stress are crucial during the action stage. This will allow you to effectively move on to the maintenance stage, without experiencing the relapse stage.
The Maintenance Stage
The maintenance stage of Prochaska and DiClemente's transtheoretical model of change is concerned with continuing to achieve the progress that began in the action stage. For people with addictions, this means upholding the intentions made during the preparation stage and the behaviors introduced in the action stage.2
Usually, this will mean staying abstinent from alcohol or drugs, keeping to a reduced level of addictive behaviors, sticking to limits set – such as following a spending plan for compulsive gambling or shopping addiction or continuing to pursue harm reduction goals, such as practicing safer sex.
The maintenance stage is most challenging after a period of time has elapsed and the focus on reaching the goal has lost its intensity.
People can become complacent at this point, and they may begin to think that a small lapse will make no real difference.
Maintenance can also become difficult when the stress of life catches up with you and the old, familiar ways of coping – using the addictive behavior – re-surface. This is why it is important to learn new ways of coping with stress during the action stage so that alternative strategies will be available to you during the maintenance stage.
Although many people are successful at maintaining abstinence from addictive behaviors, controlled drinking and substance use, and moderation in other addictive behaviors, relapse is also common. For this reason, "relapse" is also sometimes included as a stage within the stages of change model.
The Relapse Stage
The relapse stage is sometimes included in the stages of change model, in recognition that a person might have some or even many small lapses, or even relapses – periods when the addictive behavior is taken up again – before maintenance is achieved. In reality, the outcome of the process of change is highly individual – some people are able to adjust to controlled drinking, drug use or addictive behaviors without becoming addicted. For others, abstinence is the only way that a person can keep their addiction under control.
Sometimes it is only after several relapses that the person discovers what recovery from an addiction means for them.