Stages of Change and Substance Abuse Treatment
May 13, 2009 by Emily Battaglia
Historically, substance abuse treatment methods and programs have engaged in some negative approaches, including focusing on client “noncompliance” and “failure.” A relatively recent approach, the Transtheoretical Model of Change (also known as the Stages of Change model) turns reverses this dynamic by emphasizing client readiness as a key component of treatment. Understanding an addict’s readiness to change aids treatment providers in understanding barriers to successful treatment, helps clients anticipate relapse, lowers client and provider frustration with the process, and improves client satisfaction and success with treatment.
The Stages of Change model states that most people experience a change in behavior gradually, and in stages. In the first state – precontemplation – the client is uninterested, unaware, or unwilling to make a change. In the second stage – contemplation – the client moves to considering a change.
Once the addict decides to make a change, he moves into the third stage, known as preparation. The fourth stage – action – is perhaps the most crucial. The client begins to take genuine, determined action. In the fifth stage – maintenance – the client attempts to maintain the change in behavior and prevent relapse.
It is important to note that most people who are recovering from addiction cycle through the stages several times before achieving long-term recovery. In this way, relapse is actually a crucial part of the process of working toward lifelong change.
The Precontemplation Stage is characterized by denial and ignorance of the problem. Individuals in this stage are not even thinking about changing. For instance, a chain smoker in this stage may not even grasp the fact that health warnings about smoking apply to them; a food addict may have tried so many weight-loss programs that she has simply given up.
Clients in this stage benefit from encouragement to rethink their behaviors; education about the risks and potential short- and long-term consequences of their behavior; and assistance in conducting self-analysis. If you suspect that you may be in this stage, ask yourself some simple questions: Have you tried to change an addictive behavior in the past and failed? Do you have any habits that your loved ones worry about? How would you know that you had a serious problem? What would have to happen for you to consider your behavior a serious problem?
The Contemplation Stage is characterized by ambivalence, uncertainty, and conflicted emotions. Individuals in this stage are becoming aware of the risks associated with their behavior and the potential benefits of making a change. The contemplation stage can vary widely in duration, from a couple of weeks to even years. In fact, some people never make it past this stage.
Addicts are ambivalent about changing because they see change as giving up an enjoyed behavior. The prospect of giving up this behavior causes them to feel a sense of loss despite the potential benefits. During this stage, individuals wrestle with perceived barriers to treatment and recovery, including time, expense, hassle, and fear.
Clients in this stage benefit from help in weighing the pros and cons of changing their behavior; encouragement to have confidence in their ability to change; and help determining ways to break through barriers to treatment. If you are contemplating a behavior change, there are some questions you can ask yourself: Why do you want to change? Is there anything preventing you from changing? What are some things that could help you make this change?
The Preparation Stage is the first active stage. In this stage, the addict begins to experiment with making small changes and begins collecting information about change and recovery. For example, a problem drinker may begin trying to limit alcohol consumption and may seek information on local self-help groups; a chain smoker may try switching to a brand of cigarettes with less nicotine.
Clients in this stage benefit from writing down their goals, preparing a plan of action, and making a list of motivating statements. If you are in the Preparation Stage, it is crucial to locate healthy outside sources of information, education, and advice, and support in the form of support groups, counselors, or friends.
In this stage, the client takes direct action toward achieving a goal. This stage shows whether the client has adequately prepared for change. Without clearly articulated goals and a specific and thorough long-term plan of action, many efforts at recovering from addiction fail. For example, many people make New Year’s resolutions to lose weight and stick to a diet for about two weeks, but due to lack of long-term commitment and planning, most abandon their lifestyle changes relatively soon.
Individuals in this stage benefit from praise of any positive action taken toward recovery; receiving rewards for successes; help reinforcing their goals and plan of action; support in making healthy choices and taking steps toward positive change. In you are in the Action Stage, take the time to regularly review your motivations, resources, and progress. This will help you renew your commitment to change and your confidence in your ability to do so.
Maintenance and Relapse Prevention
In this stage, recovering addicts focus on maintaining their new patterns of behavior and avoiding temptation. Those in this stage are learning to incorporate their new behaviors into their long-term identities, goals, and activities. As mentioned previously, most individuals cycle through the stages several times before achieving long-term change. Relapse, although ideally avoided, may provide excellent opportunities for clients to learn more about themselves and about addiction, making their next effort at recovery even more successful.