People experiencing substance abuse go through a complex set of decisions about their recovery. The “stages of change” model is one of the most common ways of understanding the process. It was developed in the late 1970s by researchers James Prochaska and Carlo DiClemente.
The authors were studying how people stop smoking, but it has been successfully used in substance abuse treatment. In this article, I explain what the stages are and how they apply to overcoming addiction.
Overview
The 5-stage model assesses an addict’s readiness to deliberately go into recovery. A sixth stage called “Relapse” was added later. These stages are often represented as a cycle. In theory, people should go through them in sequence. In practice, people jump between stages, going forward and backward, even being in more than one stage at a time.
1. Precontemplation (Not Ready)
“I don’t have a problem”.
The person just doesn’t believe they have a problem. They resist change or don’t even think about making change and certainly not in the next 6 months. This is often the longest stage. It requires patience and determination to help someone move from pre-contemplation to contemplation.
The person has likely not yet experienced any negative consequences of their behavior. Or they may be in denial about the negative aspects or severity of the consequences they’ve experienced. This is so even when confronted by a loved one or employer.
The challenge is you can’t force people to make changes. They have to be ready. When they move from awareness to acknowledgment they realize they need to move forward.
Helping strategies include:
- Keeping communication open
- Offering information about the consequences of substance use in a non-judgmental way
2. Contemplation (Getting Ready)
“I know I have to stop what I’m doing but I enjoy it.”
A person intends to change, cut down, moderate, or quit the addictive behavior in the next six months. They know the benefits of doing so, but are also aware of the drawbacks. They may begin to see the consequences of their use but may not understand where the problem came from.
They may be more open to:
- Receiving information about the consequences of their addictive behavior
- Learning about strategies for controlling or quitting the behavior.
- But they may not commit to a specific approach or promise to make a change
A person may be in this stage for years. They may continue to use, but report that they enjoy it less. They may move forward or back a stage. They may have alternating feelings of hopelessness and hopefulness.
Helping strategies include:
- Ensuring the person knows that they are the only ones who can decide to change
- Reviewing the pros and cons of continuing ot changing the behavior
- Focusing on the future, not the negative past
- Encouraging the person to talk about making the change
- Showing confidence that they can do it
3. Preparation (Ready)
“I know I have the strength to change. I just don’t know how.”
The person wants to make the change soon, often within the next month. Usually, they have already taken steps to change. They are preparing to change and begin to set clear goals to help change.
They have a plan of action, such as joining a gym, talking to a counselor, enrolling in a therapy program or relying on a self-change approach.
Helping strategies include:
• Ask for permission to suggest options.
• Reinforce the reasons for change.
• Encourage small initial steps.
• Identify barriers and work together to find ways to move beyond them.
4. Action
“I’m working on it.”
The person has made changes in the past six months. They have started the physical process of recovery. They make initial changes to their behavior, surroundings or experiences. They may have reduced or stopped using substances.
They are actively working on the problem and may have enrolled in a rehab facility like The Encino Recovery & Detox Center. They are creating a solid foundation for recovery.
This stage is often the shortest but is when they are at greatest risk of relapse, depending on their willpower to follow through. Usually, they are open to offers of help and support.
Helping strategies include:
- Offering practical advice on how to make the change
- Reinforcing the long-term benefits of making the change
- Regularly following up by family, friends or counselors
- Focusing on their strengths and prior success in making the change
- Supporting the person in replacing substance use with new experiences and activities
5. Maintenance
“It’s a one day at a time process”
The person has made changes to their lifestyles and are working to prevent relapse. They have stopped using substances for at least six months and are working to maintain this success. The person is less tempted to relapse and become more confident in their ability to continue with these changes.
On their return home the person faces triggers that may cause relapse. It requires dedication, inner strength and time to manage these successfully. Participating in a sober community can be very helpful.
Helping strategies include:
- Figure out what has worked well
- Reinforce the benefits of continued change
- Identify positive changes the person has made
- Assist in developing plans to deal with situations that may cause relapse
6. Relapse
“I messed up.”
The person reverts back to old behaviors they were working on changing, or goes back to an earlier stage. Relapse is a common occurrence and a person may relapse more than once before making a permanent change. Relapse should be seen as a useful part of lasting change, not as a failure.
The relapse stage is sometimes included in the stages of change model as it is common. A person may have small lapses or relapse more than once before making a permanent change. Relapse should not be seen as a failure but as a useful part of lasting change before maintenance is achieved.
The outcome of recovery from substance use is highly individual. Some may be able to continue using drugs or drinking without becoming addicted. Others may require total abstinence to control their addiction.
Helping strategies include:
- Reassuring the person that relapse is a normal part of the recovery journey
- Demonstrating understanding but share confidence in their success
- Looking at what triggered the relapse and make new plans to deal with it next time
Sources
Addiction 101. Stages of Change. Centre for Addiction and Mental Health (CAMH).
Hartney E. 2023. The Stages of Change Model of Overcoming Addiction. verywellmind.
