Stages Of Change

By George Stoupas, MS, RMHCI, CAP

Stages Of Change

Why do some people stop using drugs and alcohol when it becomes a problem while others do not? A person’s ability to make important changes in his or her life depends on a number of variables. These range from external factors like financial resources or social support, to internal obstacles like fear or ambivalence. While external barriers are very real and can stand in the way of recovery, they only tell part of the story. More often, internal, psychological barriers to change interact with external circumstances and result in the difficulties people experience with respect to change.

Accurately assessing a person’s motivation to change is crucial. Everyone would probably benefit from making certain changes in their lives, but not everyone is ready or willing to do so. In the early 1980s, James Prochaska and Carlo DiClemente began developing what would come to be known as the Transtheoretical Model to explain how people change. Initially, they were interested in how people quit smoking cigarettes. Since that time, however, this Model has been used to explain how people change a number of problem behaviors ranging from substance abuse to overeating. In their research, Prochaska and DiClemente identified five stages a person passes through in the process of change. These are Precomtemplation, Contemplation, Preparation/Decision, Action, and Maintenance.

Precontemplation Stage: This stage is similar to what is commonly referred to as “denial.” A person in this stage of change is not seriously thinking about changing; they may not believe that there is a problem to change. At this stage, people do not plan on doing things differently for the near future – often measured as the next 6 months. They may be seen as resistant, defensive, or stubborn, but are more accurately characterized as uninformed or undecided. People at this stage of change will not remain free from drug or alcohol use following treatment because they have not, in fact, decided that their substance use is a problem that requires changing. By becoming educated about the consequences of their behavior, weighing pros and cons, and increasing insight into the problem, people begin the transition to the Contemplation Stage.

Contemplation Stage: Here, a person begins to seriously consider his or her problem behavior. People engage in an honest cost-benefit analysis and further increase their awareness of the consequences of change, which is usually anticipated to begin within the next 6 months. At this stage, the pros and cons appear in fluctuating proportions as the person resolves his or her ambivalence. Again, people will not be successful in remaining drug and alcohol free because they are not yet committed to recovery. Further exploration into the benefits of change can lead a person to begin making preparations to change, which is the next stage.

Preparation/Decision Stage: In this stage, a person has made a conscious decision to change his or her behavior and plans to begin within the next month. Small, tentative steps are taking to initiate the process of change. People in this stage may begin researching treatment Stages of Change By George Stoupas, MS, RMHCI, CAP centers, therapists, or 12 Step meetings on their own or with friends and family. They may also reassess their social lives or look for alternative employment or living arrangements. It is imperative that people spend enough time in this stage and develop plans of action that suits their needs. Those eager to make changes may rush from contemplation to action without sufficient research, and may subsequently fail in their efforts.

Action Stage: As the name implies, people in this stage are actively engaged in change. They are doings the things necessary to remain abstinent from substance use, such as those listed above. As time progresses, new behaviors are cultivated and people take great care to develop safeguards against a return to problem behaviors – otherwise known as relapse. People in early recovery from substance abuse are developing a new way of being, a new lifestyle that does not include drugs and alcohol. This stage generally lasts around 6 months, but may vary depending on the extent of change needed. The important part of this stage is maintaining hope and developing alternative coping skills.

Maintenance Stage: The final stage in Prochaska and DiClemente’s Model is simply maintaining the change that was developed in the previous stages. People in this stage are not as fragile as those in the Action Stage due to their practice and experience, and exert less effort to maintain new behaviors. The primary objectives in this stage are to fine-tune a person’s new lifestyle and to increase awareness into triggers that could lead to relapse. People may remain in any one of the above stages for different lengths of time, and some may never resolve their ambivalence about change and progress beyond the beginning stages. According to this Model, it is possible to regress from one stage to a previous stage, such as going from Action to Preparation/Decision. This can occur when a person faces new, unforeseen circumstances that produce increased stress.

In my work at Sunset House, it is crucial to accurately determine where a patient is on this continuum. I have found that many people who are in treatment have not yet made a conclusive decision to stop using drugs and alcohol, but are rather prompted to enter treatment due to some outside force – be it legal, social, financial, or some combination thereof. While it may seem like treatment will be ineffective if an individual has not formally decided to change, thankfully this is not the case. For most patients, treatment itself consists of providing guidance and support in the transition from one stage to the next in an effort to resolve ambivalence and move closer to the ultimate goal of active, self-motivated recovery.

George Stoupas is a Mental Health Counselor Intern and Board-Certified Addictions Professional. He works as primary therapist at Sunset House, a DCF-Licensed Residential Treatment Center for men located in Palm Beach Gardens, FL. You may contact him at