A Guide To The ‘Stages of Change’ Model of Addiction

Published On 19-July-2020
By Tim Wood

stages of change

Addiction to drugs or alcohol is a progressive disease.  No one simply wakes up one day and chooses to become addicted to a substance which takes over their life and health. But the same applies to recovery from alcohol addiction - what is deemed as "natural recovery." There are stages of change when an individual decides to recover from their addiction, and this blog post will tell you more about this cyclical process.

According to James Prochaska, a psychology professor prominent in the 1970s, a certain process takes place in the mind of individuals who wish to overcome addiction. This theory has been widely accepted in motivational and person-centred recovery circles. [1]

It is based on an understanding that making changes within the lives of those battling addiction takes place gradually rather than in a moment. The Stages of Change model by Prochaska breaks this process down into four distinct stages - with two more additional ones added in later research. Each represents the mind-set of an individual working their way out of addiction and toward sobriety.

What Exactly Is The Stages of Change Model?

The Stages of Change model is designed to offer a theoretic approach that includes a wide variety of socio-behavioural aspects. These are often overlooked in other models. [2]

It works by understanding to the best extent possible what stage an individual is currently in when they accept their problem. Thus, when receiving the help they need, therapists and patients can be better equipped to address the issues they currently face. It enables them to make progress in a more effective way in future.

This process can help determine the best approach. It also bridges the gap of understanding between family members, the subject, and the rehabilitation process.

Having a general structure and model to help someone who may be resistant to change provides a clear outline that both patients and professionals need. Loved ones can also benefit from this model when striving to assist with changes in a person's life to rid them of addiction.

Denial is a common factor for many struggling with addiction, and going beyond these thought patterns and emotions is essential for making genuine progress. This is something the Stages of Change model intends to clarify and provide a framework for.

What are the Stages of Change?

The five stages of change are designed to identify how ready an individual is to accept help for their condition. It enables them to actively work toward changing it for the better. Below we have discussed in detail the main four stages addressed in Prochaska and DiClemente's (1983) Stages of Change Model: [3] 

1. Pre-contemplation

The first stage is known as “pre-contemplation” where the individual is not yet ready to accept responsibility for their addiction. They may still be dealing with issues of denial, or attempting to minimize their problems.

This may be because they have not suffered any repercussions or negative outcomes from their addiction. Individuals in this stage often perceive their habits as a positive, pleasurable, or fun experience and do not wish to hear of the negative impacts it has.

2. Contemplation

The contemplation stage refers to when the individual begins to seriously consider making a break away from their usual addictive tendencies.  They begin wondering about cutting down, moderating, changing their behaviour or quitting altogether. 

Individuals during stage two are more open to receiving help or information about moderating or improving their lifestyle choices. However, they are not fully open to doing whatever it takes to get sober as they cannot see their behaviours as an addiction. 

They wish to learn about controlling their urges and cutting down, but all the while still being able to consume their substance of choice. These stages can last for many years, and often people stay in this limbo of receiving helpful information but not doing anything about it.

3. Preparation

Here, the person has stopped thinking and has started planning. The preparation stage is when the person is clearly ready to take action and is getting themselves in a position to do so. They might:

  • Decide on the change they want to make (cut down, change, or quit altogether)
  • Plan how they're going to implement the change (if they're going to cut down, how much by?
  • Get the necessary resources (medications, books, groups)
  • Omit triggers from their life (getting rid of alcohol or drugs from the house, cutting up credit cards, or blocking gambling or pornography sites)
  • Ask for support (from friends, family, or support groups)

4. Action

This stage is what it's all about. The action stage is where the individual has made sincere and concrete efforts to change their lifestyle. They are working toward a drug and alcohol-free daily living pattern. 

This stage can be intense and stressful, but it can also be hugely rewarding and eye-opening. Action starts normally on day 1 of quitting that substance, which is typically day 1 of detox at a treatment centre.

Action can occur in small stages, for example, stopping smoking by one less cigarette per day. Each situation is different and with the proper preparation and support, the action stage can last into a viable future.

More About the Preparation Stage

A key component to ensuring a positive and successful result in the recovery process includes making the most of the preparation stage. This is in order to place the subject on an optimal trajectory toward overcoming their disease.

This may involve first arriving at a clear understanding of the kind of change that needs to occur. It also involves removing clear triggers that cause a person to use, such as a person of influence or a situation and environment that encourages this type of behaviour within them.

It can be difficult for many people facing addiction to acknowledge that a problem exists in the first place. So starting by coming to terms with the reality of the situation may be the best place to start.

From here, many of the central and underlying thoughts, issues, and emotions that are associated with the individual's alcohol or drug abuse can be brought out into the open and addressed in a variety of ways.

Stage 5: Does One Exist?

Additional stages to Prochaska's Model are 'maintenance' and 'relapse.' Let's talk firstly about the maintenance stage, which is stage 5. This stage is all about upholding the new rules set out in the preparation phase and the abstinence/ behaviour the individual has set up in the action phase. [4]

This literally means sticking to your guns, whatever that may be. It might be quitting alcohol or drugs altogether, only smoking 10 instead of 20 cigarettes a day, or setting yourself a limit on your credit card if you suffer from a shopping addiction.

This stage is most difficult as it quite literally needs to last a lifetime in order to be successful. Once the novelty of reaching sobriety or abstinence has worn off, the individual is posed with every day triggers and possibly boredom. They may begin to believe that 'one small taste' won't matter in the long run.

This stage is truly a battle between the old way of life and the new ways of thinking. Putting resources, people, stress-coping methods, support and trigger-free environments in place in the preparation phase will cushion this stage.

Stage 6: Is There A Relapse Stage?

Unfortunately, those dealing with substance use disorders face a significant statistical relapse rate of between 40% and 60%, and once the subject enters this phase, the process of refocusing their efforts upon the Stages of Change must take place once again. [5] 

Relapse comes in many different forms, from small lapses to more prolonged periods where a substance is taken up for a longer time period. This process depends greatly upon the individual and numerous factors that may or may not be involved, as people respond quite differently and in unique ways when presented with a variety of substances and scenarios.

For example, some people may be able to have brief episodes of using without completely returning to their old continual abuse patterns while still others will face a harder and longer road back toward their recovery commitments after once again taking part in their substance of choice.

The person must be made aware of, and come to terms with the fact that complete abstinence from the substance is the only way their addiction can be kept under control, and this process may potentially involve several relapse events until a firm commitment to total recovery can be made.

In these cases, it is best to continue working through these events with the goal of sobriety and abstaining from the substance in view at all times. Sustaining a consistent level of sobriety over time must obviously play a key role in achieving lasting progress and full rehabilitation over the long term.

Termination Stage: Is It Really Over?

Outside of the main six* stages recovery process, the "termination" stage occurs when the individual has completed the journey. They feel confident enough in their sobriety where their past drug or substance of choice is no longer a threat that is hanging over their head. [6] 

Reaching this stage means having the conviction to not use no matter what setting they may find themselves in. The state of mind of a recovered individual becomes their natural one. The strong will to use their substance has been completely replaced with a positive outlook on a drug and alcohol-free future, with plenty to strive toward and look forward to.

What Processes Do We Go Through During the Stages of Change?

There are specific exercises and areas of focus when traveling through the different stages of change. These are intended to help bring about the type of change that is hoped to be achieved within the patient.

The activities are known as “processes” and involve useful tools and things to think about in order to facilitate the growth to the next stage of recovery. The first among them is consciousness-raising. This involves developing a deeper knowledge of oneself (in the case of the patient), and the problem of addiction and its consequences. [7]

Next, outside factors that include the individual’s social environment are examined. This is alongside a deeper understanding of the emotions that may come into play during the need to use. A re-evaluation of oneself is undergone to assess the benefits of making a change, as well as what the patient may feel they are losing by choosing recovery.

Finally, the person makes a commitment to take action through an acknowledgement that they are the only ones who are capable of making the change they hope to see.

Planning for these changes and finding healthy alternatives to old habits are the concrete steps that are then taken to follow-through on this clear statement of purpose.

Understanding Decisional Balance and Self-efficacy

Nearly every decision of consequence we make in life is accompanied by a set of “pros” and “cons.” These often come into focus as either positive or negative ramifications stemming from such choices.

The process of decisional balance, developed by Janis and Mann in 1977, serves as a core idea relating to the Transtheoretical Model employed in the Stages of Change. It seeks to make clear the advantages that are to be gained through an open acceptance of the problem of addiction and a firm decision to move in a new direction.

Self-efficacy is a notion that seeks to measure the degree of progress the recovering individual has made. It also relates to how much they have let go of the urge and temptation to use their substance of choice.

In the early pre-contemplation stage, the individual may still feel as though the behavioural changes necessary for success and recovery are not equal to their desire for continuing to use their substance of choice. This parameter assesses a subject’s level of confidence in determining their own path forward.

The amount of control they are able to exert over their own life situation and willingness to use is also assessed. This assessment occurs as the person progresses from the pre-contemplation or contemplation stages into the action and maintenance stages.

By seeing things clearly for what they are, these issues can then be properly examined. They can then be brought to the forefront, possibly leading to a re-evaluation in which the patient may begin to favor pursuing the road of recovery instead.

Critical Assumptions of the Transtheoretical Model

The Transtheoretical Model is developed around the behavioural and psychological processes involved with a person transitioning from addiction to recovery. It is also founded upon a number of key critical assumptions as to the nature of behavioural change, and the methods involved in accomplishing such a task.

Mainly, that genuine behavioural changes take place over time, as an unfolding process that takes place through a series of stages. This eventually leads to a complete and total reversal of past behaviours.

Also, these different stages are subject to change as conditions change. This means that an individual can be motivated to take action by emphasizing the "pros" involved with the process and paying less attention to the "cons".

Finding the necessary principles and processes throughout each stage of the journey can help to place focus where it’s needed most. This is the way to bring about the sort of progress necessary for true and lasting recovery.

Ready to make the change?

At Rehab 4 Alcoholism, we offer free advice & guidance on addiction, substance abuse, and recovery. Call us today on 0800 111 41 08.

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1852519/

[2] https://www.prochange.com/transtheoretical-model-of-behavior-change

[3] https://socialworkpodcast.blogspot.com/2009/10/prochaska-and-diclementes-stages-of.html

[4] https://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html 

[5] https://psychcentral.com/lib/stages-of-change/

[6] https://experiencelife.com/article/the-stages-of-change/#:~:text=Stage%206%3A%20Termination,former%20behavior%20is%20entirely%20gone.

[7] http://www.cpe.vt.edu/gttc/presentations/8eStagesofChange.pdf


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