The Stages of Change Model of Overcoming Addiction

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.

This model was developed from research looking at how change occurs in “natural recovery” from addictions. It has been embraced by health care providers seeking to move away from confrontational and pathological approaches toward motivational and person-centered approaches, such as motivational interviewing.

1

The Four Stages of Change

Diagram of the stages of change model

Elizabeth Hartney, 2011

There are four main stages in this model: Precontemplation, contemplation, preparation, and action. Maintenance and relapse are also sometimes included as additional stages.

These stages can be represented as a cycle, and in theory, people should 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.

2

The Precontemplation Stage

Diagram showing the precontemplation stages in the model

Elizabeth Hartney, 2011

Precontemplation is the first stage in the stages of change model of addiction and behavior change. People in the precontemplation stage 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 in the precontemplation stage, they are often not very interested in hearing about negative consequences or advice to quit their addiction.

People in this stage usually experience their addictive behavior as a positive or pleasant experience. However, negative consequences do eventually affect people engaging in addictive behaviors. These negative consequences can push the individual into the "contemplation” stage.

3

The Contemplation Stage

Diagram showing the contemplation stage in the model

Elizabeth Hartney, 2011

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 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.

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 promising to make a change.

People with addictions may be in the contemplation stages for many years. From here, they may move forward to the next phase—the preparation stage—or they may move back to the precontemplation stage.

Contemplators typically benefit from non-judgmental information-giving and motivational approaches to encouraging change (rather than confrontational methods).

4

The Preparation Stage

Diagram showing the preparation stage in the model

Elizabeth Hartney, 2011

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 learned about in the contemplation stage. With substance addictions, thorough and thought-out preparation can be important to success.

During the preparation stage, a person might:

  • Plan the kind of change to be made: Do you intend to cut down, reduce harm, or quit completely?
  • Determine how to make the change: For example, if you intend to cut down on cigarette smoking, how much should you reduce your smoking by?
  • Obtain necessary resources: For example, if you intend to use nicotine patches to stop smoking, you will need to research the most suitable type of patch, discuss a suitable dose with your physician (many people do not use strong enough patches, and end up experiencing cravings); and actually purchase supplies of patches.
  • Get rid of triggers: Triggers are reminders of your addiction that can cause cravings and make it hard to avoid addictive behaviors. Triggers could include ashtrays and lighters for a smoker, or pornography for someone with a sexual addiction. Letting go of these reminders can be difficult, but the process can harden your resolve to overcome your addiction.
  • Put support in place: Support can include informing friends and family who want you to overcome your addiction, booking a place in detox and/or a treatment center, or finding a support group. It can even mean informing your addiction buddies (such as fellow smokers) of your plans, asking them to respect your process and to not engage in the addictive 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. They may also be able to help you with other preparations. Once the necessary preparations have been made, a person is typically ready to move onto the action stage.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

5

The Action Stage

Diagram showing the action stage in the model

Elizabeth Hartney, 2011

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. Here, trained professionals provide support through the early phases of discontinuing an addiction.

For others, particularly those whose goals are around moderating or controlling behavior (rather than quitting completely), the action stage can be similar to 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 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.

6

The Maintenance Stage

Diagram showing the maintenance stage in the model

Elizabeth Hartney, 2011

The maintenance stage of the 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.

Usually, this will mean staying abstinent from alcohol or drugs, keeping to a reduced level of addictive behaviors, sticking to limits (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—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.

7

The Relapse Stage

Diagram showing the relapse stage in the model
Image: Elizabeth Hartney, 2011

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 to keep their addiction under control.

Sometimes it is only after several relapses that a person discovers what recovery from an addiction means for them.

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