In the journey from substance use disorder to recovery, every person experiences changes in their mindset and perspective. These are known as the Stages of Change, based on the “Transtheoretical Model of Change.”
The Stages of Change provide a broad outline of what most people undergoing treatment for addiction can expect throughout their time in recovery.
The Transtheoretical Model was developed in 1977 by James O. Prochaska at the University of Rhode Island, to analyze the process of behavioral change.
Well-known in the field of addiction treatment, the stages of change model also serves as a roadmap for other types of behavioral change as well.
While it might seem somewhat academic, understanding the transtheoretical model of change, or put another way, having an overview of what to expect during treatment and recovery from addiction, can help ease anxiety and track progress.
What are the Stages of Changes Based on the Transtheoretical Model?
There are six stages of change in this model. While they are represented in a particular sequence, it’s not uncommon for people in recovery to jump to different stages out of order.
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse or Termination
It’s also possible for some people be in more than one stage at a particular time.
The Transtheoretical Model of Behavioral Change Includes the Following:
1. Precontemplation
In the Precontemplation Stage of Change, people are generally unaware or are in complete denial that they have a substance use disorder at all. They might even see their behavior as a positive aspect in their life because they have yet to experience any negative consequences, like losing a job, getting in trouble with the law, experiencing depression, anxiety, or relationship troubles.
It is difficult, if not impossible, to convince anyone in this stage that they need treatment for substance abuse or addiction.
However, as a person continues in this stage, negative consequences can be inevitable and will often usher them into next change.
2. Contemplation Stage of Change
Like the word implies, people in the Contemplation Stage of Change are more open to the idea of changing their behavior. That doesn’t necessarily mean treatment, but they might try “cutting back,” moderating their drug or alcohol intake or, in some cases, even try stopping on their own.
In this stage, an individual is usually able to acknowledge some of the negative consequences, especially physical ones like hangovers. Many may even have some clarity on unintended consequences, like damaging relationships.
This is only contemplation, however. It is weighted more toward the “self” in self-help, meaning people tend to think about how they can stop bad things from happening under their own power, and this stage can last for years.
3. Preparation Stage of Change
“Something has to change,” is a likely type of thought for someone in the Preparation Stage of Change.
In this stage, the range of preparation can be from implementing strategies for moderating drug or alcohol intake, all the way to preparations leading to treatment for addiction.
In reality, most people struggling with a substance use disorder will make numerous attempts to curb their behavior on their own. That process can last a very long time.
However, with repeated failure to change on one’s own accord, the preparation stage can also grow closer to a person throwing their hands up and seeking help.
In more serious cases, an individual may be faced with consequences so dire they have no choice but to take whatever help or treatment is offered.
When a person does finally move into the next phase, any effective treatment facility will have further preparations for an individual’s particular circumstances. These are meant to improve the chances of their recovery.
Additional preparations may include some of the following:
- Determining the most effective approach, whether it be a 30 to 90 day stay at a residential facility or in an intensive outpatient treatment program
- Creating a network of support, from family members to counselors and, if necessary, physicians that are trusted and there to help a person successfully transition into recovery
- Diagnosing and addressing any underlying psychological drivers of addiction, such as anxiety, depression or post-traumatic stress disorder. The presence of a mental health condition and a substance use disorder together is known as a dual diagnosis. Both issues must be treated at the same time for success
- Planning for the end of treatment, which may involve continued follow-ups, staying in a sober-living facility for a time, or returning home if that is the best option for continued recovery
4. Action Stage
The Action Stage of Change can be the most stressful, especially when a person is attempting to moderate their behavior on their own. In treatment, it can be scary if a patient needs to go through a difficult detox so their body is no longer dependent on drugs or alcohol.
Some people may avoid seeking help for this very reason, which is why it’s important to seek treatment at a facility that medically monitors patients in detox and can prescribe medications that make the process safer and more comfortable.
Like the other stages, the action stage can occur in small bits as a person works on their behavior and healing. It may also end up being the life changing phase that they’ve truly needed when they seek professional treatment for a substance use disorder.
5. Maintenance Stage
In the Maintenance Stage, a person is working to maintain the changes developed in the action stage. For recovery from addiction, this may mean avoiding old friends, going to support group meetings, or having follow-ups with therapists and working to avoid triggers that can lead to old behaviors.
This phase can be particularly challenging after a period of time. There’s no stopping life and if a person gets complacent, as is normal during the maintenance stage, it’s easy for stress, anxiety and old behaviors to work their way back into our lives.
Thorough preparation and action, though, can help prevent this. In the preparation stage, acknowledging that stress is a key factor in addictive behavior and identifying ways to manage that is then deployed during the action stage.
This means that a person will have new techniques for managing stress and anxiety or any triggers before immediately falling backwards into relapse.
6. Relapse or Termination Stage
The Relapse or Termination Stage is included only to acknowledge that sometimes people will fall back into old, addictive habits. In fact, for many people, relapse is what pushes them back into the action and maintenance stages.
Relapse should never be considered a failure. In fact, people in recovery from substance use disorders have about the same relapse rates as those of other chronic diseases, like type II diabetes, asthma, and other illnesses.
When a person relapses, it sends a message that more preparation, action, and maintenance are required to get back on track.
The Stages of Change is a Behavioral Model
The Stages of Change is not a treatment method, but rather a behavioral model to help people understand the steps necessary for changing their ways.
The Transtheoretical Model was originally studying methods for people to quit smoking. It has since been used to illustrate all kinds of behavioral change, such as losing weight or stopping gambling.
Changing behavior can be difficult for almost anyone, especially those trying to overcome addiction. Having an awareness of the stages one must pass through on the road to change can make it easier to attain their goals.
This behavioral change model can serve as a roadmap to know where a person is at any time during the process.
