August 15, 2013 by Dr. Bob Weathers
Emerging out of motivational interviewing, the Stages of Change model has proven to be helpful to those working in recovery, guiding attuned and empathic interventions (Britt, Blampied, & Hudson, 2003; Ilgen, McKellar, Moos, Finney, 2006; Kinney, 2012).
The first stage for the addicted individual is called Precontemplation. This stage is characterized by the addict’s denial of there being any problem. “Precontemplation” points to the client’s not yet being ready to truly “contemplate” change in his or her life.
The second stage is that of Contemplation. Here are the first signs of opening into any self-awareness of there in fact being an addiction problem. Yet there is not yet any deeper willingness to actually change the addictive behavior. In fact, there is oftentimes a large amount of mixed feelings about really changing. I particularly like how Kinney (2012) brings in practically applicable research evidence here:
“Several studies show that people are far more likely to make changes to avoid losing something than to make changes in response to losses….The prospect of loss gets the individual’s attention. When weighing the negative factors associated with not doing anything, against the benefits associated with making changes, the deck is stacked in favor of the latter. Thus the balance is in favor of making changes. The person is poised to move from the stage of contemplation to the next stage. But if the loss has already occurred, and there is no longer anything to be gained by making changes, the individual is likely to move from contemplation back to precontemplation.” (p. 253)
The third stage is called Preparation. Here there is at last a beginning decision to change. For the addicted individual, the problem of drug or alcohol abuse or addiction is now being acknowledged. The primary move here is of formulating a do-able strategy for ceasing the no longer acceptable addictive behavior.
The fourth stage is Action. This is where change is concretely enacted. One important note: this stage can sometimes feel overwhelming to the addicted individual, as he or she realizes the monumental, ongoing commitment now required.
Once action has been taken, and the hex of the addictive behaviors has been (at least temporarily broken), there comes the Maintenance stage. Here the focus is on sustaining sobriety, managing triggers, and possibly learning from possible relapses. When relapse occurs, the goal is to immediately wrap back to the previous stages, wherever necessary, and to get the recovering addict back on-track with his or her goals of abstinence and sobriety.
Britt, E., Blampied, N.M., Hudson, S.M. (2003). Motivational interviewing: A review. Australian Psychologist, 38(3), 193-201.
Ilgen, M.A., McKellar, J., Moos, R., Finney, J.W. (2006). Therapeutic alliance and the relationship between motivation and treatment outcomes in patients with alcohol use disorder. Journal of Substance Abuse Treatment, 31(2), 157-162.
Kinney, J. (2012). Loosening the grip: A handbook of alcohol information. NY: McGraw-Hill.