Five Stages of Change

The Transtheoretical Model of Change is currently the most complete picture we have in psychology to explain how and why individuals are able to create and sustain behavioral or attitudinal changes in their lives. It is my hope that by helping the reader to better understand this model I can help you to better understand the behavior of a loved one suffering from addiction. This model is primarily based on the work of Prochaska and DiClemente who first developed it in a study published in 1983. While useful and informative when dealing with substance use it should be understood that the insight provided by this model need not be limited to the treatment of addiction. It has been shown to be descriptive of behavioral change across a wide spectrum of behaviors and individuals.

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1. Precontemplation

Individuals in this stage often are resistant to any mention or conversation of the behavior in question.

The precontemplation stage is characterized by an individual having no intention of modifying his or her behavior. Often he or she is not able to acknowledge that said behavior has any negative impact on themselves or others. Individuals in this stage often are resistant to any mention or conversation of the behavior in question. He or she is not engaged in the change process in an immediate sense and may resist any effort from others aimed at getting them to quit. Often individuals in this stage are thought to be in denial. My experience of these individuals, more often than not, is that they are aware of their behavior(s) but don’t see them as a problem yet. 

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2. Contemplation

He or she is now more aware of the personal and social consequences of their actions.

During the contemplation stage of change the individual in question is becoming aware that his or her behavior is problematic. He or she is now more aware of the personal and social consequences of their actions. Parallel to this, the individual is beginning to be more cognizant of the benefits of change. That said he or she is often still ambivalent of undertaking the change. At times an individual will pass through this stage very quickly while for others it may take months or years. As someone concerned with a loved one suffering from addiction you will most often find them more open to conversation and information surrounding their problematic behavior. Often for substance use disorder the fear of the detox process, and other short term costs associated with quitting will nag at the individual. They are thinking about quitting and want to want to stop.

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3. Preparation

Preparation is one of the shortest stages and often lasts no more than a couple of weeks

In the preparation stage of change the person of concern is now prepared to make a change. This could also be called the research phase as often one in this stage will actively be attempting to accumulate information and knowledge germane to their problem. He or she may be calling treatment centers and other providers, or be searching on the internet for information about their problem. He or she may even be attempting to take their first tentative steps toward modifying their behavior or abstaining completely. Preparation is one of the shortest stages and often lasts no more than a couple of weeks.

4. Action

This is also a very tenuous time as success is largely dependent on the willpower and commitment of the individual

This is the shortest of the stages and lasts no more than six months. The individual has begun to take decisive noticeable actions to change or abstain from the behavior in question. This is also a very tenuous time as success is largely dependent on the willpower and commitment of the individual. He or she is paying the short term costs of change without yet enjoying many of the benefits. Also, the individual will not yet have been able to develop many methods for staying committed to change or coping mechanisms for when stress and temptation arise. Risk of relapse is greatest during the action stage.

5. Maintenance

By this point one will be able to mostly avoid temptation to return to former behavior and if tempted will have developed coping mechanisms to successfully overcome the temptation.

After six months in the Action stage an individual will progress into the maintenance stage of change. During maintenance an individual's behavior has changed. With addiction he or she will be abstinent. By this point one will be able to mostly avoid temptation to return to former behavior and if tempted will have developed coping mechanisms to successfully overcome the temptation. A maintainer will be increasingly focused on the good that has come as a result of change and will be determined to maintain the new state of affairs moving forward. He or she will feel a strong sense of self efficacy and satisfaction at having been able to change.

In the original work by Prochaska and DiClemente there was a sixth stage that they termed Termination. In Termination, former behaviors are non existent and are no longer perceived in a positive fashion ever. I find the inclusion of this stage problematic as it relates to addiction. Addiction is a chronic disease and often relapse is a component of change. This is true of many other chronic medical conditions. The rate of relapse in addiction is lower than with asthma and hypertension, and only marginally higher than with diabetes. Therefore, while not a necessary consequence relapse happens often enough that it needs to be considered a part of the process of change. It is most useful to move away from the conception of relapse as a personal failing. Rather in viewing it within the broader scope of chronic illness, as I’ve tried to illustrate above, we can empower an individual to learn from the process and not to let it derail the overall effort at recovery.

While not specifically noted in the research it is imperative to understand that most often it is the efforts of family and friends to support an individual in making a change that creates momentum moving through the stages. It is never too early to start a conversation. There are many methods which can be employed to do so and to help support health change in an individual and within a family system.

If you are concerned that a loved one is in active addiction and need help please consult a professional, their guidance can be indispensable. If you have questions, or concerns, and we can be helpful please don’t hesitate to contact us at Granite Mountain BHC, through our website or by phone at 844-878-3221. We are here to help.

Until next time

Your friend in service,

Rob Campbell


If you or someone you know is in need of help for substance use disorder call us today at 1-844-878-3221 or reach out to us via email.