Recovery Tools-Aspects of Recovery

Stages of Change

Stages of Change

The Stages of Recovery are often referred to as the Stages of Change. They are a series of thought processes for change; five steps involved in changing health behavior according to the transtheoretical model:

  • pre-contemplation (not thinking about changing behavior)
  • contemplation (considering changing behavior)
  • preparation (occasionally changing behavior)
  • action (practicing the healthful behavior on a regular basis, resulting in major benefits)
  • maintenance (continuing the behavior after 6 months of regular practice).

They were developed by U.S. clinical psychologist James O. Prochaska, and used widely as a basis for determining treatment methods for drug and alcohol use disorders.

Pre-Contemplation Stage of Change:
Pre-contemplation is the first stage of change. People in the pre-contemplation stage usually do not consider their behavior to be a problem. They may have not yet experienced any negative consequences of their behavior, or they may be in denial about the negativity or severity of the consequences they have experienced.

In this stage, most people ate not interested in hearing about negative consequences or advice to quit using or drinking. They do not see their behavior as addictive, or if they do, may validate their reasons for use.

This stage reveals unmotivated people who see no need to find a solution to a problem because they usually do not believe that one exists. Individuals in this stage are unaware of or have limited awareness of the problem or lack insight into the consequences of their negative/addictive behavior.

It is important to understand that a person in this stage is in complete denial and even tends to defend their actions. People in this stage often present as resistant, unmotivated, and unready and unwilling to change. Furthermore, this individual often obsesses about the negative side of change rather than recognizing the benefits that they would gain. In other words, the cons outweigh the pros.

Should a Pre-contemplator present to therapy, it is likely to be due to the constant pressure of others in their life, who are likely pushing them to seek help. At times, they may even exhibit elements of change as long as the pressure from others remains present and constant. If that pressure to change is no longer present, Pre-contemplators will quickly return to their old habits.

Then how does one progress to the next stage of change when there is no consideration of the recognition of a problem in the first place?

Consciousness-raising therapy, in addition to changes in life circumstances, may help. When people enter a new stage of their life, they tend to critically evaluate their behaviors and consider if those behaviors are serving them and those around them in a positive way. Until they gain such insight, an individual remains in this Pre-contemplation stage and will continue to engage in adverse behaviors. People in this stage have no intention of making a change in the next six months and often make comments like, “I don’t see a problem with what I’m doing, so there’s no reason to change anything.”

Contemplative Stage of Change:
The second stage is contemplation. This stage is marked by awareness and acknowledgment of the problematic behavior with serious consideration to change. However, the person is uncertain if the problem behavior is worthy of correcting. Therefore, this internal approach-avoidance conflict results in no commitment to taking the necessary steps toward change.

In contemplation, the problem sits “center stage,” but the actor never moves. The ambivalence and indecisiveness that occur in this stage cause people to remain stuck in “contemplation” sometimes for at least six months. In general, people in this stage are more open to receiving information regarding their behaviors and finding solutions to correct them. They may make comments such as, “I know I have a problem, and I think I should do something about it.” This behavior is also known as chronic contemplation or behavioral procrastination. 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.

This stage reveals unmotivated people who see no need to find a solution to a problem because they usually do not believe that one exists. Individuals in this stage are unaware of or have limited awareness of the problem or lack insight into the consequences of their negative/addictive behavior.

It is important to understand that a person in this stage is in complete denial and even tends to defend their actions. People in this stage often present as resistant, unmotivated, and unready and unwilling to change. Furthermore, this individual often obsesses about the negative side of change rather than recognizing the benefits that they would gain. In other words, the cons outweigh the pros.

Should a Pre-contemplator present to therapy, it is likely to be due to the constant pressure of others in their life, who are likely pushing them to seek help. At times, they may even exhibit elements of change as long as the pressure from others remains present and constant. If that pressure to change is no longer present, Pre-contemplators will quickly return to their old habits.

Then how does one progress to the next stage of change when there is no consideration of the recognition of a problem in the first place?

Consciousness-raising therapy, in addition to changes in life circumstances, may help. When people enter a new stage of their life, they tend to critically evaluate their behaviors and consider if those behaviors are serving them and those around them in a positive way. Until they gain such insight, an individual remains in this Pre-contemplation stage and will continue to engage in adverse behaviors. People in this stage have no intention of making a change in the next six months and often make comments like, “I don’t see a problem with what I’m doing, so there’s no reason to change anything.”

Preparation Stage of Change

This stage begins once the person has decided to change and begins to plan steps toward recovery. An individual who decides to stop abusing substances and plans to attend counseling, AA, NA, or a formal treatment program. This person needs work on strengthening commitment. A brief intervention might give the client a list of options for treatment (e.g., inpatient treatment, outpatient treatment, 12-Step meetings) from which to choose, then help the person plan how to go about seeking the treatment that is best for him.

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 they intend to cut down, reduce harm, or quit completely?
  • Determine how to make the change: For example, if they intend to cut down on cigarette smoking, how much should they reduce your smoking by?
  • Obtain necessary resources: For example, if they intend to use nicotine patches to stop smoking, they will need to research the most suitable type of patch, discuss a suitable dose with their 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 their 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 sexual addiction. Letting go of these reminders can be difficult, but the process can harden their resolve to overcome their addiction.
  • Put support in place: Support can include informing friends and family who want them to overcome their addiction, booking a place in detox and/or a treatment center, or finding a support group. It can even mean informing their addiction buddies (such as fellow smokers) of their plans, asking them to respect your process, and to not engage in the addictive behavior around them.

**Important note: Using friends tend to either fade away at this point, or attempt to lure them back to use. This can result in serious personal changes in an addict’s or alcoholics life, and the support of non-using friends can be a major contributor to success.

There may be many other preparations that need to be made in their specific circumstance, such as finding a clean, safe place to start their new life. If they need help from a counselor or social worker, this is the time to get it. They may also be able to help them with other preparations. Once the necessary preparations have been made, a person is typically ready to move onto the action stage.

Maintenance Stage of Change:

In this stage, the person establishes new behaviors on a long-term basis. This person attends counseling regularly, is actively involved in AA, NA, or another community support group, has a sponsor, maybe on a medically managed medication, has made new sober friends, and has found new substance-free recreational activities. At this stage, the person is actively participating in their recovery and is committed to living soberly. During this stage, relapse prevention, strengthening coping skills, and addressing medical needs. As people progress through this stage, they gain more confidence in their ability to sustain positive lifestyle changes. They are and less tempted and less fearful of relapsing.

They can maintain a new status quo and can remind themselves of the progress they have made. At times, they may have thoughts of returning to old habits; however, because of the positive strides they have made, they resist the temptation and remain on track. People become skilled at anticipating potential triggers that may result in relapse and have constructed coping strategies to combat these situations in advance. Typically, people remain in this stage anywhere between six months to five years.

This is an excellent time to reevaluate one’s triggers, reassess one’s motivation for change, reassess old/new barriers to achieving goals, and plan for stronger contingency plans. It is essential to recognize the possibility of relapse and to acknowledge it as a reality.

The maintenance stage is most challenging after a period of time has elapsed and the focus on reaching goals 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 them 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 so alternative strategies will be available to them during the maintenance stage.

Approximately fifteen percent of people who relapse regress to the Pre-contemplation Stage and often try to suppress the memory of the unsuccessful trial and thoughts of the negative behavior. Eighty-five percent of individuals who relapse return to the Contemplation Stage or Preparation Stage.

Important Note: Each stage of recovery may incorporate the stages of change, as this depicts. Recovery is individual to each person, it is not linear, and many aspects are interchangeable. It is not important to assume that a person should be at one stage or another. It is only important to support each progress wherever that might be.

Relapse-Not a Stage of Change
A word about Relapse: Relapse is defined as “returning to a diagnosable state of illness: a state that has previously been diagnosed and the symptoms of which have returned to the point where the threshold has again been reached for diagnosis.” Most acute service providers within the health care system use the word relapse and believe that it is a useful and commonly understood term. The chronic nature of addiction means that for some people relapse or a return to drug use after a period of recovery may be part of their process, but it should not be confused as a normal part of recovery.

Relapse is a symptom of the disease of addiction and should be addressed as such. Tools, such as A Relapse Autopsy(download your printable copy below), can be useful in identifying those factors that contributed to and led up to, the relapse. Relapses can be a helpful part of the recovery process if the person examines the event and makes changes to prevent future lapses. As many factors that contribute to developing addiction can factor into a relapse. Relapses are not a moral or spiritual failing; they are an indication of the strength of the disease of addiction and treatments, supports and strategies need to be re-evaluated for efficacy and efficiency.