The Stages of Change Model

Interventions for people with self-destructive behaviors (such as substance abusers) have to be tailored to individuals with varying levels of readiness to change. The Prochaska and DiClemente model, developed over the past 20 years, identifies 5 stages: precontemplation, contemplation, preparation, action, and maintenance (1). It covers a cycle of attitudes from denial to secure, solidly established commitment to change. The stages-of-change model is particularly influential in the field of addictions. More often than not, individuals regress to earlier stages of change before permanently reaching the maintenance stage—as is illustrated by Mark Twain’s observation: “Quitting smoking is easy, I have done it many times.” Here is a description of the five stages (click on a stage for some thoughts about how to approach someone in that stage):

1. Precontemplation - no thought of changing, now or later. Others who care about us may repeatedly urge us to take action on our problem but at this stage, we are deaf to their pleas.

2. Contemplation - thinking about changing, about why one follows the bad habit, what its payoff is. Bring both the rational mind and the emotions into play to move yourself to a commitment to change.

3. Preparation - remove temptations, plan how action will be taken, arrange support and understanding from family, friends, perhaps a support group. Arrange substitutes for the missed habit or activity or substance. Beware of substituting a new problem (over-eating, over-spending) for the old.

4. Action - the stage most of us picture, actual practice of the new way of being.

5. Maintenance - Prochaska shows that many people benefit from learning the difference between a lapse and a total relapse, (a complete collapse back into the old way). Being prepared to recognize a lapse and take immediate action can save the effort.

It is entirely possible for a person to fail at one stage or another, only to make a second or subsequent attempts that succeed.