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 – During this stage, people become more and more aware of the potential benefits of making a change, but the costs tend to stand out even more. This conflict creates a strong sense of ambivalence about changing. Because of this uncertainty, the contemplation stage of change can last months or even years. In fact, many people never make it past the contemplation phase. During this stage, you may view change as a process of giving something up rather than a means of gaining emotional, mental, or physical benefits.

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.