Change isn’t as simple as doing something different. Research suggests that behavior change is actually a process that includes several steps. And many of these steps begin in a person’s mind.
The stages of change model developed in the 80’s continues to be used to describe the process of change (1, 2, 3). This model suggests that there are 5 distinct stages of change that people progress through when they make a major life change. Addiction treatment uses this model to help people overcome drug and alcohol problems.
Each stage of change is marked by specific patterns. These patterns show up in the way a person thinks about their drug or alcohol use. It also shows up in how it affects their decisions to use.
As a person progresses through the stages of change, they become more aware that their drug and alcohol use is a problem. As a result, they become more ready, willing, and able to engage in recovery.
Each of the 5 stages of change discussed below provide specific examples to help readers determine which stage of change they are in. They also provide specific methods of advancing to the next stage.
Stage I: Precontemplation
Precontemplation is the first stage of change. It is characterized by a lack of awareness that there is a problem or a need to change. A person who is in the precontemplation stage is often described as being in ‘denial’. This is because they are unwilling to be honest with themselves about their substance use and the problems it has created for them (1, 2). Being in denial isn’t always a conscious choice a person makes.
Most people in denial over their addiction can convince themselves that they don’t have a problem. They do this in several ways, including (2, 3):
- Comparisons: People in precontemplation may compare themselves to other people. Especially to those who they perceive as having more serious or severe drug or alcohol problems. This can lead to thoughts like, “at least I’m not as bad as so-and-so”. Sometimes, people will also compare themselves to a stereotype of what they assume an addict is. This leads them to think, “I can’t be an alcoholic because I can go a few days without drinking”. Or, “I get up and go to work every day so I must not have a problem”.
- Excuses: People in precontemplation stay stuck in denial by making excuses for their substance use. They might blame “stress” or “back pain” or tell themselves that “it’s ok because I’m not doing any hard drugs”. These kinds of excuses allow them to feel like there is a valid reason or excuse that makes the substance use ok.
- Avoidance: People in precontemplation often avoid conversations or situations that make them think about their substance use. They might become defensive or evasive in conversations with others about how much or how often they use. They might even hide their use altogether to keep others from confronting them about it. Avoidance of thinking about their drug or alcohol use is a key strategy that keeps people in denial.
Developing honest self-awareness is what helps people in precontemplation move to the next stage of change. This requires people to do some honest reflection. This is done by asking themselves some hard questions and acknowledging the truth even when it’s uncomfortable. Some of the ways to start this process include journaling or talking with another person. Reflecting on the following questions help too:
- How much and how often are you actually drinking or using drugs? If you aren’t sure, set aside a week and track your use each day to become more aware of your current patterns.
- Have you been successful in cutting back or stopping on your own? Consider challenging yourself to go 2 weeks without drinking or using drugs to test this.
- Has your drug or alcohol use caused any problems, consequences, or unwanted effects? This can be on your physical or mental health, work, relationships or other areas of life.
Stage II: Contemplation
The second stage of change is when a person acknowledges that there is a problem. But they flip back and forth between knowing they need to change and not wanting or feeling ready to.
Contemplation is an uncomfortable stage for people because they are more aware that their drug and alcohol use is a problem. But they struggle with the idea of stopping. Many different kinds of thoughts and internal conflicts can plague people in the contemplation stage, including (1, 2, 3):
- Feelings of fear and doubt: People are afraid of stopping their substance abuse because they worry they won’t be able to function without the substance. They might also fear that they aren’t strong enough to stop. Withdrawal symptoms can also cause fear. They might even worry that their life would become boring and completely meaningless without the substance.
- Ambivalence: Ambivalence is also common in the contemplation stage. It describes the conflicting feelings a person has about getting clean and sober. They might go back and forth between wanting to stop and not wanting to. Feeling ready and not, or feeling sure they will and then going back into doubt or fear. These mixed feelings can create a lot of confusion for people. This can result in erratic decision making.
- Defensiveness: People in contemplation are often defensive towards others who push them to cut back or stop. They might lash out, pull away or stop talking to a loved one who confronts them about their substance use. They might do so even if they are encouraging them to get help. This is often indicative of the inner conflict they are having about their substance use. It is often not about a conflict with the other person.
To move through the contemplation stage, people need to make a commitment to change. And they need to stick to this commitment even when they experience fear, doubt or ambivalence. Some of the things people in the contemplation stage can do to move forward include (1, 2, 3):
- Identifying your “why”: Knowing your reasons for wanting to cut back or stop is important in helping you make a commitment to change. Make a list of some of the major motivators that make you want to stop. This can include things you are afraid might happen if you keep using.
- Talk about change: Talking to other people about making a change actually makes it more likely that you will follow through. You can talk with a close friend for support. A counselor trained in addiction can help. You can even show up at a 12 step or other recovery meeting to begin these conversations.
Stage III: Preparation
The next stage of change is preparation. This includes planning and preparing to make a change. There are certain ways that some people get stuck in the preparation stage. Some of the common traps that can keep people stuck in preparation include (1, 3):
- Setting a date too far out: Setting a quit date that is months or more in the future might relieve some anxiety. But it can also set a person up to fail. Setting a date within the next 30 days is the key to committing to following through with the plan.
- Being too flexible with the date: Having a plan to cut back or stop using that is too flexible is another common trap. For example, planning to stop “if” or “when” you get a job or get time off. This makes it likely that you’ll keep changing the plan as the date draws near.
Preparation comes after a person has made a commitment to cut back or stop using. It is a stage characterized by being proactive about putting a plan into place. This plan should have some components, including (2, 3):
- Setting a preliminary goal: Part of what keeps people going back and forth about stopping is the idea of never being able to drink or use drugs again. People who aren’t ready to commit to being sober can bypass this by setting a short-term goal for themselves. Agreeing to go a month without drinking, for example.
- Identifying a timeline: It’s normal for people in contemplation to set a quit date and then keep pushing it back. But this keeps them from being able to move forward. Setting a firm quit date that’s not too far in the future is important. It provides the commitment needed to progress to the next stage.
- Planning for success: The more time goes into planning and preparing for the quit date, the more “ready” people will feel when the day arrives. This can include steps like initiating treatment, taking a few days off work, and getting rid of temptations or triggers in your home.
Stage IV: Action
The action phase is when the actual behavior change begins. This phase occurs when a person makes some kind of behavior change to cut back or stop using drugs or alcohol. The action stage is one where people need a lot of support and encouragement to be able to follow through with their plan. It is also when they will encounter the biggest risks for relapse. Some of the ways that people in the action phase can help to ensure their success include (2, 3):
- Social accountability: Telling those closest to you that you are making a change can help you be successful. Knowing these people will ask you about your progress or notice if you slip up will help motivate you to stay on track. Telling other people will also help you build a support system. You can talk to your support system about your recovery during times when it is hard.
- Slow down and think before acting: Many poor decisions are the quick ones made in moments of stress. Getting emotional or having a strong craving or urge are times of stress. Slowing down and pausing to think before making any decision can help you avoid impulses.
- Stay connected to a recovery plan and community: Staying connected to supportive people and routines is another way to stay on track. While you might lose motivation or interest in continuing them, doing them can be the difference between recovery and relapse.
Stage V: Maintenance
The final stage is maintenance. This occurs when a person has been successful in making a change and sustaining it for a substantial period of time. 90 days is often used as a marker in the recovery world that can signal the shift to maintenance. But some people consider this stage only when a person has a year or more clean.
During maintenance, people no longer need to invest so much of their time, effort and energy into staying clean. However, remaining vigilant for signs of relapse is a key to long-term success (3).
Some of the signs that can indicate relapse include:
- Feeling more easily stressed, upset or overwhelmed
- Wanting to withdraw from other people or recovery activities
- Having positive memories about drug or alcohol use
- Minimizing or questioning sobriety or the harmfulness of your addiction
- Becoming very busy, overcommitted, and not making time for self-care
- Tempting fate by putting yourself in situations where you could relapse
Some of the ways that people in the maintenance phase can prevent relapse include (2, 3):
- Stay aware of the warning signs (those listed above and any individual warning signs you identified in treatment).
- Be proactive about managing your stress in healthy ways by practicing self-care, setting boundaries, maintaining work-life balance, and not overcommitting yourself.
- Stay connected to your supports by not pulling away, isolating or withdrawing during times when you are doing poorly or even times when you are doing well.
- Continue to practice healthy coping skills that don’t rely on distraction or avoidance, including exercise, talking to supports, creative hobbies, etc.
- Keep a structured routine that includes time for things you need to do and also things you want to do and enjoy doing.
- McConnaughy, E. A., Prochaska, J. O., & Velicer, W. F. (1983). Stages of change in psychotherapy: Measurement and sample profiles. Psychotherapy: Theory, Research & Practice, 20(3), 368.
- Miller, W. R., & Rollnick, S. (2004). Talking oneself into change: Motivational interviewing, stages of change, and therapeutic process. Journal of Cognitive Psychotherapy, 18(4), 299-308.
- Zimmerman, G. L., Olsen, C. G., & Bosworth, M. F. (2000). A’stages of change’approach to helping patients change behavior. American family physician, 61(5), 1409-1416.