Transtheoretical Change Model
The Transtheoretical Change Model is the most common way to understand the ways in which behavioral change occurs in addiction recovery. Developed by Prochaska and DiClemente, the Transtheoretical Change Model is also known as the Stages of Change Model and posits that there are five main stages people move through as a new behavior takes hold. These stages are Precontemplation, Contemplation, Preparation, Action, and Maintenance. Later evolutions of the model added a sixth stage of Termination or Relapse, depending on the behavior. Let us explore how these stages specifically apply to addiction, treatment, and the recovery process.
The first stage is called Precontemplation. In the Precontemplation stage, a person does not consider their behavior to be a problem. This may be due to lack of negative consequences from their behavior, or it could be a result of denial about the severity of the consequences they have experienced thus far. A person in this stage does not see the behavior as a problem and might say, “I can quit anytime I want.” However, negative consequences do eventually begin to take effect. These negative consequences can lead someone into the Contemplation stage.
During the Contemplation stage, a person realizes that they have a problem. Those in the Contemplation stage of change are more open to the idea of changing their behavior. They begin to contemplate their substance use and the effects it is having on their life (and those around them). However, the person is not yet ready to commit to making a behavioral change. Some people stay in this stage for long periods of time. They may move back and forth between Precontemplation and Contemplation for some time before moving on to the next stage.
The next stage of change is called Preparation and involves someone actually “preparing” to make a behavioral change. The person realizes that they have a problem and they understand that they need to fix something. They might reach out for help. They may take the steps to call clinics and research rehabilitation programs. But, they still continue to use drugs or drink alcohol. The next step is to actually make the step and implement the tangible change.
During the Action stage, a person makes active changes in their lives. They come to terms with the fact that their substance use is destructive to their quality of life. They also decide to take actions in order to arrest its progression. This stage may include participating in medical detoxification if it is needed, attending treatment, and starting the recovery process. This stage carries the highest risk of relapse. This is due to the fact that an actual behavioral shift has occurred and old habits and patterns pull someone back toward the familiar.
The final stage of change in the Transtheoretical Change Model does not have a designated endpoint or natural shift into another stage. The Maintenance stage can last for a lifetime as a person solidifies the changes made during the Action stage and continues practicing the habits to maintain long-term recovery. The intensity of cravings will likely lessen over time, but there always remains the risk of relapse. Since addiction is understood as a chronic and progressive disease, the Termination stage (the ability to abstain from drugs without effort) is likely not an accurate descriptor for the behavioral changes which occur in those who maintain long-term sobriety. The Relapse stage can occur at any time during action or maintenance. A person might return to any prior stage from Precontemplation through Preparation (and even right back into Action after what is sometimes referred to as a “slip”) upon experiencing Relapse. Relapse is not inevitable in recovery, but can be an occurrence and is evidence of the chronic, recurring, and episodic nature of the disease of addiction.
One interesting note about these stages is that they can apply independently to different substances within the same person. For example, someone might be in Maintenance for Opioids, Action for Cocaine, Preparation for Methamphetamine, and Precontemplation for Marijuana. That is why a thorough diagnostic assessment is so important, as it gives a clearer picture of the individual and their current readiness to change as it relates to each substance.
The Transtheoretical Change Model is a useful tool to help clients and professionals understand where someone is in their understanding of drug and/or alcohol abuse and its consequences as well as their commitment to the recovery process. This model can apply to any change a person makes, but for our purposes we are concentrating on the problematic behavior of substance use. Ambivalence about change is a normal part of any significant change process, and is especially present when taking the uncomfortable steps to address addiction issues. This introduction of the Stages of Change Model was meant to increase understanding of both our diagnostic assessments, which specifically question a person’s thinking about their substance use behaviors and readiness to change, and interventions, which target motivational enhancement and commitment as well as behavioral change.
