Recovery from addiction is about behavioural change. James Prochaska and Carlo DiClemente’s model about the stages and processes of behavioural change has made a very significant contribution to the field. I have described this model in some detail in my article Understanding Intentional Behavioural Change. Here, I include the first part of this article: which focuses on stages of behavioural change.
‘The Transtheoretical Model of Intentional Behavioural Change, originally developed by James Prochaska and Carlo DiClemente starting in the late 1970s, emerged out of the perceived need to find an integrative framework that could bring together fragmented approaches to treating problematic behaviours.
The model was derived from an analysis of the diverse theories of how people change, and their related therapies, and highlighted potential common processes that could be identified across the various perspectives. [1,2]
Early research investigations focused on how nicotine-addicted smokers were able to quit smoking. However, these investigations broadened into an exploration of how people change various addictive behaviours, both through self-change and through treatment.
As research further expanded, it became evident that the process of change is a generic one—there is a common pathway involved whenever an individual moves through intentional change, be it an addictive behaviour or a general health behaviour.
The Transtheoretical Model consists of four broad dimensions of change and their interactions—stages, processes, markers, and content of change.
1. Stages of Change
Prochaska and DiClemente proposed that intentional change comprises a series of five stages, with each stage representing specific tasks that must be completed and goals that need to be achieved if the individual is to move from one stage to the next. These stages of change are:
Precontemplation is the stage in which people have no intention of changing their behaviour. They may be at this stage because they are uninformed, or under-informed, about the consequences of their problem behaviour. Alternatively, they may have tried to change a number of times unsuccessfully and now feel demoralised.
People at this stage may be in denial. They tend to avoid reading, thinking, or talking about their problem. Their family, friends or work colleagues may see they have a problem, and may complain or pressurise the person, but they can’t see the problem.
Tasks of this stage involve an increased concern about the pattern of behaviour, an increased awareness of the need for change, and an envisioning of the possibility of change. The goal is a serious consideration of changing this behaviour.
Contemplation is the stage where people acknowledge that they have a problem and begin to think seriously about solving it. They may have difficulties in trying to understand the problem, seeing its causes, and may be unsure about solutions.
The Contemplation stage involves a process of evaluating risks and benefits, the pros and cons of both the current behaviour pattern and the potential new behaviour pattern. The person may experience a profound ambivalence that can keep people stuck in this stage for long periods of time. There must be an increase in the pros for change and decrease in the cons for the person to move to the next stage.
Preparation is the stage where people develop a plan of action and create the commitment needed to implement the plan. The person must focus their attention and energy on breaking the old behavioural pattern and creating a new one. Planning is the activity that organises the environment and develops the strategies for making change. Commitment involves finding the time and energy to implement the plan.
The tasks for the Preparation stage are to summon the courage and competencies to accomplish the change.
Action is the stage where people implement their plan of action—they make specific overt modifications in their behaviour and lifestyles. Changes during the Action stage are the most visible, and therefore receive the most recognition. However, the new behaviour must be sustained over a long period time in order to create a new habit. The old behaviour retains its attraction and returning to it is often easier than sustaining a new pattern.
The tasks in this stage are to take effective action in the face of barriers and challenges to making the change.
Maintenance is the stage where the new behaviour pattern becomes automatic, requiring little thought or effort to sustain it. The new behaviour becomes integrated into the lifestyle of the person. However, there is still an ever-present danger of reverting back to the old pattern—lapses or relapses may occur. A variety of strategies are implemented during the maintenance phase to help prevent lapses and relapse.
Termination is the ultimate goal for all people changing a problematic behaviour. This is the stage where the former addiction or other problem does not present any threat. The behaviour will never return and the person has complete confidence that they can cope without relapse. There is no continued effort in maintaining termination.
It is rare that a person moves through the stages of change in a consistent and linear manner. Some people stay in Contemplation for a long period of time, then move forward to Preparation and then backward to Contemplation and Precontemplation. Some move to Preparation and make a plan, but fail to initiate the plan effectively. Others act but fail to sustain the behavioural change and return to an earlier stage in the process of change.
People can cycle back and forward before finally reaching the Termination stage.’
You can read more about the topic of behavioural change in my original article.
References:
[1] Carlo DiClemente, Addiction and Change: How Addictions Develop and Addicted People Recover, The Guilford Press, 2003.
[2] James O. Prochaska, John C. Norcross and Carlo DiClemente, Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward, Harper Collins, 1994.