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Stages of Change | Transtheoretical Model

Making a lasting change can be difficult. Anyone who spends time in a neighborhood gym knows that scores of people will crowd the treadmills and weight benches in the month of January. But as time passes, the resolve to follow through on their resolutions starts to dwindle.

For people struggling with a substance use disorder, making a lasting change can be extremely difficult. There are plenty of barriers to recovery like financial concerns, the fear of withdrawal symptoms, and responsibilities you have at home. But one of the most common barriers to recovery is your readiness to change. When it comes to behaviors, bad habits, and addictions, if you don’t see a problem or a need to change, it will be very difficult for anyone to get you to change.

The transtheoretical model was developed in the 1970s to help understand how people, particularly cigarette smokers, go about making a lasting change. The model is often called the stages of change and involves six unique stages.

The stages can be applied to any behavioral change from losing weight to addiction recovery. When it comes to addiction, recognizing your stage of change can help you advance toward getting the help you need to facilitate a long term change.

Learn more about the transtheoretical model and how it can help you take steps toward your recovery. 

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Can Treatment Be Effective if You Aren’t Ready to Change?

Though it’s a challenge to approach treatment before you’re ready, it’s not impossible. In fact, treatment doesn’t even have to be voluntary to be effective. Many people enter addiction treatment even if they don’t see a need for it.

Some people go to rehab to appease persistent family members. Others are compelled to go into treatment because of a court order. Some believe that you can’t get clean until you hit rock bottom and realize that you need treatment. 

While there is some truth to the fact that your mindset toward recovery is important, you don’t necessarily need to be the one who initially decides it’s time to change for addiction treatment to be successful.

Between 2007 and 2010, researchers from the University of Pennsylvania studied people under criminal justice supervision to find out if mandated treatment was effective.

Not only did they find that it could be effective, but they also found that court-ordered criminal offenders were more than ten times as likely to complete treatment compared to those that entered treatment voluntarily. 

The Six Stages of Change

The stages of change include pre-contemplation, contemplation, preparation, action, maintenance, and relapse. The stages are often depicted as a wheel where one stage leads into another. However, you may not move through each stage of change in a seamless order. It’s possible to jump around from one stage to another, skip stages, and exit and reenter at any stage.

For instance, you may be in the preparation phase when you decide to stop thinking about making a change and return to pre-contemplation. Then, you may reconsider and go right back to planning without going through contemplation again. The relapse phase can take you out of the maintenance phase, but you might get right back to the action phase when you decide to continue in your recovery.

Here’s a brief overview of each of the stages:

Pre-contemplation is the earliest stage of change in the transtheoretical model. This stage is marked by denial or complete ignorance of the problem. People in pre-contemplation aren’t thinking about making a change, and if they’re confronted with their need to change, they may remain in denial. Denial may cause you to be ignorant of damaging behavior, and the strain substance use is putting on your health, relationships, finances, and other areas of your life.

Some people move beyond denial to resignation. If you’ve been through several relapses, you may feel like you’re not capable of achieving sobriety. To examine whether or not you’re in this stage, ask yourself what would need to happen for you to make a change. You can also think about the things your close friends and family members have been saying about your substance use. Are these concerns warranted?

Contemplation is the stage where a person first starts thinking about potentially making a change. They become more aware of the harms that may be caused by their substance use, and they may start to see the positives that may come from making a change. At the same time, people in this phase might find the prospect of changing to be a daunting task.

They may also struggle with the idea of quitting a substance for good. Contemplation is marked by mixed emotions and internal conflict, and it can last for a long time. Getting past this phase can be difficult, and many people never get beyond it. However, it helps to think of change in terms of the benefits you’ll be gaining from sobriety.

The preparation stage involves taking active steps toward making a change in order to prepare. This stage is often marked by collecting information about what you would need to do to make a change. You may also start to experiment with small changes.

In the case of drug use, you might start to cut back on your doses or take doses less frequently. Preparing for recovery can also involve collecting information about detox, addiction treatment, or community resources. It can help to make a list of your goals and things you need to accomplish to start on the path to recovery. Make a plan of action and take active steps toward them.

The action stage is the most visible stage of change and involves taking direct action toward achieving a lasting change. Strategies to improve success in this phase include seeking support and accountability, rewarding your success, and making a list of motivating factors.

It’s important to reassess your strategies frequently and make adjustments where needed. When it comes to addiction, this phase will likely include addiction treatment where you can address underlying issues of addiction and develop relapse prevention strategies.

This phase is where the new behavior is maintained. In recovery, this is when you will apply your relapse prevention strategies in independent life. It helps to continue your pursuit of recovery by staying involved in community resources like 12-step programs and staying connected to your support system.

Relapse can happen at any time after you start to make a change. Some people chose to present the stages of change without the relapse stage to avoid it being perceived as an inevitable part of the process, though it is often a part of recovery.

Relapses are characterized by a return to old behaviors and can bring feelings of disappointment, self-doubt, and hopelessness. It helps to revisit triggers and barriers to success that can be overcome in the future. It may also help to recognize that treatment and the work you’ve put in up to relapse isn’t worthless because it allowed you to learn about yourself and addiction. A relapse isn’t inevitable, but if it happens, it also doesn’t mean that you are incapable of success in recovery.

Sources

Boston University School of Public Health. (2018, August 29). Behavioral Change Models. Retrieved from http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html

Coviello, D. M., Zanis, D. A., Wesnoski, S. A., Palman, N., Gur, A., Lynch, K. G., & McKay, J. R. (2013, April). Does mandating offenders to treatment improve completion rates? Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578041/ National Institute on Drug Abuse. (2016, February). 8: Medical detoxification. Retrieved from https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/7-medical-detoxification

National Institute on Drug Abuse. (2018, January). Principles of Effective Treatment. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment

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