Evidence Based Practices: Stages of Change

Facilitating a major change in behavior for our clients requires a thorough understanding of the underlying stages of change.

The Stages of Change Model (or SCM) helps our clinicians “meet clients where they are” and use the appropriate therapeutic processes to help them through a very drastic change in their lives.

The stages that are outlined in the SCM include:

  • Precontemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance

If you look closely at the process of someone who is an active addict or alcoholic and successfully becomes sober, you will see that they progress through each of the following stages:

  • Precontemplation (Not Ready): the user has not intention of changing their behavior. It is possible that the user is still in denial that there is a problem.
  • Contemplation (Getting Ready): at this point, the user has acknowledged that a change is necessary and is thinking about attempting to change.
  • Preparation (Ready): the user is preparing to make the change (ie accepting that treatment will be necessary).
  • Action: the user is trying to quit using drugs and/or alcohol.  The user is often in treatment, participating in the treatment curriculum and trying to learn new behaviors.
  • Maintenance: the user has changed their behavior (stopped using drugs and alcohol) and is doing work to solidify their new pattern.  Hopefully, by the time the user leaves treatment they are solidly in the maintenance phase and use continuing care resources (counseling, 12-step meetings) to transition back to their home (or wherever they move) while maintaining the sobriety.

Relapse and Length of Treatment

The stages of change are fluid, and can change with a relapse. Relapse is by no means a failure or a complete loss of previous progress, but an indicator that different processes and activities are warranted to return the client to a stable drug-free routine.

Still, there have been many studies showing a positive correlation between time spent in residential treatment and likelihood of long term successful outcomes (sobriety). One way to look at this data is from stages of change perspective: the client who has been in treatment longer has had more time to assimilate new behaviors in the Action and Maintenance stages, strengthening the adoption of these new behaviors and reducing the likelihood of relapse.

Approaching Clients “Where They Are”

The value in about recognizing what stage of change a client is in is being able to approach them in a way that they will respond to. If the person is in the Precontemplation stage, then it is not appropriate to try and get them to plan for which 12-step meetings they will go to or participate in working the steps. At this stage, the clinician is better off using Motivational Interviewing techniques to artfully guide the client to self awareness of their problem behavior.

An intervention may take a client from the Precontemplation stage into the Action phase in one sitting. This is why interventionists are always familiar with the stages of change and have received a lot of training in leveraging the client’s support system to quickly move the client through the first 3 stages of change.

For information about planning an intervention or any other aspect of treatment, please contact our admissions team.