Addictions

 

Many people struggle with habits that are potentially self-destructive including smoking, gambling, and over consuming alcohol.  Frustrated at their lack of progress in helping people break free of addiction, researchers uncovered the process necessary to strengthen self-control. Knowing at which "stage of change" a person is illuminates what needs to happen to progress forward.

 

Precontemplation

Precontemplation is the stage in which people are not intending to change or take action in the near future, usually measured in terms of “the next six months.”  People may be in this stage because they are uninformed or under-informed about the consequences of their behavior.  They may have tried to change several times and become demoralized about their abilities to do so.  They also may be defensive, denying there is a problem.  People in this stage avoid reading, talking, or thinking about their high-risk behaviors. 

 

People in precontemplation underestimate the benefits of changing and overestimate the costs.  They typically are not aware that they are making such mistakes.  If they are not conscious of making such mistakes, it will be difficult for them to change.  Many remain mired in the precontemplation stage for years, doing considerable damage to their bodies, themselves and others.

 

Contemplation

Contemplation is the stage in which people intend to change in the next 6 months.  Although more aware of the pros of changing, they also are acutely aware of the cons. When people begin to contemplate acting seriously, their awareness of the costs of changing can increase. There is no “free change.” The balance between the costs and benefits of changing can provoke profound ambivalence. This ambivalence can reflect a type of love-hate relationship, as with an addictive substance or destructive relationship, and it can keep people immobilized in this stage for long periods.  We often characterize this phenomenon as chronic contemplation or behavioral procrastination. 

 

Preparation

In this stage people intend to take action in the immediate future, usually measured in terms of “the next month.”  Typically, they have taken some significant action in the past year.  Individuals in preparation have a plan for action, such as going to a recovery group, consulting a counselor, talking to their physician, buying a self-help book, or relying on a self-change approach.  These are people best recruited for brief action-oriented treatment programs. They are ready to use them.

 

Action 

Action is the stage in which people have made specific, overt modifications in their lifestyles within the past 6 months.  Because action is observable, behavior change often has been equated with the action stage. 

 

Maintenance

In maintenance, people are working to prevent relapse, but they do not apply change processes as frequently as do people in action.  They are less tempted to relapse and are increasingly more confident that they can continue their changes.  Based on clients’ reports of self-efficacy and temptation experienced, it is estimated that maintenance lasts from 6 months to about 5 years.

 

A common reason that people relapse early in action is that they are not well prepared for the prolonged effort needed to progress to maintenance.  Many think the worst will be over in a few weeks or a few months.  If they ease up on their efforts too early, they are at great risk of relapse.

 

Overcoming chronic problems, like addictions, is like running a marathon.  Only those well prepared can sustain their efforts mile after mile.

 

Termination

In this last stage, individuals experience zero temptation and 100% self-efficacy.  No matter whether they are depressed, anxious, bored, angry, lonely, or stressed, they are confident that they will not return to their old unhealthy pattern as a way of coping.  It is as if they never developed the pattern in the first place.  Although the ideal goal is to be cured or recovered, for many people the best that can be accomplished is a lifetime of maintenance.

 

Implications

The pros of changing must increase for people to progress from precontemplation. Identify all of the benefits of changing.

 

The cons of changing must decrease for people to progress from contemplation to action.

 

An Excellent Resource Book:

Changing for Good: A revolutionary six stage program for overcoming bad habits and moving your life positively forward: James O. Prochaska, John Norcross, Carlo DiClemente.

Internet Resources:

HeretoHelp - Alcohol and Other Drugs

American Family Physician - A "Stages of Change" Approach to Helping Patients Change Behavior 
 
Online Quit Smoking Program:

Albertaquits.ca