The Stages of Change

By Patrick O’Neil

It can be difficult to comprehend why someone struggling with addiction and alcoholism doesn’t just stop using and get sober. From the outside addiction doesn’t make sense to people that care. Many addicts and alcoholics are in denial of their substance abuse and the resulting negative consequences. While others want to stop but don’t know how. Some days they exhibit the willingness for change by seeking out the help they need. Other times they have relapsed and are absent from life. This doesn’t make them bad people. It’s just the nature of the disease. Yet what’s important to realize is that recovery isn’t always linear. There will be progress, setbacks, willingness, unwillingness, inactivity, and change. 

The honest truth is recovery from active addiction is not easy. It takes a desire to change, determination, and a lot of hard work. “In fact,” writes Dr. Tom Horvath, “change of any sort is usually somewhat stressful and uncomfortable. Whether or not someone attempts [recovery on their own] or gets help, ‘something’ must change. In other words, ‘something’ must cause them to move away from addiction and toward recovery. That ‘something’ is the motivation to change.”

And while it may be hard for those that do not suffer from addiction to grasp what it’s like to be struggling. It’s very important for them to understand what stage of change the addict and alcoholic is in—as it directly correlates to where they are in their recovery and how they can best support them. “Psychologists have developed effective ways to help people change their behavior,” states psychosocial rehabilitation specialist Kendra Cheery, “one of the best-known approaches to change is the Stages of Change… [where] change occurs gradually and relapses are an inevitable part of the process. People are often unwilling or resistant to change during the early stages, but they eventually develop a proactive and committed approach to changing a behavior.

Here are the “Stages of Change” broken down into explanatory steps in order to help loved ones and family members get a better understanding of an addict’s motivation for recovery. 

1. Precontemplation: Possibly the hardest stage for the addict and alcoholic’s family, friends, loved ones, and significant others. In precontemplation the addict and alcoholic do not see their addiction as a problem. “An individual in the pre-contemplation stage of recovery still prefers to remain in active addiction rather than to seek any rehabilitative services,” writes journalist Dane O’Leary. “In short, the perceived benefits of continuing to abuse alcohol or use drugs are thought to be greater than the cost and repercussions.” According to the Substance Abuse and Mental Health Services Administration, “This [person] needs information linking [their] problems and potential problems with [their] substance abuse. A brief intervention might be to educate [them] about the negative consequences of substance abuse.”

2. Contemplation: In this stage the addict and alcoholic, “are willing to consider the possibility that they have a problem, and the possibility offers hope for change,” writes Dr. Mark S. Gold. “However, people who are contemplating change are often highly ambivalent. They are on the fence. Contemplation is not a commitment, not a decision to change. People at this stage are often quite interested in learning about alcoholism and treatment.” According to life coach Kate Larsen, “At this stage, identifying and amplifying a person’s internal motivators for behavior change — the things uniquely important to them as an individual — is very important to tipping the scales. Just as we have behavioral habits, we also have thinking habits. And generally, those mental patterns have to shift before lasting behavior change can occur.

3. Preparation: “In transitioning from contemplation to preparation, the addict realizes the repercussions of addiction far outweigh any perceived benefits,” proclaims O’Leary. “Moreover, he or she decides the behavioral changes necessary to get sober are attainable and accepts that there’s a need for treatment, thus beginning the preparation stage. Once this stage is reached, the individual is aware that making better choices will be life-changing.” For the addict in the preparation stage Cheery suggests, “[gathering] as much information as you can about ways to change your behavior. Prepare a list of motivating statements. Write down your goals. Find resources such as support groups, counselors, or friends who can offer advice and encouragement.

4. Action: This is probably the most encouraging stage for the addict, their families, friends, and loved ones. Here the addict believes they have the ability to change. They immerse themselves in their recovery; enter treatment, attend 12-Step meetings, go to counseling, and commit to staying abstinent. “The action stage is more than getting sober,” writes O’Leary. “Rather, the individual is committing to making significant lifestyle changes that will ensure a healthier and more productive life moving forward.” According to Dr. James Prochaska, “During the Action stage, when people are working to strengthen their commitment to the change, external support is critical. Even though they may not be inclined to ask for it, people in this stage benefit from offers of emotional and physical support, and from having people around them recognize their progress and help keep them accountable.”  

5. Maintenance: In this stage “a person is able to maintain their changed behavior over a sustained period of time,” writes Dr. Gold. “New behavior becomes self-sustaining and takes the place of drinking and associated behaviors. Change requires building a new pattern of behavior over time, and continues on its own momentum with little outside intervention.” The Substance Abuse and Mental Health Services Administration further defines the actions of the maintenance stage as when an addict “attends counseling regularly, is actively involved in AA or NA, has a sponsor… has made new sober friends, and has found new substance-free recreational activities.” According to author Jessie Sholl, being in this stage “means they’ve successfully avoided or overcome the obstacles that could have caused them to slip back into old behaviors. Through practice, they’ve attained a greater level of confidence and capacity. Their new behaviors have started to become a more integrated part of their lifestyle and identity, and their risk of relapse is much lower than when they began.

6. Termination:At termination stage, the transformation of recovery is basically complete,” writes O’Leary. “Although remaining sober is a lifelong endeavor, an individual in the termination stage of recovery is likely to have regained his or her health, maintains healthy relationships, has a stable job or career, is financially independent, and feels confident that he or she will remain in this state. When asked, most individuals in this stage have no desire to return to active addiction and are relieved to no longer have the same habits as when they were addicted.” According to Dr. Horvath “[the] characteristics of this stage include: confidence; enjoying self-control; and appreciation of a healthier and happier life. The relapse prevention plan has evolved into the pursuit of a meaningful and healthy lifestyle. As such, relapse into the former way of life becomes almost unthinkable.

And speaking of relapse: It is often said that relapse is a part of recovery. However the reality is relapse is a symptom of the disease. Left untreated addiction will always win over willpower. At any stage of change there is the possibility of relapse—especially if the addict or alcoholic does not maintain their program of recovery. As stated earlier, “recovery from active addiction is not easy,” and “isn’t always linear,” and relapses do occur. Yet relapse isn’t the end of recovery, as sometimes, after the addict or alcoholic has relapsed numerous times they are able to finally realize what recovery means and how precious sobriety is.

Understanding your readiness to change by being familiar with the six-stage model of change can help you choose treatments that are right for you,” states, Dr. Gold. “A treatment professional with the right training will understand where you are in terms of readiness to stop drinking [and using] and help you find and maintain the motivation to stop.” Changing even the most extreme addiction or mental-health issue begins with saying, “Yes, I want to do this!” The staff at CAST Centers would like to help guide you in discovering the freedom from active addiction and in turn allow you to be your best self.

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