About two decades ago, two alcohol abuse researchers, Carlo C. DiClemente and J. O. Prochaska, designed a stages of change model intended to help addiction professionals improve their understanding of patient substance abuse and motivate change.
The model is based on the researchers’ personal observations of how people successfully mitigated addiction behaviors, such as smoking, drinking, and overeating.
The stages of change include:
A treatment professional with proper training can use the stages of change model to help patients understand their readiness to stop drinking and motivate them to go further.
Individuals in this stage are not yet thinking about changing their drinking behavior. They either do not consider it a problem or do not believe that others are exaggerating.
Reasons people remain in the pre-contemplation stage (the four R’s) consist of the following:
- Resignation – The person has given up change after failed attempts to quit or cut back.
- Reluctance – The person does not consider change due to a lack of knowledge of inertia.
- Rebellion – The person is willful about their drinking behavior and doesn’t like others telling him or her how to behave.
- Rationalization – Persons use reasons/excuses for justifying drinking behavior, and why it may be a problem for others but not for him/her.
Persons in this change are beginning to consider the possibility that their drinking is a problem, and that there is hope for change. Still, people in this stage are often ambivalent – that is, there is no commitment or firm decision to make changes.
These individuals are frequently interested in learning about alcohol abuse and available treatments. They have realized that this behavior is negatively affecting their lives and health, but are reluctant to begin action.
During this stage, people may start to consider the pros and cons of their drinking behavior, in addition to the benefits and drawbacks of change.
At this stage, the individual decides to stop drinking and decides that the pros and cons favor change. There may still be ambivalence, but it is not longer an insurmountable barrier.
During this stage, most persons are committed to making a concerted effort to change imminently. The individual engages in preparation and is actively constructing realistic goals and plans, often with the help of a professional.
Before beginning action, the person begins to assess the difficulty facing addiction recovery, and anticipate barriers/construct solutions that will be integral to their treatment.
Action: Plan Implementation
Plan implementation simply means the individual begins to put the plan into action. If the person has not yet entered treatment or counseling or attending group meetings, they will do so now.
This process often requires him or her to make a public commitment (such as to friends and family) to recover. This action helps people retain their support, while also creating external monitors.
The person can also use the words of those who believe he or she will fail as an incentive to succeed. And if the individual begins to see the plan evolve and work effectively over time, it becomes a positive self-fulfilling prophecy that restores self-confidence and renews and strengthens determination.
The action stage usually takes 3-6 month to complete.
Maintenance, Relapse and Recycling
Maintenance occurs during long-term sustained changed over long periods of time. The individual has become consistently substance free, and the threat of relapse and return to old behaviors begins to fade.
However, alcoholism is chronic, so the possibility of relapse is always present. Persons in this stage may fall to the temptation to drink or let down their guard and begin to slip.
However, individuals during this stage are equipped with many skills that are effective at preventing relapse. They also have a support system in place to use if they need it and learn from relapse experiences that may prevent future failure.
Termination is the ultimate goal of alcohol recovery, but not everyone can reach it.
At this stage, the individual does not perceive alcohol as a temptation or threat.
He or she has confidence in his or her ability to cope with all situations without fear of relapse.
There is no set timeline for any given person’s experience for any of the stages of change. For example, the pre-contemplation and contemplation stages can last years, or a lifetime.
Also, individuals may advance to a far stage, such as maintenance, only to have a setback and return to an earlier stage due to frustration and resignation.
Alcoholism is a potentially a lifelong illness, and therefore individuals may encounter multiple stages of change more than once. But learning can come from failure, and those who keep trying are far better off than those who disparage and give up hope.