In 1983, alcoholism researchers Carlo C. DiClemente and J. O. Prochaska introduced a five-stage model of change to help counseling professionals understand their clients with addiction problems and motivate them to change. The model, which is widely used by addiction counselors, is based on the researchers’ observations of how people went about modifying problem behaviors such as smoking, overeating and alcohol abuse.
Noreen Ammons, clinical director at New Life Addiction Counseling Services in Pasadena, Md., says the stages of change represent a growth process many treatment clients go through as they begin and progress in recovery.
In the Pre-contemplation Stage, clients “may not actually want to change,” Ammons says.
Addiction is a disease of denial, and not all treatment clients are there by their own choice; some have been court-ordered into treatment, or coerced by family members who want them to change.
“Clients frequently don’t think they have a substance abuse problem. They may think they have a ‘mom and dad problem’ because their parents are fed up with them, or a spouse or significant other problem – ‘I’m here because my wife is tired of my drinking.’”
Treatment counselors strive to move clients into the Contemplation Stage, in which they consider how their alcohol or drug use is impacting their health, family and other relationships, finances or legal status. “Once they start to understand that something is going on, then you (the counselor) have an opportunity to talk about doing something about the problem,” says New Life counselor Dwayne Gould.
In the Preparation Stage, the client is already starting to take some significant actions such as making small changes – maybe just joining a gym or going to mental health counseling with a therapist in the community. They may start attending Alcoholics Anonymous or Narcotics Anonymous meetings and making connections with the people there, Ammons says.
When clients reach the Action Stage, they have made significant specific modifications to their lifestyle, and there is an observable process of behavior change happening, Ammons says.
“I always know when clients have started going to 12-step meetings, because they start using the lingo and start understanding what the educational groups are talking about. They may start to get excited – ‘Look what I am doing!’ – and their self-esteem gets a boost.”
By the Maintenance Stage, clients have made modifications in their lifestyles and they start working to prevent relapse, Ammons says. “That can go back and forth; they may slip between stages of change, usually between action and maintenance, until they get it right.”
In the maintenance stage, “people continue to do the things that got them to the point of recovery – -whether that is going to meetings, working the steps, or continuing with mental health counseling,” Gould says. “The continual rebuilding of a person is going on.”
The client may relapse, but the counselor can help the client make the relapse a learning experience, Ammons says. The counselor can do that by helping the client analyze the thinking and behavior – and/or the trigger – that led up to the relapse. “Relapse starts way before the person ‘picks up,’” Ammons says.
Well before the actual relapse takes place, the client may have started to change their thinking, without realizing it, Ammons says. They may drift away from the positive habits that have enabled their recovery so far. Often, stress and boredom are underlying factors, especially if the client does not have a support network they can call.
With relapse a client may slide back as far as the pre-contemplation stage, “back into the denial they started out with. They may talk themselves back into denying they have a problem.”
How the client deals with relapse can set the stage for their continued growth in recovery – or their lack of success.