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Stages of Change
The Transtheoretical Model
One of the most successful methods used to help people quit any given undesired behavior.
Most strategies for supporting intentional behavior change focus on just one dimension of the problem (social factors, psychological issues, etc.). What makes the Transtheoretical Model so highly-regarded is that it combines the most effective techniques from several different areas of study. That’s the basis for the name – trans, a prefix meaning across, plus theoretical, meaning concerned with the theory of a subject or area of study.
The Transtheoretical Model has been developed over a period of nearly three decades, and was first conceived in 1977 by James O. Prochaska and other researchers at the University of Rhode Island. In that span of time, tens of millions of dollars in grants and well over 100,000 research participants have worked toward testing and improving the model.
The Transtheoretical Model consists of 4 constructs:
- Stages of Change
- Processes of Change
- Decisional Balance
Stages of Change for Addiction Behavior Modification
The core of the Transtheoretical Model is breaking down the complex process of changing behavior into 5 distinct stages: precontemplation, contemplation, preparation, action, and maintenance.
- Precontemplation (Expected Duration – 6 months):
During the first stage of the Transtheoretical Model, the addict is either uninformed about the risks of substance abuse, or they choose to ignore these risks. They’re not reading, talking, or even thinking about the consequences substance abuse brings to themself and their family. At this point, the addict will actively resist anyone who attempts to get them to change their behavior. They’re not ready for treatment.
- Contemplation (Expected Duration – 6 months):
Over time, the addict begins to recognize that there are significant reasons for them to change their behavior. At the same time, they’re also aware of the negative effects that will occur if they quit their substance of choice (there’s the physical fear of detox, and the possibility they’ve used substances as a coping mechanism to treat depression, childhood trauma, or some other issue for a long time, and if they stop using they’ll have to finally face that issue).
- Preparation (Expected Duration – 6 months):
It is not until the third stage of the model that addicts are ready for treatment. They’ve weighed the pros and cons of quitting their substance of choice, and they’ve decided to quit. In fact, they’ve gone further than just deciding to quit – they’ve taken concrete steps toward changing their behavior – this could include buying a self-help book, going to see a therapist, or checking into a treatment center.
- Action (Expected Duration – at least 1 month):
Now comes the actual act of change. Rather than the traditional 12-step approach, Inspire Malibu focuses less on belief in a higher power and more on techniques that have been developed and reinforced objectively and scientifically. We use numerous types of therapy (individual counseling, group counseling, neurofeedback therapy, cognitive therapies, etc.), as well as improving health and fitness routines.
- Maintenance (Expected Duration – Indefinite):
Even after a client has left our center, the work required to abstain from destructive substances is not yet over. All it takes is one stressful situation to potentially make an addict relapse. At Inspire Malibu, we teach our clients techniques that will help them recognize and respond to these triggers without relapsing back into substance misuse.
The Processes of Change
It helps to break down the process of change into 5 stages, but that doesn’t offer much practical insight into what someone can actually do to change themself.
The following 10 Processes of Change are implemented throughout the Stages of Change to help addicts quit:
- Consciousness Raising:
recognizing the causes, consequences, and concerns of addiction
- Dramatic Relief:
feeling the positive effects that are produced when substances are no longer misused (less anxiety, improved health, etc.)
- Environmental Reevaluation:
recognizing how substance abuse affects one’s environment (family life, career, etc.)
- Self Reevaluation:
recognizing how substance misuse affects one’s self-image
- Social Liberation:
increased social opportunities as a result of no longer abusing substances
- Self Liberation:
belief that one has the ability to change, and also the commitment required to follow-through on that belief
- Counter Conditioning:
using healthy habits to replace the time and energy once spent supporting and engaging in substance abuse
- Helping Relationships:
using the support of friends and family to strengthen the resolve one needs to go through treatment and prevent a relapse later on
- Reinforcement Management:
encouragement and rewards for when one stays on the right path toward quitting their substance of choice
- Stimulus Control:
staying away from stimuli and people that have the potential to inspire a relapse
Decisional Balance is basically just a fancy term for “pros and cons.”
The pros and cons of engaging in substance abuse change drastically for an addict as they progress through the stages of change. In fact, those changes to the decisional balance are what motivate an addict to progress through those stages.
During the Precontemplation Stage, whether consciously or not, the addict decides that the cons of quitting their substance of choice outweigh the pros of quitting it.
During the Contemplation Stage, the balance between pros and cons is about even. As the pros start to outweigh the cons, the addict begins to recognize that they have a problem that must be addressed and they move on to the Preparation and Action stages. During the Maintenance Stage, the pros must continue to outweigh the cons in order to prevent a relapse.
Efficacy is defined as “the power to produce a desired result or effect.”
The construct of self-efficacy describes how well the addict is able to handle temptations to engage in substance abuse.
During the Precontemplation and Contemplation Stages, they can’t control temptations. During the Preparation and Action Stages, addicts learn techniques that allow them to have more self-control, and finally when they’ve reached the Maintenance Stage they’ll have the tools they need to not engage in substance abuse and fight any future urges to relapse.