Updated on February 6, 2024
7 min read

What Are the Stages of Change in Substance Abuse Recovery?

Drug or alcohol abuse and addiction are complex issues that require a multifaceted approach to recovery. A critical aspect of this approach is understanding the stages of change.

Researchers James O. Prochaska and Carlo DiClemente introduced the stages of change, or the transtheoretical model, in the late 1970s.1 They identified five stages that people go through when making a significant behavior change, such as overcoming substance abuse.

These stages are pre-contemplation, contemplation, preparation/determination, action/willpower, and maintenance. Let's look at each stage and how they apply to recovery.

What is the Transtheoretical Model of Change?

The Transtheoretical Model of Change (TTM), or the Stages of Change Model, is a theoretical framework for understanding and assessing the process of behavioral change. It recognizes that change isn't a linear process, and you may move back and forth between stages before reaching success.2

Researchers have applied this model to various behaviors. These include quitting smoking, losing weight, and recovering from substance abuse.

While the model isn't a one-size-fits-all solution, it provides a useful framework for understanding the different stages of your recovery journey. TTM also highlights the importance of personalized approaches to achieve successful outcomes.

What are the Stages of Change in Recovery?

According to the Transtheoretical Model, there are six stages in the cycle of change.1 The last one, Termination, was originally not included but has been added later as a possible outcome.

1. Pre-Contemplation

In this stage, you don't acknowledge or are not aware that you have a problem with substance abuse.3 You may justify your behaviors and minimize any negative consequences.

As such, you don't see the need for change and may resist any attempts to help you. In substance abuse cases, this stage often manifests itself as denial and a reluctance to seek treatment or make changes.

Common challengesDenial and lack of motivation to change
Helpful tools and resourcesInformational books, articles, and videos about substance abuse and recovery
Ideal support from loved onesEncourage awareness and understanding of substance abuse and its effects
Signs of progressIncreased awareness and acceptance of substance abuse as a problem
Signs of setbacksDenial and continued resistance to change

2. Contemplation

During the contemplation stage, you start recognizing that you have a problem with substance abuse. You may begin to think of how to have a more positive or pleasant life experience when you overcome addiction.2

The contemplation stage can take weeks or even months. It's common to move back and forth between this stage and pre-contemplation.

During this stage, you may also begin considering the potential consequences of your behavior. However, you may still feel unsure about committing to change.

The pros and cons will often weigh heavily on people’s minds, making it challenging to take action. This uncertainty can stem from fear, ambivalence, or a lack of confidence in one’s ability to change.

Common challengesAmbivalence and uncertainty about making a change
Helpful tools and resourcesTherapy, support groups like Narcotics Anonymous, and self-reflection activities
Ideal support from loved onesProvide empathy and understanding while encouraging self-reflection and considering treatment options
Signs of progressDecreased ambivalence and increased motivation to change
Signs of setbacksRemaining indecisive and uncertain about taking action

3. Preparation/Determination

In this stage, you're ready and committed to making a change.3 You may have started taking small steps toward recovery, such as researching treatment options or building a support system. This stage is often marked by setting a specific goal or intention to change.

Common challengesDifficulty finding effective coping strategies and fear of failure
Helpful tools and resourcesRecovery workbooks, online forums, and support from family and friends
Ideal support from loved onesOffer practical support, such as attending therapy sessions or appointments with them, to show commitment and accountability
Signs of progressIncreased commitment to finding effective coping strategies and seeking treatment
Signs of setbacksDifficulty following through and taking concrete steps toward change

4. Action/Willpower

In this stage, you're actively taking steps towards change.4 You may be doing the following at this point:

  • Attending therapy or support group sessions
  • Visiting a treatment center
  • Implementing coping strategies
  • Making lifestyle changes to support your recovery

This stage can be challenging and may require significant effort and willpower. It's also the stage where you may see the most significant changes and progress in your recovery.

Common challengesWithdrawal symptoms, cravings, and challenges in building new habits
Helpful tools and resourcesProfessional treatment programs, therapy sessions, and relapse prevention strategies
Ideal support from loved onesBe a source of motivation and encouragement and providing a positive environment free from substances
Signs of progressCompleting a treatment program
Signs of setbacksContinuing to struggle with cravings and relapse

5. Maintenance

Maintenance is about sustaining the changes you made during the previous stage and preventing relapse.1 It involves creating a long-term plan for managing triggers, coping with challenges, and maintaining healthy habits.

This stage can last for an extended period, as it's essential to continue actively working on your recovery to avoid relapse.

Common challengesComplacency, overconfidence, and dealing with potential triggers and temptations
Helpful tools and resourcesContinued therapy or support group attendance, healthy lifestyle habits, and ongoing accountability
Ideal support from loved onesOffer ongoing emotional support and understanding of any challenges or triggers you may face in maintaining sobriety
Signs of progressDeveloping healthy habits and coping skills to maintain sobriety
Signs of setbacksBecoming complacent and potentially experiencing a relapse

6. Termination

While not initially included in the model, termination is now recognized as a possible outcome in the change cycle. In this stage, you've fully integrated your new behavior into your life and no longer feel at risk of relapse.1

However, termination doesn't mean you're "cured." Recovery is an ongoing process, and you must continue practicing healthy habits and coping strategies to maintain your progress.

Common challengesFear of relapse and maintaining progress in the long term
Helpful tools and resourcesContinued maintenance efforts and ongoing support and accountability from a strong recovery network
Ideal support from loved onesRemain supportive and encourage continued maintenance efforts to prevent relapse
Signs of progressMaintaining long-term recovery
Signs of setbacksFearing potential relapse and difficulty sustaining progress
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How Does Relapse Fit Into the Stages of Change?

Relapse doesn't necessarily mean you've failed or are back at square one.5 Instead, it's a natural part of the process and an opportunity for growth.

Relapse, or a return to substance abuse after a period of abstinence, can happen at any stage in the change cycle. Learning from it can help you identify triggers and weaknesses in your recovery plan, making you better prepared to handle similar situations.

What Are the Steps to Renewal After a Relapse?

If you experience a relapse, taking steps towards renewal and getting back on track with your recovery is essential.

These steps can include:

  • Accepting that relapse is a part of the process and not a sign of failure
  • Identifying triggers or situations that led to the relapse
  • Reevaluating your recovery plan and making any necessary changes
  • Reaching out for support and seeking professional help

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How Can the Stages Improve Treatment Outcomes?

Understanding the stages of change can help healthcare professionals and therapists tailor treatment plans to meet your needs. By identifying where you are in recovery, they can create personalized interventions and support systems that are most effective for that stage.

Understanding the stages can help you determine your progress and what to expect regarding challenges and successes. This knowledge can provide motivation and a sense of direction for your recovery journey.

Why is Social Support Important in Each Stage of Change?

Social support is crucial in each stage of change because it can provide validation, encouragement, and accountability.6 A strong support network can also help you navigate challenges and setbacks, making the recovery journey more manageable.

In the early stages of change, social support from family and friends can help motivate you to take action and make healthy choices. In later stages, support groups can offer valuable insights and understanding as you work to maintain your progress.

A Healthcare Professional’s Role Through the Stages

Healthcare professionals support you through the stages of change by providing guidance, education, and resources. They also help create personalized treatment plans to ensure you receive the best care for your needs.

In the early stages, they may assist in increasing awareness and understanding of substance abuse and guide the next steps. As you progress through the stages, they can offer therapy and support to help you build coping skills and prevent relapse.

Additionally, healthcare professionals play a vital role in identifying any potential underlying mental health issues that may contribute to your substance abuse. Treating these issues simultaneously can lead to more successful recovery outcomes.

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Summary

The stages of change model is useful for understanding the recovery process for substance addiction. Each stage has unique challenges and goals, and it's essential to have a strong support network, personalized treatment plan, and ongoing accountability throughout the journey.

Relapse is a natural part of recovery, but remission is never impossible. By understanding and utilizing the tools and resources available at each stage, you can successfully navigate the change cycle and maintain lasting recovery.

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Updated on February 6, 2024
7 sources cited
Updated on February 6, 2024
  1. The Transtheoretical Model (Stages of Change).” Boston University School of Public Health.
  2. Stages of Change Model.” Loma Linda University School of Medicine.
  3. Stages of Change.” The University of Rhode Island.
  4. Raihan et al. “Stages of Change Theory.” StatPearls Publishing, 2023.
  5. Guenzel et al. “Addiction Relapse Prevention.” StatPearls Publishing, 2022.
  6. Greaney et al. “Social Support for Changing Multiple Behaviors: Factors Associated With Seeking Support and the Impact of Offered Support.” Health Education & Behavior, 2018.
  7. Truong et al. “Challenges on the road to recovery: Exploring attitudes and experiences of clients in a community-based buprenorphine program in Baltimore City.” Addictive Behaviors, 2019.

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