Ceasing an addiction such as smoking, drinking or drug use requires a person to go through expected stages of change. Since Prochaska and DiClemente’s hallmark research in 1982, these stages have been comprehensively scientifically reviewed. It is not often that a person is able to successfully give up their addiction after going through these stages only once. Typically people make a number of attempts to change before giving up for good. For example, someone might give up smoking several times over, only to recommence smoking again five years later during a divorce, then have to give up smoking all over again.

Recognising someone’s exact stage of change is helpful because targeted strategies can successfully assist change. Misidentification of a person’s stage of change can cause rehabilitation to fail – for example, pressure to give up their addiction can create resistance and a determination to continue the feel-good behaviour. The various stages of change and some targeted strategies to quit are:

Precontemplation

The precontemplation stage is characterised by denial and avoidance of negative results of the behaviour. There is no motivation to change, and the person is solely aware of the pleasurable aspects of the addiction. People generally dispute the detrimental effects of their behaviour by saying something like “Gran smoked 40 a day and she lived to be 95!”.

A wake-up call, such as an alcoholic being confronted with the fact that his mate had a serious crash while drink-driving, is the most powerful stimulus to change. Going to see their family doctor for a health check can act as a motivator for change. If this doesn’t produce any motivation to change, try discussing the effects of their behaviour in regards to their physical and mental wellbeing, their relationships with others and their occupation (i.e., liver lover, livelihood). Ask: “What would have to take place to demonstrate that you had a problem with this behaviour?”. Don’t give any recommendations or be pushy; rather have the person tell you the reasons why they should cease their behaviour. Heed the saying “I learn what I believe as I hear myself speak”.

Contemplation

This stage is marked by uncertainty, procrastination and fence-sitting as the person begins to question their current beliefs. People assess the benefits of change versus the harmful effects of their addiction. However, the costs related to change are still significant. It is likely that change in behaviour will happen within six months.

Encourage people in this stage to think about the positive and negative consequences of their behaviour. It is essential that you are supportive of all desires and endeavours to minimise or cease the behaviour, regardless of how successful they are. It is important that you remain non-judgemental as any perceived confrontation can elicit resistance and relapse.

Preparation

During this stage the person’s motivation to modify their behaviour increases significantly, and the possibility of change occuring within the next month is high. The person realises that the benefits of change outweigh the costs, sets about devising a plan to cease their behaviour, and begins to put this plan into action.

Stay calm, positive and supportive during this stage. Assist to research treatment options and be available to talk. It is worthwhile to offer to make initial contact with the program the person is most interested in – for example, if a person with an alcohol addiction feels they can only manage ‘one step at a time’, joining an AA group might be the best option for them.

Action

Hard work is very much in progress throught this stage, and change is seen as being beneficial with little or no costs. Specific changes in thought processes and feelings are noticeable.


You can support change by assisting the person to attend therapy sessions, eg organise transport, talk about issues raised in therapy sessions, help with homework and reinforce change efforts. Encourage family members and friends to be engaged in the therapy process – for example they may be interested in attending therapy sessions, collecting information or keeping records of progress.

Maintenance

This stage is characterised by a growing level of certainty that change can be maintained. During this stage the temptation to fall back into old ways is less persistent, and this period can last between six months and five years.

Keep reinforcing alterations in behaviour as the person becomes accustomed to, consolidates and internalises the new behaviours. In order for the change in behaviour to be continued, it is essential that support is offered to the person’s family and friends so they can help facilitate the therapy process.

Termination

The final stage of change indicates a absolute and permanent recovery as the addiction has gone for good, without any temptation to relapse, ever. It is common for people to take a few years to get to this stage!

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