Precontemplation: During the precontemplation stage, substance-using persons are not considering change and do not intend to change behaviors in the near future. They may be partly or completely unaware that a problem exists, that they have to make change, and that they may need help. Most of the time, the substance-using person may not have experienced any negative consequences because of the behavior.
Contemplation: As the substance-using person becomes aware that a problem exists, he or she may begin to feel the need to change. During this contemplation stage, the individual may still be using substances but is considering the possibility of stopping or cutting back in the near future. It is common for individuals to remain in this stage for extended periods of time because of ambivalent feelings of wanting to change and not wanting to change.
Preparation: A shift into the preparation stage occurs when the substance-using person perceives that the advantages of change and negative consequences of substance use outweigh any positive features of continuing to use the substance. Preparation involves making choices about attending treatment and building a capability to change. Individuals in this stage may still be using substances, but they intend to stop using them soon. Goal setting and changes in friends and the environment often occur during the preparation stage.
Action: Individuals in the action stage choose a strategy for change and begin the change process. At this stage, they are actively modifying their habits and the environment. They are making drastic lifestyle changes, such as deleting the phone numbers of dealers from their cell phones, removing drug paraphernalia from their homes, limiting the amount of isolated free time, attending 12-step support group meetings, and searching for treatment programs. Clients may experience issues of withdrawal during the action stage and struggle to grasp their own self- image without the substances. This stage can last for three to six months.
Maintenance: Once abstinence has been established, it is important to make an effort to sustain the change and prevent relapse. This is an opportunity to learn how to identify and guard against triggers for relapse. Maintenance requires prolonged behavior change for a minimum of six months to several years.
It is important to note that the stages of change are cyclical in nature, and individuals typically move back and forth between stages and cycle through the stages at different times. In most cases, individuals who make attempts to maintain sobriety often experience relapse and then return to earlier stages in the change process. Reference: Prochaska, J. O., & DiClemente, C. C. (1984). The transtheoretical approach: Crossing traditional
boundaries of therapy. Homewood, IL: Dow Jones-Irwin.