Prochaska and DiClemente’s Six Stages of Change in Addiction Recovery

Recovery from addiction is long and tedious. The individuals working through their substance abuse disorders experience a number of changes both during and after treatment. Most of the time, these changes reflect a pattern that has since become a model for the addiction recovery process: the Transtheoretical Model, also called the Six Stages of Change.

An Overview of the Transtheoretical Model (A.K.A. The Six Stages of Change)

The Transtheoretical Model (the Six Stages of Change) was developed and published by James O. Prochaska, Ph.D. and Carlo DiClemente, Ph.D. This biopsychosocial model offers a unique insight into the process of purposeful behavior adjustments and reformation of poor habits— like substance abuse, for example. Rather than focusing only on specific aspects of change (i.e., social influences, biological factors, etc.), the Six Stages examines and includes elements from other similar theories to create a comprehensive outline of general changes that focus more on the “big picture.” In fact, the Six Stages model of behavioral change:

  • Incorporates information gathered from over 35 years of scientific research and observational studies
  • Utilizes the results of research that had a budget of over $80 million in grants
  • Was constructed after the co-developers examined the results for over 150,000 research participants
  • Is used by behavioral science professionals all over the world

Aside from addiction recovery, the Six Stages also apply to a variety of other perceivably negative behaviors. The flexibility of this theory’s application is what gave it its name: transtheoretical. Still, it’s most often used to examine cases of substance abuse and recovery. In William Morrow’s Changing for Good, Prochaska and DiClemente outline their model and break it down into the six titular stages: pre-contemplation, contemplation, preparation, action, maintenance, and termination.

The six stages of change

Stage One: Pre-Contemplation

During the first stage of Prochaska’s and DiClemente’s model, people with substance use disorders will typically make excuses— or deny their addiction entirely. Those who get stuck in this stage may be fully aware that their addiction is a problem, but may also try to justify their choices to continue to reap the “benefits” (i.e., the desired effect) of their drugs of choice. Still, the transition into the next stage of change usually occurs when the people struggling with addiction begins to feel shame, embarrassment, or guilt.

Stage Two: Contemplation

The second stage of change is where someone with a substance use disorder comes to realize that the addiction is a problem. However, people at this stage don’t take action quite yet. Instead, they weigh their options about how to address their substance abuse— or whether or not they even should. Commitment to change may not happen just yet at this stage, but at the very least, people struggling with addiction may start researching addiction treatment options for themselves.

Stage Three: Preparation

The third stage marks the actual initiation of change for people struggling with substance use disorders. This is the stage where people truly begin to show commitment by making the decision to quit drugs, stop drinking, and get professional help to develop a long-term treatment plan. As the name of this stage suggests, people looking to conquer addiction take the time to prepare for treatment and plan their next move. Then they take action.

Stage Four: Action

The fourth of the Six Stages of Change marks the beginning of specific adjustments to a person’s lifestyle during ongoing addiction treatment. This stage encompasses the bulk of the addiction recovery process and lasts up to six months. During stage four, those affected by addiction will receive treatment, which may include but is not limited to:

Stage four is over when those in treatment achieve initial sobriety. Once that happens, the people in addiction recovery move on to stage five: maintenance.

Stage Five: Maintenance

The maintenance stage happens immediately after initial treatment has ended. Usually, during this stage of change, people in addiction recovery will stay committed to their newly achieved sobriety by receiving encouragement and support from others at home and during meetings. Additionally, those in recovery may choose to continue their progress in outpatient treatment or additional counseling outside of group meetings. Typically, the maintenance stage will typically last anywhere from six months to five years, although forms of support should continue throughout the addict’s life. It all depends on the individual, the treatment plan, and the new routine. In any case, people that have reached this point of the Six Stages of Change in addiction recovery are motivated to stay sober— and they now have all the tools to make that possible. After about five years of continued abstinence, the chances of relapsing diminish to practically none.

Stage Six: Termination

The sixth and final stage of Prochaska’s and DiClemente’s model marks the ultimate goal for anyone in addiction recovery: termination. When people in recovery reach this stage, they no longer feel threatened their substance use disorder. They still have to be mindful of triggers, of course, but all in all, the urge to use or abuse substances has vanished completely. Life at this point in addiction recovery is happy and addiction-free. From this stage going forward, people in recovery continue to practice maintenance of their sobriety and new, healthy habits with little to no chance of relapse.

Relapse During the Six Stages of Change

Relapse chances decrease with timeWhile the model seems straightforward in its layout of the addiction recovery process, it’s important to keep in mind that relapse is still entirely possible at any point during the Six Stages of Change. Relapse is a common occurrence in addiction recovery, but this does not negate the progress of those who are sober or working to get sober. The people who do relapse during addiction recovery can bounce back by returning to treatment, learning from the experience, and moving on. Remember, addiction is a chronic disease, and just like any other chronic disease, the risk of relapse will always be there. Still, the chances of relapse will decrease with diligence and continued abstinence.

The Treatment Center Can Aid in the Six Stages of Change in Addiction Recovery

Everyone experiences the Six Stages of Change differently, which is why individualized care is so necessary for the addiction recovery process. At The Treatment Center of the Palm Beaches, all of our patients receive with treatment plans and services that fit their individual needs. If you have an addiction and would like more information about the programs we offer, please call us at (855) 899-5065. All calls are confidential.

For more information on The Cycle of Addiction.