Stages of Change

Individuals are formulating a plan of action Stages of Change Precontemplation Lack of acknowledgement that what they are doing is a problem in fact it is often seen as a solution (“in denial”) Contemplation Beginning to think about change, but not quite ready. Characterised by AMBIVALENCE; the weighing up of the pros and cons of problem and solutions Relapse Normal, predictable stage in the process of change. Exploring relapse can be a useful learning experience. Preparation Individuals are formulating a plan of action Maintenance This is a period of continued change that is being maintained by active strategies. Action The individual puts the plans devised in the previous stage into practice (ready, willing and able) Termination

Evaluating Stages of Change Precontemplation (Denial) “What problem? I’m not thinking about it.” Contemplation (Ambivalence) “I wonder if I might have a problem? I’m thinking about it but not ready to decide anything yet.” Preparation / Determination (Admission) “I have a problem.” Action (Taking steps / Making changes) “I have a problem and I’m ready to do something about it.” Maintenance (Continuing what works) “I’m stabilized and doing well. How can I support my ongoing recovery?” Relapse / Recycle (Trying again) “I’m stabilized but have relapsed. How can I get back into active recovery?”

Precontemplation: “Huh? What problem?” A Precontemplation-stage person is described as, “It’s not that they can’t see the solution. It’s that they can’t see the problem.” This stage of change has been given the label of “Denial” in times past.

Precontemplation: “Huh? What problem?” Treatment for someone in the Precontemplation stage would seek to engage them in the process of objectively evaluating whether they have a problem, and supporting movement along to the Contemplative stage of change.

Precontemplation

Am I Precontemplative? “What Problem?” “Who, me?” “I see no reason to change.” “I wish people would just leave me alone already!” Hand out orange Stages of Change worksheet and let people know they can follow along and identify where they think they’re at in the stages if they choose to. Example: smoking – person doesn’t think there’s any issue with their smoking – isn’t interested in hearing about health risks and doesn’t really want to discuss it. Talk about the term “denial,” how it has come to have a negative association, when in fact it serves as a defense, a protection until greater internal strength and external support can be established. “Precontemplation” is a newer name for what used to be called denial.

Evaluating Stages of Change Precontemplation (Denial) “What problem? I’m not thinking about it.” Contemplation (Ambivalence) “I wonder if I might have a problem? I’m thinking about it but not ready to decide anything yet.” Preparation / Determination (Admission) “I have a problem.” Action (Taking steps / Making changes) “I have a problem and I’m ready to do something about it.” Maintenance (Continuing what works) “I’m stabilized and doing well. How can I support my ongoing recovery?” Relapse / Recycle (Trying again) “I’m stabilized but have relapsed. How can I get back into active recovery?”

Contemplation: “Problem? Yeah . . . Action? Nah.” Contemplation-stage folks may know their destination, and even how to get there, but they are “not ready yet.” Someone in this stage of change may be ambivalent about doing anything about a problem that they can clearly identify having.

Contemplation: “Problem? Yeah . . . Action? Nah.” Treatment for someone in the Contemplation stage would seek to engage them in the process of gaining motivation to address their problem, and supporting movement along to the Preparation stage of change.

Contemplation

Am I Contemplative? “I might have a problem.” “I’m not ready to make any decisions yet.” “Problem? Maybe.” Considering change, but ambivalent. Example: smoking – well maybe I smoke too much; how much is too much smoking; what would a smoking problem look like; what does smoking do to your body, etc. Person may be looking for information, asking questions, etc, but not yet committing that it pertains to them.

Evaluating Stages of Change Precontemplation (Denial) “What problem? I’m not thinking about it.” Contemplation (Ambivalence) “I wonder if I might have a problem? I’m thinking about it but not ready to decide anything yet.” Preparation / Determination (Admission) “I have a problem.” Action (Taking steps / Making changes) “I have a problem and I’m ready to do something about it.” Maintenance (Continuing what works) “I’m stabilized and doing well. How can I support my ongoing recovery?” Relapse / Recycle (Trying again) “I’m stabilized but have relapsed. How can I get back into active recovery?”

Preparation: “Almost ready to take action . . .” Preparation-stage individuals are planning to take future action, but are still making the final adjustments before committing. Someone in this stage of change may be working through the final obstacles that are getting in the way of taking action.

Preparation: “Almost ready to take action . . .” Treatment for someone in the Preparation stage would seek to engage them in the process of taking action to address their problem, i.e., supporting movement along to the Action stage of change.

Preparation

Am I in Preparation? “I have a problem, but don’t want to commit to doing anything about it yet” “I’m developing plans to change” “Problem? Yes… Change? Not yet…” Example: smoking – asking the psychiatrist about how they would go about getting treatment options like the patch or nicorette gum; making plans for how they will support themselves or deal with cravings (where’s a local support group, etc). Person is asking for specific information about how they would get what they need (how much, where, who do I need to talk to to get it, etc) and making plans for following through.

Evaluating Stages of Change Precontemplation (Denial) “What problem? I’m not thinking about it.” Contemplation (Ambivalence) “I wonder if I might have a problem? I’m thinking about it but not ready to decide anything yet.” Preparation / Determination (Admission) “I have a problem.” Action (Taking steps / Making changes) “I have a problem and I’m ready to do something about it.” Maintenance (Continuing what works) “I’m stabilized and doing well. How can I support my ongoing recovery?” Relapse / Recycle (Trying again) “I’m stabilized but have relapsed. How can I get back into active recovery?”

Action: “Let’s get going” The Action Stage is described as the one in which individuals most overtly modify their behavior and surroundings to accomplish their goal. Someone in this stage of change is taking visible steps and making visible changes in order to work on their recovery.

Action: “Let’s get going” Treatment for someone in the Action stage would seek to assist them in taking all indicated steps to be successful in their recovery, and to support movement along to the Maintenance stage of change.

Action

Am I at Action stage? “I have a problem and I’m ready to do something about it.” “I’m making changes.” “Problem? Yes… Change? YES!” Example: smoking – person is using treatment options like the patch, gum or inhaler; person has identified and is attending a smoking cessation group, etc. Person is making actual steps – taking action. Important: for the purposes of this discussion, it doesn’t matter is the person is successfully staying sober/stable or not – just that they are taking action regardless of the reasons why they’re doing it.

Evaluating Stages of Change Precontemplation (Denial) “What problem? I’m not thinking about it.” Contemplation (Ambivalence) “I wonder if I might have a problem? I’m thinking about it but not ready to decide anything yet.” Preparation / Determination (Admission) “I have a problem.” Action (Taking steps / Making changes) “I have a problem and I’m ready to do something about it.” Maintenance (Continuing what works) “I’m stabilized and doing well. How can I support my ongoing recovery?” Relapse / Recycle (Trying again) “I’m stabilized but have relapsed. How can I get back into active recovery?”

Maintenance: “I’m in a good place, let’s keep it up!” In the Maintenance Stage, the focus is on consolidating gains and preventing relapse. Someone is this stage has an effective set of tools and “program of recovery” that they commit to continuing to practice. Treatment for someone in the Maintenance stage would seek to strengthen and increase their “tool kit” and to support ongoing recovery success.

Maintenance

Am I at Maintenance? “I’m stabilized and doing well. How can I support my ongoing recovery?” “I’ve made the changes I want; now I want to maintain my gains.” Example: smoking – person has quit smoking, but may have a plan for how to deal with cravings if they arise or how to deal with certain environments that may bring on cravings; person has support network in place to remain smoke free.

Evaluating Stages of Change Precontemplation (Denial) “What problem? I’m not thinking about it.” Contemplation (Ambivalence) “I wonder if I might have a problem? I’m thinking about it but not ready to decide anything yet.” Preparation / Determination (Admission) “I have a problem.” Action (Taking steps / Making changes) “I have a problem and I’m ready to do something about it.” Maintenance (Continuing what works) “I’m stabilized and doing well. How can I support my ongoing recovery?” Relapse / Recycle (Trying again) “I’m stabilized but have relapsed. How can I get back into active recovery?”

Relapse / Recycle: “How can I get back on track?” Relapse is often part of the chronic disease process, and recovering individuals need to be prepared to deal with it, including damage- control strategies. “Progress not perfection,” supports gentleness and freedom from shame, and “Progress not permission” emphasizes the importance of personal responsibility to stay active in one’s own recovery, even when slips or relapses occur. The Recycling aspect of relapse supports the view that recovery-strengthening lessons can be learned from relapse episodes – “The only bad relapse is a WASTED relapse”

Relapse / Recycle

Relapse / Recycle “I’m stabilized but have relapsed. How can I get back into active recovery?” “How can I learn from my relapse to strengthen my recovery plan?” Example: smoking – person has been not smoking for 6 months and has a cigarette, but continues with efforts to maintain being smoke-free and continues participating in their support network; person may use “relapse” as a time to reflect on why it happened to strengthen recovery plan. Both mental health disorders and substance use disorders are CHRONIC, RELAPSING CONDITIONS! It isn’t helpful to dual recovery to feel shame, or to be defensive about lapsing or relapsing when it happens – rather, a positive focus is put on analyzing the relapse and learning from it so as to strengthen recovery moving forward. (ex. facilitated “relapse autopsy” exercise in group)