Stages of Change

Question 1

Precontemplation

Answer 1

Individuals in the precontemplation stage of change are not even thinking about changing their drinking behavior. They may not see it as a problem, or they think that others who point out the problem are exaggerating.
Dr. DiClemente has referred to them as “the Four Rs” — reluctance, rebellion, resignation and rationalization:

Reluctant precontemplators are those who through lack of knowledge or inertia do not want to consider change. The impact of the problem has not become fully conscious.
Rebellious precontemplators have a heavy investment in drinking and in making their own decisions. They are resistant to being told what to do.
Resigned precontemplators have given up hope about the possibility of change and seem overwhelmed by the problem. Many have made many attempts to quit or control their drinking.
Rationalizing precontemplators have all the answers; they have plenty of reasons why drinking is not a problem, or why drinking is a problem for others but not for them.

Question 2

Contemplation

Answer 2

Individuals in this stage of change are willing to consider the possibility that they have a problem, and the possibility offers hope for change. However, people who are contemplating change are often highly ambivalent. They are on the fence. Contemplation is not a commitment, not a decision to change. People at this stage are often quite interested in learning about alcoholism and treatment. They know that drinking is causing problems, and they often have a mental list of all the reasons that drinking is bad for them. But even with all these negatives, they still cannot make a decision to change.

In the contemplation stage, often with the help of a treatment professional, people make a risk-reward analysis. They consider the pros and cons of their behavior, and the pros and cons of change. They think about the previous attempts they have made to stop drinking, and what has caused failure in the past.

Question 3

Preparation to Action: Determination

Answer 3

Deciding to stop drinking is the hallmark of this stage of change. All the weighing of pros and cons, all the risk-reward analysis, finally tips the balance in favor of change. Not all ambivalence has been resolved, but ambivalence no longer represents an insurmountable barrier to change. Most individuals in this stage will make a serious attempt to stop drinking in the near future. Individuals in this stage appear to be ready and committed to action.

Question 4

Action: Implementing the Plan

Answer 4

Individuals in this stage of change put their plan into action. This stage typically involves making some form of public commitment to stop drinking in order to get external confirmation of the plan. If they have not done so already, individuals in this stage may enter counseling or some form of outpatient treatment, start to attend AA meetings or tell their family members and friends about their decision—or all of the above.

Question 5

Maintenance

Answer 5

Maintenance is the stage when a person is able to maintain their changed behavior over a sustained period of time. New behavior becomes self-sustaining and takes the place of drinking and associated behaviors. The action stage normally takes three to six months to complete. Change requires building a new pattern of behavior over time, and continues on its own momentum with little outside intervention.

Question 6

Relapse or Termination

Answer 6

Because alcoholism is a chronic disease, the possibility of relapse is always present. Individuals may experience a strong temptation to drink and fail to cope with it successfully. Sometimes relaxing their guard or “testing” themselves begins a slide back. People at this stage of change are armed with a variety of relapse prevention skills. They know where to get the supports they need.

Alcoholics who relapse learn from the relapse. The experience of relapsing and returning to sobriety often strengthens a person’s determination to stay sober.

The ultimate goal in the change process is termination. At this stage, the alcoholic no longer finds that alcohol presents a temptation or threat; he has complete confidence that he can cope without fear of relapse.

Because alcoholism is a chronic disease, the possibility of relapse is always present. Individuals may experience a strong temptation to drink and fail to cope with it successfully. Sometimes relaxing their guard or “testing” themselves begins a slide back. People at this stage of change are armed with a variety of relapse prevention skills. They know where to get the supports they need.

Alcoholics who relapse learn from the relapse. The experience of relapsing and returning to sobriety often strengthens a person’s determination to stay sober.

The ultimate goal in the change process is termination. At this stage, the alcoholic no longer finds that alcohol presents a temptation or threat; he has complete confidence that he can cope without fear of relapse.