Module 9: working with young people on AOD issues: facilitator's guide

3.3 The stages-of-change model

Page last updated: 2004

Traditionally, changing AOD use was viewed as a single event rather than a process. This often involved only one possible outcome: total cessation or abstinence. This view does not take into account the small steps towards cessation that a person might make and the achievement that those smaller steps might represent (such as reducing the number of cigarettes smoked in a week). Young people who did not change their substance use in this way were viewed as being resistant and unmotivated.

In the early 1980s, James Prochaska and Carlo DiClemente (among others) developed a model to explain the process of change in the context of substance use and dependence. Based on their research of 'self-changers', the Stages-of-Change model forms part of a broader conceptual framework known as the Transtheoretical Model (Prochaska & DiClemente, 1982; 1986).

This model recognises that different people are in different stages of readiness for change. It is important not to assume that people are ready for or want to make an immediate or permanent behaviour change. By identifying a person's position in the change process, a worker can more appropriately match the intervention to the client's stage of readiness for change (see Diagram).

Diagram: Stages-of-change model
The five stages of change
Relapse
Reflecting on change using the stages-of-change model
Identifying the stage of change

Diagram: Stages-of-change model

Text equivalent below for Diagram: Stages-of-change model
Top of page

Text version of Diagram

The diagram illustrates the stages-of-change model as an upward spiral process, involving progress through a series of stages until reaching the "lasting exit". Each loop of the spiral consists of the stages precontemplation, contemplation, preparation, action and maintenance.

The five stages of change

  1. Precontemplation
    People in this stage are not thinking seriously about changing and tend to defend their current AOD use patterns. May not see their use as a problem. The positives or benefits, of the behaviour outweigh any costs or adverse consequences so they are happy to continue using.

  2. Contemplation
    People in this stage are able to consider the possibility of quitting or reducing AOD use but feel ambivalent about taking the next step. On the one hand AOD use is enjoyable, exciting and a pleasurable activity. On the other hand, they are starting to experience some adverse consequences (which may include personal, psychological, physical, legal, social or family problems).

  3. Preparation
    Have usually made a recent attempt to change using behaviour in the last year. Sees the 'cons' of continuing as outweighing the 'pros' and they are less ambivalent about taking the next step. They are usually taking some small steps towards changing behaviour. They believe that change is necessary and that the time for change is imminent. Equally, some people at this stage decide not to do anything about their behaviour

  4. Action
    Actively involved in taking steps to change their using behaviour and making great steps towards significant change. Ambivalence is still very likely at this stage. May try several different techniques and are also at greatest risk of relapse.

  5. Maintenance
    Able to successfully avoid any temptations to return to using behaviour. Have learned to anticipate and handle temptations to use and are able to employ new ways of coping. Can have a temporary slip, but don't tend to see this as failure.

Overhead transparency

The five stages of change:
  1. precontemplation
  2. contemplation
  3. preparation
  4. action
  5. maintenance

Optional exercise – 'Which stage?'

Make up some A4 cards and write each stage of change on the card. Then place the cards around the room.

Ask the learners to think about a habit or something they are dependent upon and get them to identify which 'stage' of change they are at. Each learner to stand by that particular 'stage-of-change' card. Learners can then discuss their reasons for choosing this stage with other group members who have also nominated that stage. In the large group compare and discuss the characteristics of the different stages. The habit can be anything from watching day time soaps to hang gliding, dieting, eating chocolate, smoking or exercising.

Encourage learners to pick something they feel comfortable to share with the rest of the group. Top of page

Relapse

During this change process, most people will experience relapse. Relapses can be important for learning and helping the person to become stronger in their resolve to change. Alternatively relapses can be a trigger for giving up in the quest for change. The key to recovering from a relapse is to review the quit attempt up to that point, identify personal strengths and weaknesses, and develop a plan to resolve those weaknesses to solve similar problems the next time they occur.

Relapse is a factor in the action or maintenance stages. Many people who change their behaviour decide for a number of reasons to resume their drug use or return to old patterns of behaviour. Research clearly shows that relapse is the rule rather than the exception.

A note about lapse versus relapse: A lapse is a slip up with a quick return to action or maintenance whereas a relapse is a full-blown return to the original problem behaviour.

We will return to relapse management in Topic 8.

Reflecting on change using the stages-of-change model

Task

Ask learners to refer to their Learner's Workbook to complete this exercise.

Question - Choose a behaviour from your own life that you have changed or attempted to change (related to smoking, exercise, diet, caffeine intake, career direction, etc.) Note down the process you went through using the stage-of-change model and record relapses and slip-ups.

Question - What strategies did you use in making that change? For example, did you set yourself short-term and longer-term goals?

Identifying the stage of change

Divide the group into four small groups. Assign each group a case study. The following four case studies are in their Learner's Workbook.

Ask each group to identify the stage of change that seems to fit the young person in their case study.

Case study - Sarah, James, Sammie and Grace

Sarah is a 16-year-old girl who has been using speed for about two years. She uses speed intravenously, having originally snorted it for the first 12 months. On assessment, Sarah tells you that she has been trying to cut down on her speed use and has even had a period of two weeks where she didn't use it. She appears to be 'speeding' when you meet with her.

James is a 14-year-old boy who smokes cannabis and tobacco. On assessment of his cannabis use, he states that he can 'take it or leave it'. He tends to smoke with friends on the weekend. James smokes cigarettes whenever he can afford them. He also drinks alcohol to the point where he 'blacks-out' about once a month.

Sammie is an 18-year-old male who has been using heroin for about three years. He smokes heroin on a daily basis and also takes Valium or Normison if he can't get any heroin. Sammie has been caught breaking and entering on a number of occasions. His family are very worried about his drug use and the trouble he is in. Sammie has no desire to detox from heroin use. He states 'It's a hassle sometimes, but at least I don't inject it'.

Gracie is a 17-year-old female who is involved in a Drug Court program. She has a history of poly-drug use and has worked as a sex worker. Gracie has been trying to stay off cocaine and speed. She continues to drink heavily a couple of times a week and also takes street benzos as she says this helps her to sleep. Gracie's latest urinalysis reveals cannabis, benzodiazepines and amphetamines. She is pretty worried that she will be taken off the Drug Court Program and she states she really wants to stay out of trouble.

Top of pageQuestion - What state-of-change does your assigned young person seem to fit in to?

Answer
  • Sarah - Preparation
  • James - Precontemplation
  • Sammie - Precontemplation
  • Gracie - Action
Discuss the answers in the large group. Provide time for feedback and questions.