Overcoming an addiction isn’t a simple process. In fact, it may be more accurate to think of it like a journey in which you venture through uncharted territories before finally reaching your destination. The concept of recovery as a process or journey is not often conveyed in recovery literature, but understanding this concept can be helpful when you’re looking into treatment options for yourself or a loved one.
While there are a number of ways to break down the recovery process into easy-to-digest steps, one of the most compelling was introduced by psychologists James Prochaska, John Norcross and Carlo DiClemente in their 1994 book Changing for Good. In the book, Prochaska, Norcross and DiClemente break the addiction recovery process into six stages of change in recovery, which are sometimes referred to as the Transtheoretical Model. Each of the psychologists’ stages — pre-contemplation, contemplation, preparation, action, maintenance and termination — correspond to particular phases in an individual’s journey from active addiction to lasting sobriety.1 Moreover, these six stages essentially decipher the rehabilitation process, making it easier to understand by reducing the long road to recovery into a series of distinct checkpoints. Of course, understanding the importance of this model requires a closer look at each of these six stages.
As an addiction worsens in severity, so do its consequences and their frequency. During the pre-contemplation stage, the addict has become aware of the consequences of addiction, but he or she is either justifying or minimizing them.2 The addict may even recognize that he or she is addicted and would, in theory, require treatment to overcome that addiction; however, an individual in the pre-contemplation stage of recovery still prefers to remain in active addiction rather than to seek any rehabilitative services. In short, the perceived benefits of continuing to abuse alcohol or use drugs are thought to be greater than the cost and repercussions.
The transition from pre-contemplation to contemplation is marked by the consensus that the consequences of addiction are more severe than he or she had previously believed. In particular, the addict is becoming acutely aware of the negative effects that the addiction is having on his or her life, but he or she isn’t yet sure whether the negative effects outweigh the individual’s enjoyment of alcohol or drug abuse. It’s during the contemplation stage that the addict becomes a bit more open to the prospect of recovery; while he or she hasn’t decided to get sober, it has begun to seem that recovery is likely to happen at some point in the future.
Those in the contemplation stage of recovery may openly accept that they have substance abuse problems, but when pressed about recovery, they often have some type of excuse or justification that amounts to putting off recovery until a later time. In some cases, the excuse may even sound valid. For instance, an addict who has an extremely stressful job might tell a loved one that he or she will get help for alcoholism once he or she leaves the stressful job and, therefore, will no longer feel compelled to self-medicate.
In transitioning from contemplation to preparation, the addict realizes the repercussions of addiction far outweigh any perceived benefits. Moreover, he or she decides the behavioral changes necessary to get sober are attainable and accepts that there’s a need for treatment, thus beginning the preparation stage. Once this stage is reached, the individual is aware that making better choices will be life-changing. It’s also at this point that the addict begins to accept support from family members, close friends and other important relations. There’s a newfound sense of proactivity within the individual as he or she researches different modes of recovery, gathers information, and creates an actionable plan for addressing his or her substance abuse problem. There may even be a verbal or written commitment to recovery.
After progressing from pre-contemplation through contemplation and preparation, the individual reaches the action stage of recovery. During the action stage, the addict immerses himself or herself into recovery, which can include enrolling in a treatment program, joining a 12-Step group, or utilizing some other type of resource for rehabilitation. However, the action stage is more than getting sober; rather, the individual is committing to making significant lifestyle changes that will ensure a healthier and more productive life moving forward. In addition to learning the skills and strategies of recovery, the individual is also creating dietary, fitness and career plans, as well as repairing and re-establishing relationships.
Between the action and maintenance stages, the individual completes the treatment program or other resource for rehabilitation and must assume responsibility for remaining abstinent and sober. In short, he or she must “maintain” the sobriety acquired during the action stage. This is an extremely important stage and is often not taken seriously, which is why most individuals who relapse do so during the maintenance stage. Much like a person must practice a skill or trade after learning it, someone in the maintenance stage must practice living life in recovery. Fortunately, there are many resources available to help make people more successful during the maintenance stage, including aftercare, alumni programs and support groups.
At termination stage, the transformation of recovery is basically complete. Although remaining sober is a lifelong endeavor, an individual in the termination stage of recovery is likely to have regained his or her health, maintains healthy relationships, has a stable job or career, is financially independent, and feels confident that he or she will remain in this state. When asked, most individuals in this stage have no desire to return to active addiction and are relieved to no longer have the same habits as when they were addicted.
The beauty of the six stages of change in recovery is that, as mentioned previously, they reduce an otherwise complicated process into a series of clear, concise steps. But what makes them important? How are the six steps beneficial?
Since it offers the broad strokes of recovery, the model can accommodate the diverse ways people get sober, whether through clinical treatment, 12-Step programs or some other resource. Perhaps most importantly, the six stages of recovery make the process easier to understand for those who may not have prior knowledge or experience with addiction recovery. Finally, the stages put an addict’s recovery experience over time into perspective, making it easier to determine the best resources to utilize for each stage.
In short, the implications of the stages of recovery are momentous. Not only do they offer clarity, the stages also give us insight into how treatments and other aid can be maximized.
1. Prochaska, James O, Norcross, John C. and DiClemente, Carlo C. Changing For Good. Harper Collins, 2007.
2. Gold, Mark S. “Stages of Change.” Psych Central.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton