James Prochaska and Carlo Di Clemente are the authors of the Transtheoretical Model of Behavior Change. This model is composed of five stages people go through when they are intentionally changing their behaviour. The validity of this model has been tested. It has been found useful in changing issues such as smoking cessation, starting an exercise routine, using sunscreen, losing weight and many more. Evidence shows that the five key phases people go through are quite similar, regardless of the behaviour they want to change.
This model of behavioural change has also been used extensively in addiction recovery. In this article, we will explain the five stages in the context of recovering from alcohol or drug addiction. We will use the story of Mary Jane, 33 years old, who is an alcohol addict.
Stage 1 Pre-contemplation
In the beginning, Mary is in denial. She does not to say she has a problem. She is drinking more than the accepted average for women her age. Her typical routine is: go home from work, crash on the couch, turn on the telly and drink. She has no energy to do much else apart from this. Though she is careful to not drink too much because she still has to go to work in the morning, she does not look (or feel) very healthy. She did not use to be this way.
In stage one, addicts are in denial.
Stage 2 Contemplation
One day at work Mary Jane gets the shakes. Her hands would not stop trembling. She had to take an emergency leave. When she got home, she noticed that she left the faucet on in the kitchen sink. Her dog, Waggy, was also whimpering pitifully. She had forgotten to feed him. In hindsight, Mary Jane describes this day as her turning point. She has never neglected her dog or her house before. Neither does she make it a habit to go home early from work.
These changes disturb her. But in her lowest moment, she becomes aware that she had no one to call. Mary Jane’s mum lives in a care facility because of early onset Alzheimer’s disease. Her sister was away and uncommunicative. She has lost her connections with her friends from uni. She does not socialize at work. She prefers to drink alone. At home.
In the second stage, people like Mary Jane begin to see that their behaviour is problematic. They move towards the possibility of change. Hence, Mary Jane is beginning to entertain the idea that she could be addicted to alcohol. At this time, she visits the Alcohol Anonymous website, “just in case” she is an alcoholic. She is thinking, “Maybe, I am addicted to alcohol, maybe I am not.” At this point, she is still trying to figure out what to do.
Stage 3 Preparation
Mary Jane takes pride in her looks. During her younger years, she turned heads. At 33 years old, she feels worn out. She gained a lot of weight. She stares enviously at pictures of women older than her. Her Slimmingworld magazines seem to scream, “You’re fat and ugly!” at her.
One night, after a binge, she went on a rampage. When she woke up, she found her make-up stuff on the floor. Perfume bottles were in the bin. Some of her better clothes were ripped. She does not remember doing these things herself. But she knew there was no one else to blame.
After that night, she decided she had to do something about her situation. She needed to change.
Mary Jane enters rehab/detox treatment.
The third stage is the period when addicts finally decide to recover from addiction. At this point, they enter rehab, start therapy, or join mutual support groups like AA or SMART Recovery. There is a lot of hope about what recovery will bring.
Stage 4 Action
Mary Jane spends 28 days as an inpatient for rehab for alcohol. Contrary to her fears, detox was not that bad. It was the shame that was bad. She never felt so low about herself than the first few days in rehab. She couldn’t believe that someone as well-educated as her could be an addict.
After rehab, she decided to stick with AA. She asked around and found a sponsor who was understanding and warm-hearted. Her sponsor stuck with her when relapsed. Altogether, Mary Jane relapsed three times during the first year. Every time she did, she felt lower than before. She felt like an utter failure. She sank lower and lower into spiral of self-destruction.
Stage 5 Maintenance
Three years into recovery, Mary Jane has let go of her old lifestyle. Sometimes, she catches glimpses of her old life. Although she has gotten rid of her old clothes (she gave them all away to the British Heart Foundation), she still has pictures on her phone. When she is particularly down and out, she reviews them. “To get some perspective.”
She decided to follow what her sponsor suggested, and got involved with a dog welfare charity. Regularly attending AA meetings made her realize how selfish she was about her life—she only thought of her own welfare, not giving a damn about how other beings are suffering. Particularly animals.
When she was younger, she imagined being a veterinarian. (She has let go of that fanciful notion already, since she is quite the realist.) Now she is content being a foster carer for dogs. At her home, she watches over two dogs at a time, in addition to her loyal Cockapoo Waggy (he does not mind the extra company).
The last stage of recovery is where people acknowledge that living sober is a lifestyle. It is multi-dimensional, it is about self-growth and self-love. We all need to connect to a “higher power“to give us strength. It is up to us to decide what that higher power means to us.
The journey towards sobriety takes time. Going through the five stages is progress, no matter how slow or challenging it may be. If you have a loved one or you are going through recovery yourself, keep it up. It can only get better.
One day, after her third relapse during the holidays, Mary Jane and her sponsor took their dogs out for a walk together at a public park. Since childhood, Mary Jane was always fond of dogs. Her sponsor came up with an idea. Why not get Mary Jane involved in an animal shelter? It may open up her world a little bit more.
At this stage addicts who are in recovery are actively doing their best to change for good. Sometimes change is painful; relapse may be inevitable. But working with a therapist, sponsor, partner and/or support group should be able to help hurdle the challenge. People who relapse and learn from the mistakes they made tend to progress in the recovery process.