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The transtheoretical model of addiction recovery, often called the "stages of change", is quite popular. Despite its initial appeal, the model has also been debunked pretty thoroughly.

Twelve-step programs may be an all-time favorite among addicts in remission and those trying to support them, but another model that features numbered stages — six, this time — has also been pretty popular. Commonly known as the "stages of change model", fans will claim that it's revolutionized addiction recovery through a tailored approach. The problem? Well, scientific research doesn't agree.

What do you need to know about the so-called stages of change model of addiction recovery, whether you're an addict or someone who cares about an addict?

What exactly is the transtheoretical or "stages of change" model of addiction recovery?

This model, developed by two folks called Prochaska and DiClemente, arose from a wish to create a comprehensive and integrative — a complete and all-encompassing, if you will — framework that was meant to help people understand how change occurs and to subsequently facilitate that change. It's actually been applied to many circumstances in which a need for change is identified, like health and lifestyle improvements after a heart attack for instamce, but remains most popular in the field of addiction and addiction recovery.

The model was, in the words of its pioneers, explain the full course of change, "from the time someone becomes aware that a problem exists to the point at which a problem no longer exists". It divides all addicts into six categories — the stages of change, of course — and aims to help them move through the stages through a "process of change" that comprises self-help steps. One key idea here is that helping addicts recover requires support people to be aware of the stage an addict is in to be able to tailor care and treatment.

We know you can't wait: What are the stages of change?

Stage 1 is precontemplation. Addicts in this first stage may be aware that their addiction carries consequences, but don't think they'll make efforts to stop within the next six months and their denial allows them to talk themselves into believing the benefits of the addiction are greater than its risks. As an example, a smoker may know that their addiction may one day kill them, but convince themselves that they need the nicotine to remain focused and functional. They think smoking is better for them than not smoking.

Stage 2 is contemplation. Addicts in this stage have developed a greater awareness of the harms of their addiction and may be open to quitting at some stage, perhaps even within the next month to six. The smoker from our example may now think it would one day be a good idea to quit, but not right now. 

Stage 3 is preparation. Addicts in this stage haven't only realized that recovery is important, but are preparing to quit within the next 30 days. Some versions of the model require that the addict has tried to quit for 24 hours within the last year to be put into this stage. The smoker knows smoking is destroying their health and offers them nothing but a continued impulse to smoke, and is mentally preparing to lay their cigarettes down.

Stage 4 is action. The addict is now working on recovery and is clean or sober for somewhere between zero and six months. This stage involves more than simple abstinence — addicts are working on making all sorts of positive changes and are committed to recovery and turning their lives around. Our fictional smoker, as an ideal representation of this stage, has thrown away their cigarettes, lighters, and ashtrays, has taken up hiking, and is on a healthy diet to improve their health further.

Stage 5 is maintenace. Nearing the end of the process now, the addict has been in remission for more than six months and is continuing to focus on a new, emotionally and physicall healthier, life. Yup, our ex-smoker no longer wants to return to their old habit and remains faithful to their new path. 

Stage 6 is termination. Not all versions of the stages of change model have adopted this stage, but for those that have, this stage represents complete recovery. The former addict remains abstinent and has fully embraced their new way. They could never imagine going back, and are free of their addiction. 

What does the process of change involve?

The idea that this model of change isn't linear — that addicts can regress as well as move forward — is an integral part of this particular theory. The goal, however, should be to move foward. That requires addicts to actively work on their recovery through a process of change that both allows them to maintain the gains they've already made and work on new ones. 

How? Through strategies like:

  • Working on awareness of the consequences of healthy vs unhealthy choices — because action is preceded by knowledge and acceptance of that knowledge. 
  • Working on the feelings associated with behaviors, whether good or bad. 
  • Constant self-evaluation and re-evaluation that helps the addict determine whether the choices they're making are choices they want to make. 
  • Looking at how the addiction impacts people around the addict. 
  • Working on believing that change is indeed possible. 
  • Embracing relationships with people who encourage positive change. 
  • Replacing destructive behaviors wih health-promoting ones.
  • Finding ways to reward yourself for healthy choices and behaviors, while reducing the reward you get from detrimental ones. 

That sounds quite nice, doesn't it? So, what's wrong with the stages of change model of addiction recovery?

Numerous studies have more or less "debunked" the stages of change model of addiction recovery, but one paper in particular highlights everything that's wrong with this philosophy. Aptly titled Time for a change: Putting the Transtheoretical (Stages of Change) model to rest, the paper is pretty damning. 

It points out that the problems with the stages of change model start with its core — it is "flawed even in its most basic tenet, the concept of the ‘stage’". Why? Because the stages are completely arbitrary. The only real differences between contemplation and preparation is the amount of time in which the addict plans to quit, for instance, something the author points out can be a difference of only one day. (This has several implications. Someone who is working very hard on changing may feel little is happening by staying in the same phase, but someone who is only thinking about quitting without seeking serious treatment may feel they are making excellent progress.)

Furthermore, planning a change doesn't mean one will actually come about. One of the key defining features of addiction is, after all, wanting to quit but not being able to. The model is based on conscious choices, and almost entirely ignores the brain chemistry component of addiction. By assuming that addicts are in control of their actions, the model could essentially be said to be victim-blaming — a return to notions that addiction is the addict's own fault, despite all the understanding we now have of addiction as a chronic brain disease often characterized by periods of relapse and remission.

There's more — but the heart of the matter is that studies have investigated how well the stages of change model actually works in practice, that is, what success programs based on it have in helping addicts achieve remission, and the results weren't good. Not only do at least three studies show no benefit, the model could even rob addicts of care they could really do with when a clinician fails to, for instance, offer one of the medications now shown to help smokers quit because they're in precontemplation, so "not the right stage yet". 

The stages of change model of recovery may sound quite appealing, but in conclusion, it's outdated, disproven, and has little value. 

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