Stages of Change in addiction

A Stages of Change model describes human behavior changes in terms of five stages, and is usually applied to substance abuse recovery.  One model, the transtheoretical model, or TTM, is designed to help clinicians understand the different types of difficulties clients face during each of several distinct phases that are meant to show a client's acceptance of his problem, resolve to act in changing it, ability to stay free of the problem, and possible regression (Donovan & Diclemente, 2004).  The model's proponents stress that the model is as much for the clinician in that it is meant to help organize the therapeutic process partly to help the clinician identify--and empathize--with the client's distinct challenges at each of the stages (Donovan & Diclemente, 2004, p. ix).

In the first phase, precontemplation, the client is in denial of his problem, yet he has come to therapy; the clinician understands from the nature of this first phase that patience is necessary as the client may leave therapy if too much cognizance of the problem is expected.  In the second stage, contemplation, the client is only grasping the problem and that concrete change will happen in the next two stages.  In this context, the other steps in the model are somewhat self-explanatory: preparation, action, maintenance, and relapse.  Clients will cycle through stages, but always with a positive approach to change (Noar, Benac & Harris, 2007). 

Validating the model's effectiveness is not the same as comparing it to other treatments as it is not a treatment.  It can be used as an abstraction of the process to provide, for instance, demarcations for client progress (Callaghan, 2008), though a recent study suggested that the model needed further refinement as clients were having positive outcomes before reaching the action phase.  The model can also be used to "tailor" intervention strategies to meet clients' unique needs within each of the model's phases (Noar, 2007).  At least one study shows the effectiveness of this use of the model, and there has been commercial implementation.

References

Callaghan, R. C., Taylor, L., Moore, B. A., Jungerman, F. S., Vilela, F., & Budney, A. J. (2008). Recovery and URICA stage-of-change scores in three marijuana treatment studies. Journal of Substance Abuse Treatment, 35(4), 419-426. doi:10.1016/j.jsat.2008.03.004

Donovan, D., & Diclemente, C. (2004). Substance abuse treatment and the stages of change: Selecting and planning interventions. New York: The Guilford Press.

Noar, S. M., Benac, C. N., & Harris, M. S. (2007). Does tailoring matter? Meta-analytic review of railored print health behavior change interventions. Psychological Bulletin. 133(4).