Key Takeaways
- The Transtheoretical Model identifies five stages of change: pre-contemplation, contemplation, preparation, action, and maintenance.
- Movement through the stages is often non-linear, with individuals cycling between stages multiple times before achieving sustained recovery.
- Different therapeutic interventions are most effective at different stages of change.
- Understanding your current stage helps you set realistic expectations and access the most appropriate support.
- Relapse is a common part of the change process, not a sign of failure.
Understanding the Stages of Change Model
The Transtheoretical Model of behavior change, developed by psychologists James Prochaska and Carlo DiClemente in the 1970s, describes five stages through which individuals progress when making significant behavioral changes. Originally developed to understand how smokers quit on their own, the model has since been applied extensively to addiction recovery and is now a foundational framework used by treatment programs worldwide, including Trust SoCal in Orange County.
The five stages, pre-contemplation, contemplation, preparation, action, and maintenance, describe a continuum of readiness for change. Importantly, progression through these stages is rarely linear. Most people cycle through the stages multiple times, moving forward, slipping back, and advancing again before achieving sustained behavior change. This understanding normalizes the experience of setbacks and reframes relapse as a common part of the recovery process rather than a catastrophic failure.
Each stage is characterized by specific attitudes, behaviors, and challenges, and each responds best to different therapeutic interventions. Matching the therapeutic approach to the person's current stage of change significantly improves treatment outcomes. A person in pre-contemplation, for example, is unlikely to respond to action-oriented interventions like relapse prevention planning, while a person in the action stage may become frustrated with exploratory conversations about whether they have a problem.
Stage 1: Pre-Contemplation
In the pre-contemplation stage, the individual does not believe they have a problem or is not yet considering change. They may minimize or deny their substance use, blame external factors for any negative consequences, or genuinely not recognize the impact that addiction is having on their life. From the outside, this stage can be deeply frustrating for family members and friends who can clearly see the damage being done.
Pre-contemplation is not simply stubbornness or willful blindness. The neurobiological effects of addiction, combined with psychological defense mechanisms like denial and rationalization, create a genuine inability to perceive the situation accurately. Additionally, some individuals in this stage have never been exposed to information about addiction as a disease and may lack the framework to understand what is happening to them.
The most effective approach for individuals in pre-contemplation is gentle, nonjudgmental education that plants seeds of awareness without pushing for immediate change. Motivational interviewing, which explores the person's own values and how their behavior aligns or conflicts with those values, can be effective in moving someone from pre-contemplation to contemplation. Family interventions, as discussed in our intervention guide, can also serve as a catalyst for movement out of this stage.
People in pre-contemplation are not "in denial." They genuinely may not see their substance use as problematic. Meeting them with compassion rather than confrontation is far more effective than trying to force awareness.
Stage 2: Contemplation
The contemplation stage is characterized by ambivalence. The individual recognizes that their substance use is causing problems but is not yet ready to commit to change. They weigh the perceived benefits of continued use against the acknowledged costs, and the scales have not yet tipped definitively toward change. This internal conflict can persist for weeks, months, or even years.
Common experiences in this stage include thinking about quitting "someday," feeling guilty about substance use while continuing to engage in it, researching treatment options without taking action, and making tentative commitments to change that are not followed through. The person is aware of the problem but has not yet developed the motivation, confidence, or practical readiness to address it.
Therapeutic approaches that are effective during contemplation include motivational interviewing, which helps resolve ambivalence by exploring the discrepancy between the person's values and their behavior. Psychoeducation about addiction, the consequences of continued use, and the possibility of recovery can also help tip the scales. At Trust SoCal in Fountain Valley, admissions coordinators are trained in motivational interviewing techniques and can help individuals in this stage explore their readiness for treatment without pressure.
Stage 3: Preparation
In the preparation stage, the individual has decided to make a change and is taking concrete steps to prepare for it. This might include researching treatment centers, calling for insurance verification, telling family members about their decision, reducing their substance use, or setting a quit date. The commitment to change has been made, and the person is mobilizing resources and making practical arrangements.
The preparation stage is a critical window of opportunity because motivation is high but action has not yet been fully initiated. Treatment providers should facilitate this momentum by removing barriers to entry wherever possible. At Trust SoCal, the admissions team expedites the pre-admission process for individuals in the preparation stage, handling insurance verification, scheduling assessments, and answering questions quickly to maintain momentum. Call (949) 280-8360 to begin the process.
It is important during this stage to develop a realistic plan rather than making impulsive decisions driven by the emotional high of deciding to change. A thorough assessment, a carefully selected treatment program, and practical preparations like arranging childcare, informing employers, and delegating responsibilities all contribute to a smoother treatment entry and a lower risk of abandoning the plan before it begins.
Stage 4: Action
The action stage is what most people think of when they picture addiction recovery. It is the period of active, visible behavior change that includes entering treatment, achieving sobriety, learning coping skills, and making fundamental changes to daily routines, relationships, and thought patterns. This stage typically spans the first six months to one year of recovery and requires the most concentrated effort and support.
During the action stage, individuals are engaged in the work of treatment: attending therapy sessions, participating in groups, processing trauma, learning relapse prevention strategies, and rebuilding their lives. The changes are dramatic and visible, but they are also fragile. The neural pathways associated with addiction are still active, cravings remain strong, and the skills being learned have not yet become automatic habits. External support from the treatment team, peers, family, and recovery community is essential during this stage.
Trust SoCal's comprehensive treatment programming is specifically designed for individuals in the action stage. From residential treatment through PHP, IOP, and outpatient care, every level of programming provides the structure, clinical support, and community needed to sustain the active changes being made. The continuum of care model ensures that support does not disappear when the initial intensity of treatment decreases.
Stage 5: Maintenance
The maintenance stage begins when the acute phase of behavior change has been completed and the focus shifts to sustaining the gains made during the action stage. This stage can last for years or even a lifetime, and it requires ongoing vigilance, self-awareness, and commitment to recovery-oriented behaviors. The risk of relapse decreases over time but never reaches zero, which is why continued engagement in aftercare, support groups, and personal growth is essential.
During maintenance, the individual has developed a recovery identity, established sober routines, rebuilt relationships, and created a life that supports sobriety. However, new challenges continue to arise: career changes, relationship difficulties, health problems, loss, and other stressors can all test the coping skills developed during treatment. The maintenance stage is about applying those skills to the inevitable challenges of life without reverting to substance use.
It is worth noting that some researchers have proposed a sixth stage, termination, in which the individual no longer experiences any temptation to return to the problematic behavior and the change is fully integrated into their identity. While this stage may be achievable for some behaviors like smoking cessation, most addiction specialists view recovery as a lifelong process that requires ongoing maintenance rather than a condition that can be fully terminated.
Recovery is not a destination. It is a way of living that requires daily practice, ongoing support, and a willingness to keep growing. The work changes over time, but it never truly ends.
— Trust SoCal Clinical Director
Madeline Villarreal, Counselor
Counselor
