Understanding Stages of Change in Addiction Recovery and Treatment.
- Jul 11, 2019
- 14 min read
Updated: 1 day ago
Navigating the journey from addiction to recovery can feel overwhelming, but it’s a process that unfolds in clear, manageable stages. We have a solid grasp of the behavioral models that guide this transformation, and we’re here to explain how lasting change is possible. This isn't about willpower alone; it's about a structured, step-by-step approach to a healthier life.
What are the stages of change in addiction recovery?
The Transtheoretical Model (TTM) outlines seven stages of change for addiction recovery: Pre-Contemplation, Contemplation, Preparation, Action, Maintenance, and Termination. This model emphasizes that change is a gradual process, not a single event, and accounts for individual differences and the inevitability of relapse.
Ready to dive deeper? We’ve outlined a comprehensive breakdown of each stage of the Transtheoretical Model, providing detailed insights and practical strategies for every step of the recovery journey. Continue reading to gain a full understanding of this powerful framework and how it applies to real-world addiction treatment.
Table of Contents
Understanding the Stages of Addiction Recovery and the Transtheoretical Model (TTM)
The Difficulty of Overcoming Addiction: More Than Willpower
The Foundation of the Transtheoretical Model
Stage 1: Pre-Contemplation (The Denial Phase)
Characteristics of the Pre-Contemplator
Strategies for Moving Forward: Raising Awareness
Stage 2: Contemplation (The Getting Ready Phase)
The Ambivalence Trap: Weighing Pros and Cons
Motivational Strategies for Contemplators
Stage 3: Preparation (The "Ready to Act" Phase)
Taking Small Steps and Developing a Plan
Transitioning to Action-Oriented Programs
Stage 4: Action (The Behavioral Change Phase)
Overt Changes and High-Intensity Efforts
Securing Early Recovery: Treatment Programs and Support
Stage 5: Maintenance (The Long-Term Stability Phase)
Sustaining Sobriety and Preventing Relapse
The Role of Aftercare and Recovery Support Groups
Stage 6: Termination (The Theoretical End of Addiction)
The Ideal State: Addiction No Longer a Struggle
Why Termination is Often Considered Idealistic
The Critical Role of Relapse in the Recovery Cycle
Relapse is a Setback, Not a Failure
Strategy: Learning and Re-Engagement
Advanced NLP and Cognitive Strategies for Lasting Recovery
Mindfulness and Emotional Regulation
The Power of Cognitive Restructuring
Conclusion: Your Roadmap to a Life in Recovery
Frequently Asked Questions (FAQ)
Understanding the Stages of Addiction Recovery and the Transtheoretical Model (TTM)
Recovering from an addiction is never an easy task. It is far more complex than learning a new physical skill or tying one's shoes. It involves reprogramming the brain's reward system and fundamentally altering deeply rooted behavioral patterns. Even the most rudimentary of tasks takes time to master, and a true shift away from addictive behavior takes even longer.
The process of learning any skill is broken down into smaller, manageable steps. Each step is aimed at bringing forth the desired change. This is the same philosophy that holds true in trying to change from being an addict to becoming a person in recovery. This idea is central to understanding the stages of change in addiction recovery and treatment, which outline how transformation often unfolds in a structured and gradual way.
The National Institute of Health estimates that millions of Americans have struggled with drug and substance abuse at some point in their lives. Fortunately, not all of those affected end up spending the rest of their lives in despair. There is hope for one to make real and lasting change with resources such as treatment centers and addiction programs, counseling, therapy, and 12-step programs.
The Difficulty of Overcoming Addiction: More Than Willpower
A central question has baffled addicts, counselors, and the addiction community: why is it easier for some people to overcome addiction but harder for others? The answer lies in the readiness for change, not a deficiency in character or willpower. For decades, various theories have been proposed. Nonetheless, the Transtheoretical Model of Behavior Change (TTM) is one of the theories that has endured scrutiny and proudly stands strong as a guiding framework for substance treatment.
The Foundation of the Transtheoretical Model
Traditionally, behavioral change was seen as an event: stop drinking, quit smoking, or eat healthier. The Transtheoretical Model, introduced by researchers James Prochaska and Carlo DiClemente in the 1970s while studying ways to help people quit smoking, proposes a different perspective. It asserts that for someone to completely eradicate problematic behavior, they must undergo sequentially defined stages.
Unlike other models which single out specific aspects of change, such as biological or environmental influence, the TTM model incorporates various key constructs of other models. In doing so, it provides a comprehensive theory of change that applies to a variety of behaviors, settings, and populations, thus the name transtheoretical. A key insight from DiClemente and Prochaska's theory is that relapses are simply an inevitable part of the change process, a concept crucial for guiding addiction relapse prevention.
People are different, and it is these differences that determine the time one spends in each TTM stage. That is why it is easier for some to recover from addiction and much harder for others. Even so, to create lasting behavioral change, all individuals must complete the tasks required in each stage. This raises the essential question: How do the TTM stages of change in recovery relate to addiction recovery treatment?
Stage 1: Pre-Contemplation (The Denial Phase)
In the first stage of the TTM model, the individual is unaware of the negative impact of their addiction or is unwilling to change. This is the phase of denial. They may feel that their drug use or alcohol problem is normal, or that the consequences they face are due to external factors.
Characteristics of the Pre-Contemplator
The pre-contemplator is metaphorically blind to the adverse effects of their addiction. To them, their addictive tendencies are nothing if not normal. Efforts by family, friends, or qualified professionals to highlight the link between their life problems and their addiction will rarely succeed at first.
Some pre-contemplators may have tried multiple times to change but were unsuccessful, leading to feeling demoralized about their ability to change. They are reluctant to try again. Professionals may see them as resistant, unmotivated, or not ready for change, but the truth is that traditional drug abuse treatment programs, which advocate for immediate action, are not designed to help individuals at this stage.
Usually, people in this stage who go to rehab or seek out therapy do so because they are being pressured by others, such as relatives, friends, or a spouse. The individual may feel that the situation is hopeless, believing their addictive behavior results from genetic makeup, destiny, or society, factors they perceive as unchangeable. However, the negative consequences of one's addictive behavior eventually catch up, and this is what ultimately prompts a move to the next stage.
Strategies for Moving Forward: Raising Awareness
A helpful strategy to employ with a pre-contemplator is to encourage them to rethink their behavior, practice self-analysis, and examine the risks involved. This involves non-confrontational information sharing that gently raises doubt about their current choices, encouraging a first step toward self-reflection.
Stage 2: Contemplation (The Getting Ready Phase)
In this stage, the individual is essentially at war with themselves. They are aware of the harm addiction has wrecked in their lives, but the thought of making a change, moderating, or quitting seems ambivalent. The phrase "I know I have a problem, and I need to stop, but..." perfectly summarizes this stage.
The Ambivalence Trap: Weighing Pros and Cons
For contemplators, the fear of changing often still outweighs the potential benefits to their mental, physical, and emotional state. The uncertainty associated with this stage can last for a significant time. They are engaged in a mental cost-benefit analysis, weighing the "pros" of continued substance use against the "cons" of that use, and simultaneously weighing the "pros" of change against the "cons" of change (e.g., losing friends, being uncomfortable).
Nonetheless, the individual is more open to hearing about the negative effects of their addiction than they were in the pre-contemplation stage. They may also be willing to try out different approaches to cut down or moderate problematic behavior. They are not yet ready to commit to quitting altogether, but they have become more open to the idea of changing sometime in the future.
Motivational Strategies for Contemplators
To help a contemplator move to the next stage, a practitioner or support person should confirm the individual's readiness to change, normalize the idea of change by weighing the pros as well as the cons, and identify specific barriers to behavioral change. Non-judgmental information giving along with motivational approaches of encouraging change will work better than confrontational methods. This is where the NLP concept of motivational interviewing stages of change aligns, helping the person resolve their ambivalence.
These individuals are still not ready to embark on traditional addiction recovery treatment programs which advocate for immediate change. Until the addict decides to take the leap and make a commitment, they can quickly revert to the pre-contemplation stage. This decision to commit to change is the event that propels the addict to the next stage.
Stage 3: Preparation (The "Ready to Act" Phase)
Individuals in the preparation stage acknowledge that their addictive behavior is a problem, realize the need to make a change, and are actively preparing to fix their lives. This is a crucial pivot point, often referred to as a determination stage.
Taking Small Steps and Developing a Plan
The idea of changing does not seem so impossible anymore. One may even be taking small steps to prepare oneself for a more significant lifestyle change. For instance, if an individual is preparing to quit drinking, they might start by cutting back on social activities where alcohol is prominent, researching outpatient programs, or scheduling an initial consultation with a counselor.
People in the preparation stage are not content to just sit and wait for change. They are now taking ownership. The key task here is to formalize the plan.
Make a plan and begin to take direct action, such as consulting a counselor or research drug treatment programs near me.
Prepare a list of motivating statements and another for the desired goals.
Join a mutual support group, like a 12-step program, or an alternative health club.
Inform family and close friends about the decision to change to build a recovery support system.
Read up on the addiction to learn different ways to make a successful, lasting change, engaging in psychoeducation.
Transitioning to Action-Oriented Programs
After making the necessary preparations, the individual is ready to move to the next TTM stage and can be successfully integrated into action-oriented programs. This readiness significantly improves the chances of success in early recovery.
Stage 4: Action (The Behavioral Change Phase)
In this stage, the individual has made specific, overt changes to their overall lifestyle. It is no longer a question of "I don’t want to change" or "I can’t change," but rather "I am changing."
Overt Changes and High-Intensity Efforts
Since the changes here are more observable, it is not surprising that behavioral change is often misconstrued as the action, rather than the fourth stage of change that it is. The action stage relies on the goals set in the contemplation and preparation stages.
Many people fail at making lasting changes because they do not give enough thought to the kind of change they want and do not prepare a plan of action (Stage 2 and Stage 3). For example, someone trying to eat healthier who immediately throws out all junk food and begins an extreme diet often quickly relapses.
Individuals who triumph in the action stage are those who completed the subsequent stages, seeking out rehab, individual counseling, or group meetings as a means to manage the destructive behavior. This is where drug and alcohol programs become most effective.
Securing Early Recovery: Treatment Programs and Support
The process can seem tedious and boring after the high-energy, chaotic life of addiction. Therefore, this stage carries the highest risk of relapse. Successful action involves:
Committing to being clean and sober or managing the behavior.
Identifying and eliminating triggers, a core part of effective substance use support.
Enthusiastically embracing a new, healthier lifestyle.
Engaging in cognitive restructuring to challenge and change problematic thought patterns.
If the individual commits and works diligently, they should be able to move to the next stage.
Stage 5: Maintenance (The Long-Term Stability Phase)
Recovering from an addiction is a life-long process, and Prochaska and DiClemente's original model recognizes this fact. The maintenance stage is concerned with keeping to the intentions made in the third stage and the behaviors implemented in the fourth stage. This stage begins roughly six months after the action stage began and can last for years.
Sustaining Sobriety and Preventing Relapse
Cravings and triggers may dissipate over time, but the temptation to use will never be truly eradicated. Because drugs affect the neural pathways of the brain, the sensations one felt while under the influence can never be completely forgotten. However, individuals in this stage have learned how to manage their addiction and maintain their new lifestyle with minimal effort. They have developed a new normal where they integrate change into their lives by:
Continually guarding against triggers and high-risk situations.
Focusing on preventing relapses, a major component of addiction aftercare.
Consolidating their efforts to maintain a life free of destructive behaviors.
Developing a strong identity as a person in sobriety.
The Role of Aftercare and Recovery Support Groups
Most addiction treatment professionals advocate for complete abstinence. Aftercare treatment is the foundation of the maintenance stage, including regular attendance at recovery groups, individual therapy, or engaging in sober hobbies. This stage is about adapting to a new sober life, which includes navigating complex emotions, managing stress, and building healthy relationships, all part of maintaining recovery from addiction.
Stage 6: Termination (The Theoretical End of Addiction)
Theoretically, in this stage, the individual completely overcomes their addictive behavior and stops abusing drugs without any effort. The individual no longer craves drugs, and as such, relapsing is considered close to impossible. They can sustain a clean and sober life with minimal effort or conscious thought toward their past addiction.
The Ideal State: Addiction No Longer a Struggle
Many professionals deem this stage as idealistic and impractical. Termination means the end, and for many, recovering from an addiction is a lifelong process. When the theory was first invented, the science on the brain's neuroplasticity and the chronic nature of addiction was less developed. The understanding that addiction leaves a lasting mark on the brain makes "termination" a difficult concept to fully endorse.
However, the spirit of this stage is important. It represents a state of complete behavioral freedom where the former addictive process no longer dictates life decisions. Even if one does not reach a true "termination," striving for a high level of long-term stability and resilience is the ultimate goal of all treatment and recovery efforts.
The Critical Role of Relapse in the Recovery Cycle
A fundamental aspect of the TTM is its non-linear nature. Individuals rarely move straight through the stages of change in addiction without setbacks. Relapse, which is the return to a substance use pattern after a period of abstinence, is a common and predictable element of chronic disease management.
Relapse is a Setback, Not a Failure
DiClemente and Prochaska's theory proposes that relapses are an inevitable part of the change process. It should not be viewed as a failure, but rather as a signal that the current strategies need adjustment. The individual is not starting over, but simply "recycling" back to an earlier stage, often Preparation or Contemplation, with new knowledge and insights.
Strategy: Learning and Re-Engagement
All an individual can do to guard against relapse is to identify their triggers and be on the lookout. Do not let relapses frustrate, demoralize, or disappoint you. They are part of the process.
Consider relapses as learning opportunities.
Examine the reason for your relapse and identify what triggered you, engaging in relapse prevention strategies.
Reassess your strategies for dealing with triggers and come up with new techniques you can use to handle temptations.
Reaffirm your decision to stay sober and clean, re-engaging with your recovery program.
The next time a trigger appears, the person will be better prepared, and their recovery will be safer for it. This process of re-engagement is a sign of resilience and commitment to a life in recovery.
Advanced NLP and Cognitive Strategies for Lasting Recovery
To truly bypass the cycles of addiction and avoid the pitfalls of AI-like, robotic recovery, a person must engage advanced cognitive techniques that promote emotional regulation and genuine internal change. This is where modern therapy, informed by Natural Language Processing (NLP) concepts, provides exceptional value.
Mindfulness and Emotional Regulation
The core of addiction is often a deep difficulty with managing uncomfortable emotions. Mindfulness practices and meditation help individuals develop a stronger mind-body connection. By observing thoughts and feelings without immediate reaction, they create a space between a trigger and the addictive response.
This focus on internal processing rather than external doing is the essence of true cognitive change. Individuals learn to regulate their own internal state, reducing the need for an external substance to manage distress.
The Power of Cognitive Restructuring
Cognitive Restructuring involves identifying and challenging the distorted thinking patterns that sustain addictive behavior. For instance, challenging the thought, "I cannot have fun without drinking," by actively seeking out and enjoying sober social activities.
This is an application of NLP, where the individual changes the internal dialogue (the 'language' of the mind) to support the desired behavior. Replacing negative, self-defeating statements with positive, recovery motivation statements helps solidify new neural pathways. This creates a strong psychological foundation for maintaining sobriety.
Your Roadmap to a Life in Recovery
Successful recovery from addictive behavior occurs in gradual, sequential steps over time. According to the Transtheoretical Model of Behavioral Change, lasting change can only happen if you understand the harmful effects of your addiction (Pre-Contemplation), are willing to change (Contemplation), prepare a solid plan of action (Preparation), take decisive steps (Action), and stick to your decision to change (Maintenance).
The process of finding sobriety is a journey of self-discovery, personal growth, and cognitive restructuring. If you need help with your recovery from substance abuse, reach out to a professional treatment center. Trained and experienced professionals are available to assist you in navigating every stage. The staff at any reputable recovery center is always available to help you with all of your questions regarding addiction recovery and treatment. Call anytime; your journey to a better life begins with a single step in the right direction.
Frequently Asked Questions
• What is the most difficult stage of change in addiction recovery?
Many professionals consider the Contemplation Stage the most difficult because it is characterized by intense ambivalence. The individual knows they have a problem and the potential benefits of changing, but the fear and difficulty of giving up the addictive behavior often create a paralyzing internal conflict that can last for months or years, delaying recovery steps. The Action Stage also carries a high risk of relapse duement to the intense behavioral effort required.
• What is the difference between the Contemplation and Preparation stages?
In the Contemplation Stage, an individual is aware of their addiction's harm but is still ambivalent about changing ("I might quit someday"). In the Preparation Stage, they have committed to making a change and are actively taking small, concrete steps to get ready for a significant lifestyle shift ("I am calling a treatment program this week and starting to track my usage").
• What are the five stages of recovery from drug addiction?
While the TTM has six primary stages (Pre-Contemplation, Contemplation, Preparation, Action, Maintenance, and Termination), many addiction professionals often refer to a simplified, five-stage model by lumping Preparation into Action or omitting Termination. The most commonly cited five stages are: Pre-contemplation, Contemplation, Preparation, Action, and Maintenance.
• Is relapse a normal part of the Transtheoretical Model?
Yes, the TTM views relapse, or "recycling," as an expected and normal event in the non-linear process of behavioral change. Prochaska and DiClemente's theory proposes that relapses are an inevitable part of the change process and should be viewed as learning opportunities rather than moral failures or a sign of an incapable individual. A relapse simply means the person needs to reassess their strategies and re-engage with the stages, often by moving back to Preparation or Contemplation.
•How does NLP optimize the maintenance stage of recovery?
In the Maintenance Stage, NLP (Natural Language Processing) principles, specifically applied to therapy, help optimize the recovery by focusing on internal language and cognitive restructuring. This involves identifying the internal dialogue (self-talk) that could lead to relapse and deliberately changing it to reinforce sobriety recovery and a positive self-identity. It solidifies the "new normal" through advanced self-management techniques.
After learning about the stages of change and how they relate to addiction recovery, you might be ready to take the next step. At Chateau Health and Wellness Treatment Center, we understand this journey is a process, and we are here to support you at every stage. We recognize that everyone's path is unique, whether you're contemplating change or actively working on maintenance. If you're struggling, or if you simply have questions about the process, please know we are here to help. Our team is committed to providing compassionate care tailored to your needs. Give us a call today at (801) 877-1272—let us be a part of your journey toward lasting recovery.
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About The Author
Ben Pearson, LCSW - Clinical Director
With 19 years of experience, Ben Pearson specializes in adolescent and family therapy, de-escalation, and high-risk interventions. As a former Clinical Director of an intensive outpatient program, he played a key role in clinical interventions and group therapy. With 15+ years in wilderness treatment and over a decade as a clinician, Ben has helped countless individuals and families navigate mental health and recovery challenges.
Danny Warner, CEO of Chateau Health and Wellness
Brings a wealth of experience in business operations, strategic alliances, and turnaround management, with prior leadership roles at Mediconnect Global, Klever Marketing, and WO Investing, Inc. A graduate of Brigham Young University in Economics and History, Danny has a proven track record of delivering results across diverse industries. His most transformative role, however, was as a trail walker and counselor for troubled teens at the Anasazi Foundation, where he directly impacted young lives, a personal commitment to transformation that now drives his leadership at Chateau.
Austin Pederson, Executive Director of Chateau Health and Wellness
Brings over eight years of experience revolutionizing mental health and substance abuse treatment through compassionate care and innovative business strategies. Inspired by his own recovery journey, Austin has developed impactful programs tailored to individuals facing trauma and stress while fostering comprehensive support systems that prioritize holistic wellness. His empathetic leadership extends to educating and assisting families, ensuring lasting recovery for clients and their loved ones.
