In order to give up an addiction such as smoking, drinking or using drugs, a person must go through foreseeable stages of change. Since Prochaska and DiClemente’s hallmark research in 1982, these stages have been continually scientifically reviewed. It is not often that a person is able to successfully give up their addiction after going through these stages only once. Normally people make a number of attempts to change before quitting for good. For example, someone might quit smoking many times over, only to take up smoking again five years later during a divorce, then have to cease smoking all over again.

Targeted strategies can be used to successfully aid change if a person’s precise stage of change is correctly identified. Incorrect identification of a person’s stage of change can cause rehabilitation to fail – for example, pressure to give up their addiction can create resistance and a determination to continue the feel-good behaviour. The six stages of change and several examples of specific cease detrimental behaviour are listed below:

Precontemplation

Throughout this stage, the person will outright deny the existence or severity of negative consequences of their addiction. There is no motivation to change, and the person is solely aware of the enjoyable effects of the addiction. People generally argue by saying something like "Grandpa smoked 40 cigarettes a day and it didn’t do him any harm; he lived until the ripe old age of 96!".

The most powerful stimulus to change is a wake-up call – for example an alcoholic may decide to change his behaviour after discovering that his mate was seriously injured in a car crash caused by drink-driving. An appointment with their family doctor for a health check can act as a stimulus for change. It is helpful to discuss the factual evidence regarding the health, relationship or vocational consequences of the person’s behaviour (i.e., liver, lover, livelihood). For example, you could ask "What would have to happen to show you that this behaviour is harmful to your being?". Endeavour to let the person to tell you the reasons why they should give up their behaviour and avoid giving advice or being pushy. Think about the saying "I learn what I believe as I hear myself speak".

Contemplation

This stage is characterised by uncertainty, procrastination and fence-sitting as the person begins to question their current beliefs. During this stage, people assess the harmful consequences of their behaviour versus the advantages of change. However, the costs of change are still substantial. It is likely that change in behaviour will happen within six months.

It is advisable to encourage people in the contemplation stage to reflect on the positive and negative effects of their behaviour. Commend all desires and attempts to cease their addiction. It is important that you remain non-judgemental as any perceived confrontation can elicit resistance and relapse.

Preparation

During the preparation stage the likelihood of change taking place within the next few weeks is high. During this stage people realise that the benefits of changing their behaviour outweigh the costs, bringing about a plan of action and cautious steps in the right direction.

It is critical that you stay non-judgmental, positive and supportive during this stage. Make yourself available so that the person is able to talk to you, and assist the person to gather information on available treatment programs. It is worthwhile to offer to make initial contact with the program the person is most interested in – for example, if a person with an alcohol addiction feels they can only manage ‘one step at a time’, an AA group might be the best option for them.

Action

Hard work is actively in progress through this stage, and change is seen as being beneficial with little or no costs. It is likely that you will notice specific changes in thoughts and beliefs.

It is beneficial to assist the person to get to therapy sessions and reflect on these sessions – you can help by organising transport to therapy sessions, talking about the content of the sessions with the person and positively reinforcing efforts to quit. It is beneficial for family members and friends to be involved in the therapy process – they can attend therapy sessions, compile information or even keep records of the person’s progress.

Maintenance

This stage is characterised by a rising level of certainty that change can be sustained. This stage generally lasts between six months and five years, and the temptation to relapse is less present during this period of time.

Continue to reinforce alterations in behaviour as the person practises, consolidates and internalises the new behaviours. It is imperative to give support to the person’s family and friends in order to assist in maintaining change.

Termination

This is the final stage of change; it is characterised by a total lack of temptation to relapse - ever, where the addiction has gone completely and the person has made a full recovery. It is very likely that it will take several years to reach this stage!