Stages of Change and Dual Recovery

Report
Stages of Change
in Dual Recovery
Applying best-practice models to
treatment for co-occurring
disorders. . .
Stages of Change
Prochaska, Norcross, & DiClemente
Precontemplation
Relapse / Recycle
Contemplation
Maintenance
Preparation
Action
Evaluating Stages of Change
Precontemplation (Denial)

“What problem? I’m not thinking about it.”
Contemplation (Ambivalence)

“I wonder if I might have a problem? I’m thinking about it but
not ready to decide anything yet.”
Preparation / Determination (Admission)

“I have a problem.”
Action (Taking steps / Making changes)

“I have a problem and I’m ready to do something about it.”
Maintenance (Continuing what works)

“I’m stabilized and doing well. How can I support my ongoing
recovery?”
Relapse / Recycle (Trying again)

“I’m stabilized but have relapsed. How can I get back into active
recovery?”
Precontemplation:
“Huh? What problem?”
A Precontemplationstage person is
described as, “It’s not
that they can’t see the
solution. It’s that they
can’t see the problem.”
This stage of change has
been given the label of
“Denial” in times past.
Precontemplation:
“Huh? What problem?”
Treatment for someone in
the Precontemplation
stage would seek to
engage them in the
process of objectively
evaluating whether
they have a problem,
and supporting movement
along to the Contemplative
stage of change.
Precontemplation
Am I Precontemplative?
“What Problem?”
“Who, me?”
“I see no reason to change.”
“I wish people would just leave
me alone already!”
Evaluating Stages of Change
Precontemplation (Denial)

“What problem? I’m not thinking about it.”
Contemplation (Ambivalence)

“I wonder if I might have a problem? I’m thinking about it but
not ready to decide anything yet.”
Preparation / Determination (Admission)

“I have a problem.”
Action (Taking steps / Making changes)

“I have a problem and I’m ready to do something about it.”
Maintenance (Continuing what works)

“I’m stabilized and doing well. How can I support my ongoing
recovery?”
Relapse / Recycle (Trying again)

“I’m stabilized but have relapsed. How can I get back into active
recovery?”
Contemplation:
“Problem? Yeah . . . Action? Nah.”
Contemplation-stage
folks may know their
destination, and even how
to get there, but they are
“not ready yet.”
Someone in this stage of
change may be
ambivalent about doing
anything about a problem
that they can clearly
identify having.
Contemplation:
“Problem? Yeah . . . Action? Nah.”
Treatment for someone in
the Contemplation stage
would seek to engage them
in the process of gaining
motivation to address their
problem, and supporting
movement along to the
Preparation stage of
change.
C
o
nt
e
m
pl
at
io
n
Am I Contemplative?
“I might have a
problem.”
“I’m not ready to
make any decisions
yet.”
“Problem? Maybe.”
Considering change,
but ambivalent.
Evaluating Stages of Change
Precontemplation (Denial)

“What problem? I’m not thinking about it.”
Contemplation (Ambivalence)

“I wonder if I might have a problem? I’m thinking about it but
not ready to decide anything yet.”
Preparation / Determination (Admission)

“I have a problem.”
Action (Taking steps / Making changes)

“I have a problem and I’m ready to do something about it.”
Maintenance (Continuing what works)

“I’m stabilized and doing well. How can I support my ongoing
recovery?”
Relapse / Recycle (Trying again)

“I’m stabilized but have relapsed. How can I get back into active
recovery?”
Preparation:
“Almost ready to take action . . .”
Preparation-stage
individuals are planning to
take future action, but are
still making the final
adjustments before
committing.
Someone in this stage of
change may be working
through the final
obstacles that are getting
in the way of taking action.
Preparation:
“Almost ready to take action . . .”
Treatment for someone in
the Preparation stage
would seek to engage
them in the process of
taking action to address
their problem, i.e.,
supporting movement
along to the Action stage
of change.
Preparation
Am I in Preparation?
“I have a problem,
but don’t want to
commit to doing
anything about it yet”
“I’m developing plans
to change”
“Problem? Yes…
Change? Not yet…”
Evaluating Stages of Change
Precontemplation (Denial)

“What problem? I’m not thinking about it.”
Contemplation (Ambivalence)

“I wonder if I might have a problem? I’m thinking about it but
not ready to decide anything yet.”
Preparation / Determination (Admission)

“I have a problem.”
Action (Taking steps / Making changes)

“I have a problem and I’m ready to do something about it.”
Maintenance (Continuing what works)

“I’m stabilized and doing well. How can I support my ongoing
recovery?”
Relapse / Recycle (Trying again)

“I’m stabilized but have relapsed. How can I get back into active
recovery?”
Action:
“Let’s get going”
The Action Stage is described
as the one in which
individuals most overtly
modify their behavior
and surroundings to
accomplish their goal.
Someone in this stage of
change is taking visible steps
and making visible changes in
order to work on their
recovery.
Action:
“Let’s get going”
Treatment for someone
in the Action stage
would seek to assist
them in taking all
indicated steps to be
successful in their
recovery, and to support
movement along to the
Maintenance stage of
change.
Action
Am I at Action stage?
“I have a problem
and I’m ready to do
something about it.”
“I’m making
changes.”
“Problem? Yes…
Change? YES!”
Evaluating Stages of Change
Precontemplation (Denial)

“What problem? I’m not thinking about it.”
Contemplation (Ambivalence)

“I wonder if I might have a problem? I’m thinking about it but
not ready to decide anything yet.”
Preparation / Determination (Admission)

“I have a problem.”
Action (Taking steps / Making changes)

“I have a problem and I’m ready to do something about it.”
Maintenance (Continuing what works)

“I’m stabilized and doing well. How can I support my ongoing
recovery?”
Relapse / Recycle (Trying again)

“I’m stabilized but have relapsed. How can I get back into active
recovery?”
Maintenance:
“I’m in a good place, let’s keep it up!”
In the Maintenance Stage,
the focus is on consolidating
gains and preventing relapse.
Someone is this stage has an
effective set of tools and
“program of recovery” that
they commit to continuing to
practice.
Treatment for someone in the
Maintenance stage would
seek to strengthen and
increase their “tool kit” and to
support ongoing recovery
success.
Maintenance
Am I at Maintenance?
“I’m stabilized and
doing well. How can
I support my ongoing
recovery?”
“I’ve made the
changes I want; now
I want to maintain my
gains.”
Evaluating Stages of Change
Precontemplation (Denial)

“What problem? I’m not thinking about it.”
Contemplation (Ambivalence)

“I wonder if I might have a problem? I’m thinking about it but
not ready to decide anything yet.”
Preparation / Determination (Admission)

“I have a problem.”
Action (Taking steps / Making changes)

“I have a problem and I’m ready to do something about it.”
Maintenance (Continuing what works)

“I’m stabilized and doing well. How can I support my ongoing
recovery?”
Relapse / Recycle (Trying again)

“I’m stabilized but have relapsed. How can I get back into active
recovery?”
Relapse / Recycle:
“How can I get back on track?”
Relapse is often part of the chronic
disease process, and recovering
individuals need to be prepared to
deal with it, including damage-
control strategies.
“Progress not perfection,”
supports gentleness and freedom
from shame, and “Progress not
permission” emphasizes the
importance of personal responsibility to stay active in one’s own
recovery, even when slips or relapses occur.
The Recycling aspect of relapse supports the view that recoverystrengthening lessons can be learned from relapse episodes –
“The only bad relapse is a WASTED relapse”
Relapse / Recycle
Relapse / Recycle
“I’m stabilized but
have relapsed. How
can I get back into
active recovery?”
“How can I learn from
my relapse to
strengthen my
recovery plan?”

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