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Tuesday, October 19, 2010

Stages of Change Model

Readiness to Change/Stages of Change

The field of health psychology has long recognized the fact that individuals who are engaged in voluntary behavior change generally progress through a recognizable process. The Stages of Change model (DiClemente and Prochaska, 1998; Prochaska et al., 1992) has proven utility when applied to a wide range of health promotion behaviors including smoking cessation, dieting, initiating exercise programs, adopting safe sex practices, reducing intimate partner violence, and overcoming substance abuse problems (Begun et al., in press; Carney and Kivlahan, 1995; Prochaska et al., 1994; Willoughby and Edens, 1996).
Research indicates that individuals typically progress through a predictable, but non-linear sequence of stages when modifying a specific problematic behavior. Each stage is characterized by a set of attitudes, intentions, and behaviors related to the change process itself, as well as to the specific target behavior. People progress through these stages whether or not the change process is being facilitated by formal treatment interventions. Individuals differ markedly in the amount of time and degree of effort exerted in each stage, but the sequence is remarkably similar for everyone.
Stages of Change
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance

The first stage in the change process, Precontemplation, is characterized by a lack of intent to change the behavior because it is not viewed as being problematic (lack of awareness), the pros outweigh the cons (decisional balance), or the person is discouraged and demoralized by past failed attempts to change (self-efficacy). It is not uncommon for these individuals to appear in a treatment setting, but they are seldom there without pressure from family, job, or the law (Connors, Donovan, & DiClemente, 2001). A sub-group of individuals, who may be transitioning from this to the next stage, appear highly ambivalent about making change. They score high on precontemplation measures, but average on later stages.

The second stage is Contemplation. This stage is characterized by the individual considering making a change, seeking information related to the problem, and evaluating the pros and cons of changing-however, no overt change effort has begun. An individual who enters treatment may not be ready to take action (see later stages), but is seeking a means of reinforcing and continuing their contemplation processes (Connors et al, 2001).

Subsequent to this stage, individuals enter into the Preparation stage. Here a person solidifies the gains in Contemplation and begins to develop a concrete and upcoming (within one month) plan of action. The individual shows determination and may even begin some tentative changes and increase self-regulation. Furthermore, individuals at this stage are often able to recite valuable lessons learned from past failed attempts. This stage did not appear in early discussions of the model because it initially appeared as a blend of high Contemplation and Action processes, rather than as a distinct stage itself.

The most overtly obvious stage is Action. Behavior change has clearly begun as individuals acquire and practice skills and strategies needed to implement the change. They work to modify both their own behaviors and the environmental contexts of their behaviors (reducing and avoiding temptation experiences). These individuals also become aware of 'traps' that might work against their change efforts. The transtheoretical aspect of the Stages of Change model is most evident through this stage. Diverse intervention approaches seem effective in this stage even though many are ineffective for people in precontemplation or contemplation stages. Most of the treatment evaluation research explores interventions designed for people in this stage of the change cycle. The Action stage typically lasts an average of six months in the change of substance abuse behavior (Prochaska and DiClemente, 1992).

Finally, individuals may achieve the Maintenance stage. Individuals at this stage continue working to sustain the change gains made during the prior stages. They also actively work to avoid and prevent relapse (recurrences of the problem behavior). Termination of the change process does not occur until the person is fully confident and secure in the maintenance of change. This is the ultimate goal of the change process-to move through the spiral of stages, exiting through maintenance to termination.
Most people undergo several cycles of the stages of change process before achieving their ultimate change goals. It may take an average of 5-7 serious attempts (Prochaska, DiClemente, & Norcross, 1992).

The above is from the National Institute on Alcohol Abuse and Alcoholism, of the National Institutes of Health, "Social Work Education for the Prevention and Treatment of Alcohol Use Disorders" , Module 5: Diagnosis and Assessment of Alcohol Use Disorder available at the NIAAA web site http://www.niaaa.nih.gov/Pages/default.aspx
The Stages of Change Model is important to consider since the goal is to Transform the Alcohol Culture at JMU.  In order for people to get to the "Action" stage there are usually both internal and external motivating factors.  Students report experiencing many negative consequences related to alcohol use at JMU. The education sanctions imposed by the Judicial Affairs office on students are helping students through the stages of change.  There are many situations where a person did not consider their drinking to be a problem until the consequences became severe enough to them that they began to identify themselves as having a problem. For some people a DUI is the wake up call, for others relationship dysfunction or other losses served as their wake up call.  Suspension from JMU could be the wake up call for students that their drinking was a problem and help move the student to the "Action" stage of change.  JMU needs to see suspension as a helpful tool for students individually and also for transforming the JMU negative alcohol culture .

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