BRIEF INTERVENTIONS and STAGES OF CHANGE
Clients need motivational support appropriate to their stage of change. If the clinician does not use strategies appropriate to the stage the client is in, treatment resistance or noncompliance could result.
A model consisting of five stages of change that best represents the process people go through when thinking about, beginning, and trying to maintain new behavior
| Stage | Example | Treatment Needs |
| Precontemplation. The user is not considering change, is aware of few negative consequences, and is unlikely to take action soon. | A functional yet alcohol-dependent individual who drinks himself into a stupor every night but who goes to work every day, performs his job, has no substance abuse-related legal problems, has no health problems, and is still married. | This client needs information linking his problems and potential problems with his substance abuse. A brief intervention might be to educate him about the negative consequences of substance abuse. For example, if he is depressed, he might be told how his alcohol abuse may cause or exacerbate the depression. |
| Contemplation. The user is aware of some pros and cons of substance abuse but feels ambivalent about change. This user has not yet decided to commit to change. | An individual who has received a citation for driving while intoxicated and vows that next time she will not drive when drinking. She is aware of the consequences but makes no commitment to stop drinking, just to not drive after drinking. | This client should explore feelings of ambivalence and the conflicts between her substance abuse and personal values. The brief intervention might seek to increase the client’s awareness of the consequences of continued abuse and the benefits of decreasing or stopping use. |
| Preparation. This stage begins once the user hasdecided to change and begins to plan steps toward recovery. | An individual who decides to stop abusing substances and plans to attend counseling, AA, NA, or a formal treatment program. | This client needs work on strengthening commitment. A brief intervention might give the client a list of options for treatment (e.g., inpatient treatment, outpatient treatment, 12-Step meetings) from which to choose, then help the client plan how to go about seeking the treatment that is best for him. |
| Action. The user tries new behaviors, but these are not yet stable. This stage involves the first active steps toward change. | An individual who goes to counseling and attends meetings but often thinks of using again or may even relapse at times. | This client requires help executing an action plan and may have to work on skills to maintain sobriety. The clinician should acknowledge the client’s feelings and experiences as a normal part of recovery. Brief interventions could be applied throughout this stage to prevent relapse. |
| Maintenance. The user establishes new behaviors on a long-term basis. | An individual who attends counseling regularly, is actively involved in AA or NA, has a sponsor, may be taking disulfiram (Antabuse), has made new sober friends, and has found new substance-free recreational activities. | This client needs help with relapse prevention. A brief intervention could reassure, evaluate present actions, and redefine long-term sobriety maintenance plans. |
| Source: Adapted from Prochaska and DiClemente, 1984. | ||
SAMHSA treatment improvement protocol 34
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