December 13, 2001
New book describes stages of change
By Pam Sowers
HS News & Community Relations
For years, people suffering through alcoholism or drug abuse with a family member have been told they have to confront the problem head-on, by holding an intervention and making him or her face up to the problem. The idea was that denial was part of the disease, whether it was drug abuse, overeating or smoking. Researchers are now saying that the head-on approach may be wrong-headed in many cases.
Dr. Dennis Donovan is director of the Alcohol and Drug Abuse Institute at the UW, and co-author of the recent book, Substance Abuse Treatment and the Stages of Change (Guilford Publications, Inc., 2001). Donovan says the assumption that denial is a major part of the addicted individual’s personality is beginning to disappear.
“The question becomes: Can I go about approaching this differently so the client will look at what I believe and will he or she also start to do things that I think they should try?” Donovan says.
He adds that approaching any change in behavior, whether it’s giving up chocolate, smoking, cocaine or alcohol, or starting exercising and using sunscreen more often, entails several steps or stages.
Stage One is called pre-contemplation. The person has not yet begun to gain an awareness that a problem exists or the nature and scope of the problem. This differs from denial in the way the people around the individual with the problem approach it.
“What you want to do with someone who is pre-contemplative is provide them with information,” Donovan says. “You don’t beat them over the head with it; you provide them information that deals with their specific condition in a way that allows them to start thinking about changing. Eventually that person is going to say to him or herself that something isn’t right.”
Stage Two is contemplation. Now the person is aware of the problem and is thinking about it.
“The person starts to do a decisional balance, where you look at the benefits of continuing the old behavior and compare them to the benefits of stopping,” Donovan says. “The costs of changing might be personal and social, as well as economic. In the case of drinking for example, you may say to yourself, ‘Maybe family, health, job and self-esteem are more important to me than being on the local bar’s pool team.'”
Stage Three is commitment or determination. This is making the firm commitment to engage in behavioral change.
“You’re making the commitment to yourself, but research has shown you are more likely to keep it if you make this commitment public,” Donovan says. “Tell other people about it, why you’re doing it, how you’re going to do it and how you expect to benefit from this change in your life.”
Stage Four is taking action. This is when you take active steps to engage in activities that will help you change your behavior and then maintain that change.
“This could be an alcoholic deciding to seek treatment or start attending Alcoholics Anonymous. A smoker might seek nicotine replacement skin patches. Or it might be a decision to eat better,” Donovan says. “It’s very clear from all the research that the more support you can garner from the people around you, the more likely you are to succeed. That’s why making a public commitment to change is important. Not everyone will support you, so you have to look for those who will.”
Stage Five is maintenance. This is building support and trying to establish a different lifestyle that is supportive of the decision you have made to change.
“If you have friends who have stopped smoking, it probably would be helpful for you to talk to them,” Donovan says. “It might be a good idea to talk to friends who have quit drinking if you’re trying to remain sober. Go see a counselor from time to time when you’re concerned about falling back into your old habits.”
