Substance use

When someone has problematic substance use such as alcohol or other drug use, it takes a number of steps to recover. Gaining an understanding of where someone is in the cycle of change can help determine what interventions are likely to be most effective. For example, someone in the ‘pre-contemplation’ stage is happy using and is unlikely to respond to advice on the harms of use. At this stage, interventions that focus on reducing harm from use are the only likely productive steps.

Motivational counselling at the various stages of change can be a helpful strategy in assisting the individual to go through with the particular change they are wanting to make.

The six stages of change

Pre-contemplation

These are the ‘happy users’. They are unconcerned about their drug use behaviour and will tend to ignore or discount anyone else’s belief that what they are doing is hazardous or harmful. For them, the positives, or benefits, of the behaviour outweigh any costs or adverse consequences. Hence they are happy to continue using.

Contemplation

Contemplators are people who feel two ways about their behaviour. On the one hand it is an enjoyable, exciting and
pleasurable activity. But, on the other hand, they are starting to experience some adverse consequences. These may be personal, psychological, legal, medical, social or family problems. They are ambivalent about their drug use. It is
good because of the benefits, but they are also worried by the increasing costs.

Determination/preparation

Those in this stage are ripe for change in their behaviour. They believe that the costs clearly outweigh the benefits. They know that change is necessary and that the time for change is imminent. However, some people do not progress to the next stage.

Action

People in this stage have resolved to change and have committed themselves to that process. They have embarked
on a road to change their drug use.

Maintenance

People in this stage have successfully abandoned their drug behaviour and have sustained the change for a sufficient
period to state that they not longer have problems with drug use. This stage generally occurs at least six months
after the behaviour has changed. It is believed that people are maintainers for up to five years, whereupon they become emotionally and physically detached from the old behaviour. In exceptional cases people seem able to distance themselves from their drug use much more quickly.

Relapse

This is a process that can occur during the action and maintenance stages. Many people who change their behaviour
resume drug use or return to old patterns of behaviour. People who have relapsed may have consciously changed their minds or simply slipped back into old habits. They generally revert to one of the previous stages. It is also important to distinguish a lapse (a one-off or short term return to use) from a relapse.

Source: Turning Point/NCETA
Training Program 1997 Participants’
Workbook, Turning Point Alcohol
and Drug Centre, Victoria.

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