Stages of Change and Motivational Interviewing

One of the difficulties in treating addiction is matching therapy to patient. To some degree, each addict is different. They come with their own unique problems and attitudes. Treatment specialists are always looking for a useful structure to help them “meet the patient where they are.” This is the genesis for the Stages of Change model and motivational interviewing.

The Stages of Change model outlines a stepwise process that anyone facing real change in their behavior will go through. Essentially, it is broken down into five steps – not ready, getting ready, ready, action and maintenance. The first three of these have to do with the mental concepts involved in taking action but aren’t realized until the fourth step, action, is taken. After that, the new behavior is in place, but fragile. The maintenance step addresses the long-term commitment and not relapsing into the old behavior.

Because many addicts come to treatment through circumstances outside of their control, they may arrive in any of the stages up to and including action. For instance, someone may have no desire to quit using (the first stage) all the way through to just about to try to stop on their own (the action stage). Without knowing where a patient is, a therapist will not be directing their efforts properly. At the first stage, a person needs information about their disease – they haven’t even considered quitting yet. At the next stage, it would be more appropriate to give them information about how to quit – the possibilities. In the final “ready” stage, the patient needs hard facts and a clear plan.

Discovering where someone is currently on the scale is called motivational interviewing. It’s exploratory and consists of questions about their addiction, how they think about it and what they’ve thought about as far as stopping. Therapists are wise to match their treatment to what they discover in the motivational interviewing – obviously, if someone has no desire to stop using, working on the action step wouldn’t help.

After identifying that particular person’s stance, the therapist then will try to move them along to the next step in the process. The root idea is one of partnership and not forcing something unreasonable. The important idea is that change comes at its own pace. Someone can be put in treatment by a court, but they cannot be “cured” without cooperation and motivation that springs from within. Immediate and continuing abstinence in this model is a false objective. Helping someone move closer to a real quit date is doable and worthwhile.