Stages of Change Model

SOCWe want patients to change their behavior. Do they want to change? Do they know they should? Do they even know that changing the behavior is an option? Have they tried changing and failed (or succeeded)? You can imagine how a patient might react differently to the need to change based on their answers to those questions.

A theoretical model, called the Stages of Change model captures this notion that not all of our patients come to a behavioral change from the same location. The model is illustrated in the graphic below. Similar change models have more steps, some have fewer.

The important thing is the underlying question: what experience has my patient had with trying to make this particular behavioral change? That is, at what stage are they?

Stages of Change

The premise is that individuals are typically at a specific stage of change, and that each stage of change suggests different approaches: someone who has never considered a problem may be amenable to simple information provision, for example, whereas someone who has tried to change and failed may need different support. Finally, someone who doesn’t recognize the need to change at all requires a different approach too. By understanding these stages and by identifying which stage our individual patients are at we can better help them change their behavior.

The table below lists each of the 5 steps, the associated definition, and the brief intervention element associated with that stage. The brief intervention process, as you will read in the “Brief Intervention Elements” section, suggests movement through the stages of change.

Stages of Change and Recommended BI Elements


Precontemplation

Patient is not considering change in the near future and may or may not know the potential health consequences of continued use at this level

Recommended Brief Intervention Elements

  • Feedback about the results of the screening
  • Information about the hazards of substance use/abuse

Contemplation

Patient may be aware of alcohol-related consequences but is ambivalent about changing

Recommended Brief Intervention Elements

  • Emphasize the benefits of changing
  • Give Information about substance use problems, the risks of delaying change and discuss how to choose a Goal

Preparation

Patient has already decided to change and plans to take action

Recommended Brief Intervention Elements

  • Discuss how to choose a Goal
  • Give Advice and Encouragement

Action

Patient has begun to cut down or stop use; however, change has not become a permanent feature.

Recommended Brief Intervention Elements

  • Review Advice
  • Continue to provide Encouragement

The Bottom Line: Identifying a patient’s stage of change helps us tailor our brief interventions so they are more efficient and effective for that particular patient.