Stages of Change

How do you know if your actions are helping someone with a substance use disorder or holding them back from personal progress? Explore the Stages of Change model to learn how each person’s individual willingness for change affects their journey and to find techniques that can help you guide others forward toward recovery.

Helping someone stuck in precontemplation

To help someone move out of the pre-contemplation phase, you can help them look at their substance use and its outcomes to assess if there is a problem. To increase this awareness, try any of the following: (Each topic below is expanded on in the Resources section.)

Stage an "intervention" if the stage-matched interventions are not working.

When a person living with a substance use disorder is reluctant to seek help, family members, friends, and associates may come together out of concern and love to address the issue directly. It is strongly recommended to include an experienced professional to guide the process.

Let them learn from their mistakes as long as they aren't life threatening.

Substance use often creates negative “natural consequences” like job loss, poor school performance, or broken relationships. When these happen, listen nonjudgmentally and don’t intervene. Research shows that people DO start to change when the outcomes of their actions become unpleasant.

Do not support bad behaviors.

If you try to keep the peace, give the person with substance use disorder what they want, supply them with money, or play the role of “fixer” or “protector,” you may unknowingly perpetuate their use of drugs and alcohol. Avoid supporting these negative behaviors unless the safety of the affected person is at risk.

Understanding Relapse

Relapse is not a stage of change, but it is often a part of the change process. Most people who take action to overcome an addiction may not maintain their new behavior on their first attempt. Relapse and recycling through the stages can occur frequently, and that’s very normal and should be expected. Because relapse is common, it’s important to stop thinking of change a straight progression from one to five and look at it as a staircase a substance user climbs up and down – or even a spiral pattern. Relapse can happen even after many years of sobriety, so support is essential. That includes being conscientious about environments, seeking help or additional treatment, and being prepared to deal with distress. To provide that support, you can encourage the person with addiction to learn from their relapse, remind them the only mistake they can make is to give up on their ability to change, and reassure them you believe in their ability to succeed.

Reinforcement: A Driver of Change

Recovery isn’t easy. The pleasure receptors in the brain of the person with the substance use disorder have been altered, and that makes change challenging. The good news is that the brain can be changed again by substituting healthy habits for unhealthy ones – and using positive reinforcement can be an effective way of encouraging someone with substance use disorder to seek pleasure elsewhere.

Determine what you want to reinforce

Identify the specific behaviors you want to reinforce or can genuinely support without pretending.

Identify rewards

Find rewards that are reasonably priced, easily accessible, and will appeal to the person you’re supporting. It could be something you can enjoy together, or it could be a positive statement that provides immediate reinforcements, like “Nice work, you handled that temptation!” or “Keep it up, you’re making great progress.”

Value positive communication

Keep the “positive” in positive reinforcement with clear communication, kindness, understanding, and offers to help. When appropriate, nonverbal communication like a kiss, hug, pat on the arm, or smile can make your interactions feel even more rewarding.

Make reinforcement ongoing

Rewards for positive behaviors can be offered on-the-spot or over time. Try to offer a reward that’s proportional to the behavior, switch up the rewards, and connect the reward to the positive behavior to effectively reinforce steps in the right direction.