People who have Substance Use Disorder (SUD) usually benefit from guidance and motivation as they make their way on their recovery journey. One of the most common ways to understand the cycle of addiction is the stages of change model. First developed for smoking cessation, it has been widely adopted in the behavioral health field to describe the stages someone experiencing an SUD may go through, from denial to sustained recovery.
Each stage is defined by certain tasks to be completed by a person before they move on to the next stage. The processes of change represent experiences and activities that allow for movement through the stages. It’s not a strict linear progression as individuals may move forward and back in a cyclical manner through stages as their circumstances and readiness for change shifts and relapses occur.
Read on to learn more about the stages and what they mean.
How the Stages Can Help
Many people with an SUD have difficulty making changes on their own. That’s part of the challenge of overcoming an addiction. A person with an SUD may, according to CAMH [1]:
- Not grasp the negative effects that substance use causes. As a result, they don’t see a need for change.
- Know a change is needed but don’t know how to do so
- Be afraid to make a change because they may be uncertain of what is to come.
For families and friends of someone with an SUD, the stages of change helps them see:
- Where the person is in the change process
- How ready they are to take action
- How to deal with emotions involved in suggesting a change
- How to support a relative or friend based on the stage they are in
Pre-Contemplation (Not Ready)
“I don’t think I have a problem“
In this stage, the person does not recognize their substance use as a problem. They have not yet thought about making a change, or do not want to change. They may deny the negative consequences of their behavior or be defensive when confronted about it. Signs include disinterest in advice, denial of addiction, and resistance to change.
Precontemplation is often the longest stage. It takes patience and persistence to help someone move from pre-contemplation to contemplation. It’s important for family and friends to keep the lines of communication open and to provide information about the consequences of substance use in a non-threatening way.
Contemplation (Getting Ready)
“I know I have to stop what I’m doing, but I enjoy it.”
At this stage the person is ready to make a change, just not immediately. They may begin to see their use has some consequences and consider the possibility of change. They weigh the pros and cons of quitting but are unsure or not ready to commit.
Signs they are in this stage include openness to learning about the harms of addiction and exploring ways to reduce or quit substance use.
This stage may last a long time. It’s here where family, friends, and counseling, or an addictions treatment center, can be of special support. Ways to help a relative or friend include:
- Make sure they know that only they can decide to change.
- Go over the pros and cons of continuing the behavior and of changing it.
- Encourage the person to talk about making change.
- Express confidence that they can do it.
Preparation (Ready)
“I know I have the strength to change. I just don’t know how.”
In the preparation stage, the person actively plans for recovery. They begin to set goals to change their substance use. They seek out resources such as seeing a counselor, joining a support group, going to the gym, or learning about treatment center programs. They begin to remove triggers from their environment. They may be more willing to talk about the pros and cons of substance abuse. This stage is marked by motivation and readiness to take action.
Ways a family member or friend can help include:
- Ask for permission to suggest options.
- Reinforce the reasons for change. Encourage small initial steps.
- Identify barriers and work together to find ways to move beyond them.
Action
“I’m working on it.”
During the action stage, the person implements plans made during the preparation stage. They are adjusting their behavior, experiences, or environment to deal with their problems. They may have reduced or completely stopped using substances and are working on the problem.
This is often the most challenging phase, as the person makes significant lifestyle changes, such as entering rehab, attending therapy, or avoiding triggers.
This stage is often the shortest, but it is also when people depend on their willpower and are at the greatest risk of relapse (returning to an earlier stage). It requires consistent effort and support from loved ones and professionals.
Individuals are usually open to offers of help and support. Ways to help them include:
- Provide practical advice on how to make this change.
- Remind the person of the long-term benefits of this change.
- Follow up on a regular basis.
- When the person struggles with change, talk about their strengths and previous successes.
- Support them as they replace substance use with new activities.
Maintenance
“It’s a one-day-at-a-time struggle.”
This is a long-term stage in which people have stopped using substances for at least six months. They are working to build on this success by creating new behavior patterns and sustaining them as they focus on their sobriety and preventing relapse. They continue with aftercare programs such as support groups, therapy, or 12-step meetings. They are maintaining healthy habits and avoiding high-risk situations.
The threat of relapse lessens as people become more aware of factors that can cause relapse and take steps to deal with them. Maintenance can last months to years depending on the individual.
Ways to help your loved one include:
- Help identify what has worked well for them.
- Remind them of the positive benefits of continued change.
- List the positive changes the person has made.
- Help set plans to deal with situations that may cause a relapse.
Relapse
“I messed up. Now I’m back to square one.”
At this stage people return to the old substance use behavior they were working to change., or they return to an earlier stage. Relapse is a common aspect of the stages of change. People may relapse multiple times before they make a stable change. It is not a failure, rather it’s an opportunity for learning [2].
By identifying factors that caused the relapse, family and friends can help create a more effective plan to prevent another relapse. This learning process is part of lasting change.
Ways to help your loved one include:
- Let them know relapse is a normal part of the journey to positive change.
- Show understanding while remaining confident of success.
- Look at what triggered the relapse and make new plans to deal with it in the future.
These stages provide a framework for understanding addiction recovery. It’s important to recognize that each person’s journey is unique and may involve setbacks or relapses along the way.
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Sources
[1] CAMH. 2025. 3. Supporting your Family Member’s Recovery. Stages of Change Model.
[ 2] Substance Abuse Treatment: Group Therapy [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 41.) 5 Stages of Treatment.
