Stages of Change

If you want to know how to help someone struggling with a substance use disorder, the “Stages of Change” concept is a good starting point. It’s based on the theory that behavioral change is a gradual process involving several common stages. If you can figure out which stage your loved one is at, you may be able to help them more effectively.



The first stage of change, when the person isn’t aware that change is needed; sometimes called “denial”. Don't pressure the person to seek help at this stage. A caring, positive approach where you try to help them see the consequences of what they are doing is a good start. Take a self inventory to see if there is anything you or other family members may be doing that could be enabling the person to continue their behavior. When people around them are making positive changes, it can be incredibly motivating. If the person doesn’t respond to this approach or the problem worsens, an intervention guided by a professional may be recommended. Remember to take care of yourself!



The second stage of change, when the person recognizes there is a problem and considers whether to deal with it. The person could be experiencing the consequences of their abuse or dependence at this stage, such as health concerns, work related problems, problems at home, or a DWI, prompting them to realize they can’t keep going this way. To move forward, the person needs to feel as though the balance has shifted toward recovery, and you can begin to more forcefully reinforce the cons of continued drinking or drug taking, as well as the pros of sobriety. Real life examples of each are good to pass along at this stage. And remember, the more positive and empathetic you are, the better chances you have of making a difference.


The third stage of change, when the person has decided to change and is getting ready to do so. Hope and support is critical at this stage. This is a very sensitive stage, so confrontation and impatience have no place here. Information about treatment options and providers can be gently suggested at this point. Early stage counseling can be very effective at this point, such as an informational session aimed at meeting a counselor and learning about what treatment would be like, without the pressure of commitment.


The fourth stage of change, when the person has started to actually deal with the problem. Almost all treatment can be effective for people who are ready to change. They are doing something now to become alcohol or drug free, such as receiving regular professional treatment or going to AA. They need your support and patience now more than ever, because they are giving up what was until now the most important thing in their life. They will also likely be experiencing withdrawal symptoms and the emotional effects of quitting an addiction. Also know this is just the beginning of a long road to recovery, and there will be bumps along the way.


The stage when a person has dealt with the initial challenges of changing and now continues to work to avoid relapse. The person will probably have ended or drastically cut back on formal treatment at this stage, and may be attending support groups such as AA. Don’t stop supporting them, they need to know you are still proud of what they achieved and the impact it has had on your life, and that you know its hard work for them everyday. Keep telling them what a great thing it is they’ve done!


It happens a lot. It’s important to understand it as part of the recovery process. Talk to them about it, find out how they feel and why they think they relapsed. Let them know you are still proud of them, that you know staying sober is a learning process and mistakes are bound to happen. Don’t try to push them back into treatment right away. Be patient, they’ve experienced sobriety and will hopefully want to return to it quickly. If they are defensive or defiant about continuing to use, maybe thinking they can now handle it better, keep reminding them about all the hard work they did to get sober and the positive effects it had on their life. If it doesn’t appear they are going to stop and get help, remember what you learned in the earlier stages about empathy and understanding, and don’t hesitate to call their clinician for advice.