Dr. Carlo DiClemente, Ph.D., ABPP
Provided by David Koss, SMART Recovery Facilitator, Capital SMART
Participants in SMART Recovery, in fact all individuals who change problematic behavior, owe a debt a gratitude to the Transtheoretical Model of Behavior Change, as developed and refined since the late 1970’s by, among others, Carlo C. DiClemente, PhD, ABPP, a keynote speaker at the 2019 SMART Recovery National Conference in Chicago.
The Transtheoretical Model (which we will refer to as TTM or as The Stages of Change) has been called “arguably the dominant model of health behaviour change” in the British Journal of Health Psychology.
5 Stages of Change
While the depiction of the Stages of Change has evolved, for the past few decades, it has been expressly described as follows:
1. Precontemplation (no near-term consideration of change of the particular target behavior; problem behavior seen as having more pros than cons);
2. Contemplation (seriously considering change; seeking information about problem; evaluating pros and cons of change; ambivalent; not prepared to change yet);
3. Preparation (made a decision to change and ready to change in attitude and behavior; may have begun to increase self-regulation and build a plan to change);
4. Action (modifying the problem behavior; learning skills to prevent reversal to full return to problem behavior); and
5. Maintenance (sustaining changes that have been accomplished and integrating the new pattern of behavior into lifestyle).
Professor Stephen Rollnick, one of the founders of Motivational Interviewing (MI), has said that the tools and the spirit of MI can be used to help individuals move from one of the stages to another. And it is universally recognized that the process of movement from one stage to the next is almost never a linear one. The illustration in the SMART Recovery Handbook, Third Edition, is of a spiral. Psychologist Christopher C. Wagner of Virginia Commonwealth University has said that individuals may move from one of the stages in the TTM to another (and back again) in the same therapeutic session (or SMART Recovery meeting).
Some lay people have alternative terms for the last of the stages in the TTM. Rather than maintenance, the State of New York Office of Alcoholism and Substance Abuse Services refers to the Maintenance stage as the stage of Wellness. The fourth part of SMART Recovery’s self-empowering program, living a balanced, positive, and healthy life, incorporates the Maintenance stage of the TTM. In SMART Recovery meetings that I facilitate, participants often characterize the Maintenance stage as one of heightened self-care.
Like the recovery journey generally, behavior change is not easy and moving through the stages of change not only involves moving forward and backward many times but also often (quite often) involves slips or lapses.
In Substance Abuse Treatment and the Stages of Change: Selecting and Planning Interventions, the authors write that the Stages of Change each have “a unique set of tasks, attitudes and behaviors” and that “movement through the stages of change is facilitated by the client’s involvement in stage-relevant experiential and behavioral processes of change.”
Other Helpful Resources
You can listen to a podcast interview with Carlo DiClemente, Ph.D., ABPP using the player below.
Additionally, the tools found in the SMART Recovery toolbox are very helpful in facilitating movement through the stages of change.
About Carlo C. DiClemente, Ph.D., ABPP
Carlo C. DiClemente, Ph.D., ABPP, is an emeritus professor of psychology at the University of Maryland, Baltimore County, winner of the 2019 Alfred M. Wellner, PhD, Lifetime Achievement Award by the National Register of Health Service Psychologists.
DiClemente will be speaking at the 2019 SMART Recovery National Conference on Sunday morning covering the topic of: Are Relapse and Recycling Necessary for Addictive Behavior Change? Click here to learn more about the National Conference and to register.
(The material in this essay is based predominantly on Substance Abuse Treatment and the Stages of Change: Selecting and Planning Interventions,Second Edition, 2013, by Connors, DiClemente, Velaquez and Donovan; and on Addiction and Change: How Addictions Develop and Addicted People Recover,Second Edition, 2018, by DiClemente.)
I don’t understand the need to make the Stages of Change either a circle or a spiral. What is the significance of a circle over a line, there is no connection (though it is often drawn) between Maintenance and Pre-Contemplation. Nor are lines ever drawn other than to the next stage. A line leading up to the right has all the features and sloping up would also support the concept of a relapse as an even that may involve sliding back down and to the left.
I agree
I disagree with that, being a person in long term recovery and also a certified recovery coach
Totally new to me is this description and concept.
It appears that SMART has omitted “Exit” or “Termination” (originally labelled by Prochaska) as a part of the Stages of Change. I have been a SMART facilitator for over 5 years, working with the SMART handbook at times complemented by other SMART resources. This omission has aroused some confusion with group members who see a discrepancy between the SMART handbook we work with and the website. Many have liked knowing that their sense of empowerment could direct them towards independence and not being bound in a circle to any “method”. For many, this omission reminds them of other faith-based programs or “methods” that not only didn’t work for them, but often were an impediment to their progress.
Thats an interesting comment. As a SMART Facilitator (in the UK) I am fairly open with the group about it being THEIR recovery journey. I do stress however that if they dont keep an eye on their recovery and become complacent, its possible to lapse, and then have to do some of the recovery journey again.
I agree with Emma. That is why the old terms “Exit” and “Termination” have not been regarded as one of the Stages of Change for more than 20 years. However, since, as we say at SMART Recovery, “everyone’s journey is their own” – if someone finds that living a healthy, balanced life, one of wellness and one of self-care also represents an exit or a termination from the change process, it would be inappropriate for that to result in criticism. From a technical standpoint, that would mean that if someone were to recycle or slip or lapse, then that person would be starting the change process all over again. There are, as you know, individuals who rely on SMART Recovery who self-identify as an addict or as an alcoholic. SMART Recovery does not use those terms and it is widely understood that such terms are unhelpful for most individuals. However, none of our guests at SMART Recovery meetings are ever criticized for that kind of self-labeling, especially if that helps their recovery journey.
SMART Recovery believes that people CAN (and do) fully overcome their addictive behavior and go on to lead full and satisfying lives. Once that occurs, whether it is deemed to be “ongoing maintenance” or “exit” or “termination” is subjective to the individuals themselves; it’s a matter of choice and utilizing what works personally for each individual… which is what SMART Recovery is all about.