Long-term recovery from addiction is all about change: changing behaviors, changing mindsets, and changing lives.

So what exactly is change? How does it happen? How does it work? And, perhaps most importantly, how can you make change last?

There’s plenty of scientific research about change, and in fact, the National Institute of Health (NIH) has an entire program devoted to understanding how it works. Called the Science of Behavior Change, the program promotes research on the initiative, personalization, and maintenance of behavior change. The NIH estimates that unhealthy behaviors such as smoking, overeating, and drug use account for 40% percent of the risk associated with preventable premature deaths in the US.1 Their program is designed to figure out which mechanisms and tools are effective at changing those unhealthy behaviors.

The are many other organizations conducting similar types of studies, but the most well-known scientific research about change is probably the Stages of Change Model developed by Prochaska and DiClemente.2

This model demonstrated that change doesn’t happen all at once. A person moves through stages at their own pace, until finally, they’re ready to make the change occur.

Recognizing the stages themselves, and the necessity to move through them, was an important breakthrough, because it shows change only happens when a person is ready to make it happen— although a person can be encouraged through each stage.

This model is often used to help with weight loss, alcohol and drug addiction, and other behavioral changes. Here’s how it works, and how it can be applied to recovery from substance use disorder.

Prochaska & DiClemente's Stages of Change Model

The Cycle of Change

Stage 1: Pre-contemplation

This is the stage before you even realize there’s something that needs to be changed. It may have crossed your mind, but you haven’t seriously considered doing anything differently. For all intents and purposes, you’re content with the way things are at the moment.

If you have a substance use problem, at this stage you don’t think it’s serious. You most likely believe that you’ve got it under control and you can stop at any time. Even if you can’t, you feel that the problem isn’t that bad—in fact, it’s not even really a problem at all, regardless of what others may say.

Stage 2: Contemplation

Contemplation is the point when you start thinking it might be time to make a change. Something happens, either suddenly or over time, that causes you to realize things can’t continue as they have been. At this stage, you’ll probably come up with a whole list of reasons not to change or obstacles to prevent it—but you’ll return to the idea that change is ultimately necessary.

When you’re contemplating getting help for a substance use disorder, there are questions you can ask yourself that may help you to make your decision. Start by defining exactly what it is you’re thinking about doing, and why. From there, you can figure out the when and the how. These questions can help you get started:

  • What change do I think I need to make?
  • Do I want to stop all together, or do I want to simply cut down?
  • How much will I cut down?
  • What do I hope to accomplish or gain by stopping or cutting back?
  • What will I have to give up to make this change?
  • Who will be affected?
  • When do I want to start?
  • What will I do to start?
  • What will prevent me from succeeding?
  • How can I overcome those obstacles?

When you’re answering these questions, be as specific as possible. When you know exactly what you want to do, why you want to do it, and when and how you will get started, you’ll be able to make an informed decision about moving forward.

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Stage 3: Preparation

Once you’ve determined you’re going to make a change, you enter the preparation phase. This is the point where you’ll set goals and start taking steps to meet them. You’ve made up your mind that this change is going to happen, and you’re preparing yourself physically and mentally.

When you’re recovering from substance addiction, preparation can be an exciting phase. Maybe you’ve called about treatment options, or maybe you’ve thrown out all the alcohol in your home. Stay on track by setting SMART goals3 that can help you monitor your progress and keep you motivated by your success. SMART goals are:

  • Specific: What exactly are you going to do?
  • Measurable: How can you prove you’ve met your goal?
  • Achievable: Are you physically able to do this without harming your health?
  • Realistic: Do you believe you can do this?
  • Time-based: When will you start specifically, and what’s your deadline?

You can use SMART goals for every step you take toward recovery, from starting a nicotine patch or entering treatment to talking with your family about your plans or calling your insurance company to learn more about your options.

Stage 4: Action

This phase is exactly how it sounds: You start achieving your goal with concrete action. You’re no longer thinking, planning or setting goals; you’re actually taking the steps necessary to meet those goals and make that change. You’re on your way!

Action for changing a substance abuse problem can include anything from calling your doctor to entering treatment to finding a peer support group. All of these are great steps forward! To ensure your continued success, research published by Harvard Medical School4 shows that these five action steps can give you the best chance for staying substance free:

  • Make a date: Decide exactly when you’re going to stop using drugs or alcohol
  • Try a change of scenery: Enter treatment, or get rid of any temptations in your home
  • Take up new hobbies or activities: Replace your addiction with healthy behaviors
  • Look at past efforts: Figure out what has held you back or caused relapse
  • Find support: Rely on friends, family, peer support, and doctors

Use all five steps together as your action plan, and you’ll dramatically increase your odds of successful recovery from addiction.

Stage 5: Maintenance

In the maintenance stage, you commit to making your change permanent—and to doing whatever it takes to make that happen. Aside from the transition from contemplation to determination, maintenance is one of the hardest steps in this process. To succeed, you don’t just change your behavior; you change your life to support that behavior.

To maintain the change you’ve made in your recovery from addiction, you’ll need a new action plan. Think of it like a house. When you build a house, you create a foundation, build the structure, install plumbing and electricity, and put on a roof. Now, it’s time to move into the house and keep it working over time, so you need a different plan than the one you used to build it. You need to paint it regularly, to clean the gutters, to repair shingles on the roof. You built your substance-free house in treatment. To keep it that way, you’ll need to figure out what kind of day-to-day tasks are needed to stay in recovery. And you’ll have to do the work.

View additional resources

The Stages of Change Model shows that change is possible, including for people with substance use disorders. Visit Treatment and Recovery for more information on the recovery process from start to finish.

1. National Institute of Health, https://commonfund.nih.gov/behaviorchange/index “Science of Behavior Change.”
2. Prochaska & DiClemente, 1983
3. Doran, G. T. (1981). "There's a S.M.A.R.T. way to write management's goals and objectives". Management Review. AMA FORUM. 70 (11): 35–36.
4. Editor Howard J. Shaffer, Ph.D., C.A.S., “Overcoming Addiction.” Cambridge, MA. Harvard Medical School Special Health Report 2011