‘Stage of Change’ Interventions Best for Those in Denial About Alcoholism

evolutionSome psychologists and addiction specialists believe that people affected by substance abuse or substance addiction go through varying stages of willingness to change and seek help for their problems. They also believe that affected individuals may have the greatest chance of breaking a damaging pattern of substance use when the interventions or treatments take their relative willingness to change into account. In a study slated for publication in 2014 in the journal Addiction, researchers from three German institutions compared the effectiveness of “stage-tailored” alcohol interventions to the effectiveness of interventions that don’t vary according to a problem drinker’s stage of willingness.

Substance Use and Stages of Change

Psychologists also call the stages of change theory the transtheoretical model of change. In this model, a person involved in substance abuse or any other problematic behavior is at one of six stages in relation to that behavior. In the first stage, the affected individual has not even really considered the fact that he or she has a serious problem. In the second stage, the individual is aware that a problem exists but doesn’t yet believe or understand the need to change. In the third stage, the individual actively prepares him- or herself to change the problem behavior. In the fourth stage, the behavioral change occurs for the first time. In the fifth stage, the individual grapples with sustaining the behavioral change over time. In the sixth stage, the individual relapses back into his or her old behaviors and at least temporarily drops the notion of change.

Applications in Intervention and Treatment

Substance intervention and substance treatment approaches that follow the stage of change theory employ different techniques to reach individuals in different stages of the process of change. For example, a counselor or therapist working with a person in the first stage of change might gently encourage that person to consider the idea that he or she has a significant problem. A counselor or therapist working with a person in the third stage of change might help that person resolve any final conflicts over entering treatment or otherwise changing his or her pattern of substance use. A counselor or therapist working with a person in the fifth stage of change might help that person learn how to cope with the deeply ingrained urges for substance use that commonly appear after the initial establishment of a pattern of substance abstinence. When working with a person actively involved in a relapse, a counselor or therapist might help that person reevaluate his or situation, make a decision to reestablish abstinence and devise more effective ways to avoid future relapse episodes.

Effectiveness for Alcohol Interventions

In the study scheduled for publication in Addiction, researchers from Germany’s University of Greifswald, Medical University of Lubeck and Robert Koch Institute Berlin used a project involving 1,243 problematic alcohol users to compare the effectiveness of stage-tailored alcohol interventions to the effectiveness of alcohol interventions not based on the stage of change model. All of the study participants were actively seeking to secure a job at one of three employment agencies. One-third of these individuals received a stage-tailored intervention during this job-seeking process. Another third received an intervention that didn’t factor in the stage of willingness to change. The remainder of the study participants received a basic assessment of their alcohol use, but did not receive an active intervention.

The alcohol interventions lasted three months. Over the following year, the researchers monitored the alcohol-related behaviors among the members of all three participant groups and used the information as the basis for their comparison. During the initial three months (during which two-thirds of the participants were receiving an active intervention), all three groups experienced a substantial decline in their level of alcohol intake. However, outcomes started to vary over the yearlong follow-up period. Among those individuals with an initial low degree of willingness to change, the stage-of-change intervention produced significantly better results than the non-stage-of-change intervention. However, among those individuals with an initial high degree of willingness to change, the non-stage-of-change alcohol intervention produced better results than the stage-of-change intervention.

The study’s authors emphasize the effectiveness of the stage-of-change alcohol intervention in helping those individuals least likely to seek help on their own: namely, those people who showed little interest or enthusiasm in altering their normal pattern of alcohol consumption when an intervention was first undertaken.