Stages of Change - American Psychologist September 1992...

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American Psychologist © 1992 by the American Psychological Association September 1992 Vol. 47, No. 9, 1102-1114 For personal use only--not for distribution. In Search of How People Change Applications to Addictive Behaviors James O. Prochaska Cancer Prevention Research Consortium University of Rhode Island Carlo C. DiClemente University of Houston John C. Norcross University of Scranton ABSTRACT How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key transtheoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages–precontemplation, contemplation, preparation, action, and maintenance–and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a transtheoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy. Hundreds of psychotherapy outcome studies have demonstrated that people successfully change with the help of professional treatment ( Lambert, Shapiro, & Bergin, 1986 ; Smith, Glass, & Miller, 1980 ). These outcome studies have taught us relatively little, however, about how people change with psychotherapy ( Rice & Greenberg, 1984 ). Numerous studies also have demonstrated that many people Divlahan, 1988 ; Schachter, 1982 ; Shapiro et al., 1984 ; Veroff, Douvan, & Kulka, 1981a , 1981b ). These studies have taught us relatively little, however, about how people change on their own. Similar results are found in the literature on addictive behaviors. Certain treatment methods consistently demonstrate successful outcomes for alcoholism and other addictive behaviors ( Miller & Hester, 1980 , 1986 ). Self-change has been documented to occur with alcohol abuse, smoking, obesity, and opiate use ( Cohen et al., 1989 ; Orford, 1985 ; Roizen, Cahaland, & Shanks, 1978 ; Schachter, 1982 ; Tuchfeld, 1981 ). Self-change of addictive behaviors is often misnamed "spontaneous remission," but such change involves external influence and individual commitment ( Orford, 1985 ; Tuchfeld, 1981 ). These studies demonstrate that intentional modification of addictive behaviors occurs both with and without expert assistance. Moreover, these changes involve a process that is not well understood. Over the past 12 years, our research program has been dedicated to solving the puzzle of how people
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Stages of Change - American Psychologist September 1992...

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