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The Cycle of Change

This model is commonly used in the field of substance misuse and is broadly applicable to change in a variety of settings. It is important to underline that the cycle of change serves as an indicator, not as a prescriptive stage by stage approach. No indication is given in regards to how long it takes to move from one stage to the next. This transition is best observed by listening to the way the person is thinking and behaving, for example.

Pre-contemplation

Here the person refuses to accept support despite a clear need. Those around the person/family are expressing concern about behaviour and how they are coping. The person continues in this way of thinking and behaving despite the consequences to themselves and those around them. Communication is sporadic and often difficult due to aggression or a lack of response.

Contemplation

This is characterised by a time of questioning and suspicion of previously held routines. This can include expressing doubts about relationships and friends. At this stage the person is vulnerable to 'bargaining' from those who would seek to attract the person back into previously held roles and believes e.g. as a victim, back into substance misuse.

The aim at this stage is to provide information to the person in order to help them make an informed choice. Offering too many concrete options or closed questioning can result in the person rejecting the support offered, as it can resemble previous relationships which may have had hidden agendas.

As a person evaluates how they have got to this point, it is helpful to have information and support to make successful change achievable. If the desire to move forward, such as receive support, stop taking drugs or stay with a partner (if safe), is not underpinned by self-belief, the person may feel isolated or fearful and revert to the pre-contemplation stage.

Phrases such as ' can cope... it’s not a problem... Mind your own business... Yeah yeah yeah, you don’t understand' may be evident.

Decision

This stage shows an increase in aspirations and dreams. Some of these may be unrealistic or idolised. Many promises are made, little is delivered. The person frequently has new ideas; there is a cycle of promising to take action and responsibility, but not the capacity to act upon the decision. This a a difficult time for those around as others can lose hope that the person will ever make progress or take full responsibility. There may be a number of legitimate and questionable reasons given for why the person cannot make actual change. Phrases such as 'I am going to change... I will never do this again... I am going to... When they..., I will...'

Active Change

Now the person is making decisions which have an impact on their own lives and the lives of those around them. The person is willing to take some positive risks and trust specific people and organisations to assist in this change, or the person takes massive leaps in order to change their lives. There is a noticeable change in the level of responsibility the person is taking and is generally more optimistic. 'In the old days I used to... I don’t hang around with... any more, they are not good for me/us/my child.'

Maintenance

Here the person is building constructive routines, these maybe new or building on skills which have been lost. This stage is hard work when there can appear to be little reward for the decision made. The management of expectations is vital here as the person can be saying one thing, but acting in a different way. How the person manages stress and recognises achievement often decides if the momentum is maintained. Agencies and those around the person/family can make the mistake of reducing support. If this occurs the person can revert to ways of coping which offer a 'path of least resistance'. The person can make comments such as 'I know things have not worked out yet, but I am making progress... I am going to keep going until... Why haven’t things changed as I thought they would... I don't fit in any more. I haven't got anything in common with...'

At this point the changes in behaviour, thought and action continue and the person can exit the cycle as goals are achieved. Risks are greatly reduced.

Relapse

At this stage the value of change has been judged to not be worth the cost. The person can break all contact and be either putting on a brave front or desperately seeking help. There are many feelings of guilt/anger at themselves and others. The level of trust that has been developed with support agencies/specific individuals will determine the next step.

The person makes very dramatic statements about their circumstances and character, normally dramatic or they can under play the impact of significant events. Phrases such as 'I have... it all up, I knew this would happen... struggling... It’s all good, I am great, things are going REALLY REALLY well (despite some concerns by others).

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