Stages of Change in Substance Abuse Motivational Interviewing

Clients go through predictable stages before they change and feel better.
i Creatas/Creatas/Getty Images

Motivational interviewing is a counseling style that involves getting clients to admit they have a problem, why they need to change and how they can best achieve their goals. Instead of advising and pushing patients to do the next best thing, counselors involve clients in the process to develop an internal motivation and ultimately make the desired changes. During this process, patients undergo five predictable changes.


    Motivational interviewing is a popular technique used with substance abusers. It’s during this first stage that intervention often is necessary because the patients usually are in denial about the reasons behind all their problems. During this stage, clients have no intention of changing and haven’t even given the idea any consideration. They need to be convinced of their problems before they can take the next step.


    Once patients have been made aware of their problems and how they’re affecting their lives, they are open to the possibility that they can make changes that could really make a difference. They are open to the possibility that something they are doing isn’t working anymore. They’re still ambivalent at this point, but are seriously considering taking action. But they still aren’t ready to make a commitment yet.


    Changes usually start with baby steps, but at least clients accept the fact that they need to change and are willing to try a few things. Counselors latch on to any success achieved during this phase of the treatment because it’s those successes that ultimately fuel the big changes. Patients may start experimenting with small changes like skipping an afternoon drink or avoiding a big party. They are preparing mentally to take the big steps needed to change.


    This is the time when all holiness breaks out. Addicts enter treatment or go cold-turkey; smokers crush out their last butt. The final commitment to change is made at this point and counselors have to do everything they can to support the momentum and build on the motivation that now fuels the positive actions being taken by the patient. Decisions to change should be reinforced and applauded.


    The big steps have been taken, but now the real work takes place, because it’s often easier to quit a lifelong behavior than it is to maintain new habits. While patients may slip into old behaviors occasionally, counselors remind clients that they can just jump back on the wagon. Patients may have to cycle through the first four steps a few times before it sticks, but should be reminded they are in this for the long haul. Eventually, the change takes hold and the new behavior is integrated into the patient’s life.

the nest