4.3.10 - Prochaska’s six-stage model

The model as a map of change

Prochaska's six-stage model explains addiction recovery as a process that unfolds over time. The key idea is readiness to change. Two people may both be addicted to nicotine or gambling, but one may deny there is a problem while the other has already booked a counselling session and blocked betting websites. Their different readiness may call for different conversations and support, although the added benefit of formal stage matching must be tested.

The model is often linked to the transtheoretical model because Prochaska and DiClemente tried to integrate ideas from different therapies into one account of how people change. Applied to addiction, the model is not mainly asking "what caused the addiction?" It is asking "where is this person in the change process, and what kind of support fits that stage?"

AQA asks for the application of the six-stage model. That means you must do more than list the stages. You need to use the stages to explain addiction behaviour and to suggest stage-appropriate support.

Different summaries sometimes treat relapse as a sixth stage. The six-stage version in AQA's June 2024 mark scheme and Prochaska and Velicer's 1997 account is precontemplation, contemplation, preparation, action, maintenance and termination. Relapse is still crucial, but it describes possible movement back through the cycle rather than the final successful stage. This explains why historical studies may use different group labels without changing the six-stage version taught here.

Precontemplation and contemplation

The first two stages are about readiness, not visible recovery. This matters because advice can be less engaging when it assumes a person has already decided to change. It does not mean help or encouragement should be withheld until someone reaches a particular stage.

Precontemplation

In precontemplation, the person is not intending to change in the foreseeable future. Many summaries use the next six months as a rough guide. The person may be unaware of the harm, may deny the problem, may feel the behaviour is still rewarding, or may feel demoralised after previous failed attempts.

Applied to nicotine addiction, precontemplation might look like this: Jay vapes every day and becomes irritable when he cannot vape, but says, "It is just flavour, not a real addiction." He is not planning to reduce use, and if his parents criticise him he becomes defensive. In Prochaska's model, the first goal is not a quit plan. The first goal is to increase awareness without turning the conversation into a battle.

Useful support at this stage includes:

• giving personalised feedback, such as showing how spending or health symptoms connect with the behaviour;
• asking open questions about consequences rather than telling the person what to do;
• involving trusted people where appropriate;
• building a non-judgemental working relationship.

In a gambling example, precontemplation may involve a cognitive distortion. A person may insist they are "due a win" and see losses as temporary bad luck. An awareness-focused conversation may help the person engage with protective measures such as self-exclusion. The stage label should not be used as a reason to delay needed support.

Contemplation

In contemplation, the person recognises that there is a problem and is seriously considering change, but has not committed to action. This is a stage of ambivalence: the person sees the costs of addiction but also sees reasons to continue.

Amira tells her friend that online gambling is causing debt and anxiety. She thinks about deleting the app, but keeps it because it gives her excitement after work. This is not preparation yet because she has not formed a workable plan. It is contemplation: the problem is visible, but the behaviour still has perceived benefits.

At this stage, support should focus on decisional balance. A counsellor might help Amira compare the short-term reward of gambling with the longer-term costs: debt, secrecy, shame, sleep problems and relationship conflict. The aim is not to force a decision. It is to help the reasons for change become personally stronger than the reasons for continuing.

The AO2 difference

The difference between precontemplation and contemplation is a common exam trap.

Preparation and action

The next two stages are where intention starts to become behaviour. AQA application questions often hinge on whether the person is still planning or has already made a clear behavioural change.

Preparation

In preparation, the person has decided that change is needed and intends to take action soon, often within the next month. They may have already taken small steps, but the main feature is a realistic plan.

Preparation for nicotine addiction could include booking a GP appointment, choosing nicotine replacement therapy, telling friends not to offer cigarettes, removing lighters and setting a quit date. Preparation for gambling addiction could include installing gambling-blocking software, arranging for a trusted person to hold bank cards temporarily, contacting a support service and planning what to do during usual gambling times.

The psychological logic is simple: deciding is not the same as doing. A person may genuinely want to stop, but addiction is maintained by cue reactivity, withdrawal, reinforcement, habit and social context. Preparation turns a general intention into a plan for predictable barriers.

Strong preparation plans usually include:

• a clear behaviour target, such as abstinence from betting apps or stopping smoking; the target must be specified because using NRT can meet a smoking-abstinence target without being nicotine-free;
• a start date or first treatment appointment;
• coping strategies for cravings and cues;
• social support;
• a plan for slips, so one lapse does not become a full relapse.

Action

In action, the person has made visible changes to the addictive behaviour. This stage usually covers the first six months of change, when the new behaviour is still effortful and relapse risk is high.

For nicotine addiction, action might be four weeks without cigarettes, using prescribed nicotine replacement, attending stop-smoking support and avoiding smoking cues. For gambling addiction, action might be attending CBT sessions, handing over access to credit cards, self-excluding from betting websites and replacing gambling with non-gambling routines.

Action is not just "thinking harder". It is also not a tiny symbolic change if the addiction remains essentially unchanged. For example, a smoker who switches from 20 cigarettes to 18 for one day is probably not in action unless this forms part of a clear behaviour-change plan. A gambler who switches products without meeting the agreed change target has not necessarily entered action. Stage classification therefore needs a specified target, evidence of intention and actual behaviour, not merely the fact that someone attended an appointment.

Why preparation matters for action

The model predicts that moving too quickly into action can backfire. Suppose Lena has nicotine dependence and suddenly throws away her vape after an argument. She has no plan for cravings, no support and no alternative way to handle stress. If she relapses the next day, Prochaska's model would not simply say she lacked willpower. It would suggest she entered action without enough preparation.

That is useful for AO2 because the best support may not always be "tell them to stop now". A preparation-stage answer should talk about planning. An action-stage answer should talk about supporting the new behaviour, coping with cues and reinforcing progress.