Transtheoretical theory and stages of change
Books and reports
DiClemente C 2004 Stages of change and addiction: clinician's manual, Minnesota: Hazelden
This manual accompanies a video presentation of a workshop by Carlo DiClemente, discussing the principles and processes of the stages of change.
DrugInfo resource centre no. HZ32 DIC, DrugInfo resource centre no. av HZ32 DIC (DVD)
DiClemente C 2003 Addiction and change: how addictions develop and addicted people recover, New York: Guilford
This book looks at the whole continuum of addictive behaviour change, and includes the transtheoretical model, the process of addiction and recovery and ways to tailor interventions to people at particular points in the change process.
DrugInfo resource centre no. HZ32 DIC
Prochaska JO, Norcross J & Di Clemente CC 2002 Changing for good, New York: Quill
This book, aimed at individuals wanting to change their own behaviour, offers self-assessments and case histories to help pinpoint which stage of change they are in, and to continue the process of change.
DrugInfo resource centre no. HZ32 PRO
Connors GJ, Donovan DM & DiClemente CC 2001 Substance abuse treatment and the stages of change: selecting and planning interventions, New York: Guilford
This book aims to guide clinicians in tailoring interventions to individuals with varying levels of motivation and readiness to change.
DrugInfo resource centre no. HZ32 CON
Miller WR & Heather N (eds) 1998 Treating addictive behaviors, New York : Plenum
This book, which is a collection of contributions from authors such as Prochaska, DiClemente, Kanfer and Miller, explains treatment in relation to stages of change and motivation to change.
DrugInfo resource centre no. HK4 MIL
Heather N, Gold R & Rollnick S 1991 Readiness to change questionnaire - user's manual, NDARC Technical report no. 15, Sydney : National Drug and Alcohol Research Centre
A 12 item instrument for measuring the stage of change reached by an excessive drinker of alcohol. Based on stages of change model developed by Prochaska and DiClemente.
DrugInfo resource centre no. vf HEATHER 93
Callaghan RC, Taylor L, Moore BA, Jungerman FS, Vilela FAB & Budney AJ 2008 “Recovery and URICA stage-of-change scores in three marijuana treatment studies”, Journal of Substance Abuse Treatment 35:4, pp. 419–426
Data from three outpatient studies of treatment of marijuana dependence were used to test whether behaviour change parallels stage movement in the transtheoretical model of change (TMC). This study examined one putative assumption of the TMC: individuals remaining in the preaction stages of change (i.e., precontemplation and contemplation) across time would show little change in their marijuana use. The University of Rhode Island Change Assessment (URICA) measure and two recent stage assignment algorithms were utilized to assess TMC stage status at baseline and end of treatment. The study indicates that better methods to measure stage status and test the TMC are needed if the model is to be used to guide substance abuse interventions. [Journal abstract, ed.]
DiClemente CC, Nidecker M & Bellack AS 2008 “Motivation and the stages of change among individuals with severe mental illness and substance abuse disorders”, Journal of Substance Abuse Treatment 34:1, pp. 25–35
A complicating factor affecting the treatment of individuals with coexisting substance use problems and serious mental illness is their motivation for change and how these interacting, chronic conditions affect the entire process of intentional behaviour change. This selective review explores conceptual and assessment issues related to readiness to modify substance use and readiness to initiate behaviours helpful for managing mental illness in the search for a better understanding of patient motivation for change. The recent but limited research on motivation and stages of change among dually diagnosed patients indicates that these individuals appear to access and use an intentional behaviour change process. However, it is not completely clear how this process works and what precise adaptations are needed to assess and to access motivation to change to encourage sustained behaviour change in this population. Nevertheless, motivation and readiness to change are important dimensions that need to be addressed in treatment and research with dually diagnosed populations. [Journal abstract, ed.]
McWhirter PT 2008 “Enhancing adolescent substance abuse treatment engagement”, Journal of Psychoactive Drugs 40:2, pp. 173–182
Trends in adolescent drug use are encouraging and suggest the importance of preventative programs for youth. Yet, among those who become involved with illicit substances and seek treatment, only a fraction report positive outcomes. This article describes an approach to enhance adolescent participation in substance abuse treatment. Aspects of the transtheoretical model are integrated into a treatment program designed to meet the unique developmental needs of adolescent alcohol and marijuana abusers. The result is a treatment that better engages adolescents in participation, thereby increasing the likelihood for treatment success. [Journal abstract, ed.]
Nidecker M, DiClemente CC, Bennett ME & Bellack AS 2008 “Application of the transtheoretical model of change: psychometric properties of leading measures in patients with co-occurring drug abuse and severe mental illness”, Addictive Behaviors 33:8, pp. 1021–1030
People with severe mental illness (SMI) have high rates of substance use disorders. The Transtheoretical Model (TTM) is a framework for understanding behaviour change. There are five leading measures associated with the TTM - University of Rhode Island Change Assessment, Processes of Change Scale, Decisional Balance Scale, Abstinence Self-Efficacy Scale, and Temptation to Use Drugs Scale. While these measures have been found to be reliable and valid in primary substance abusers, it is unknown if these measures are relevant in people with co-occurring SMI and substance use disorders (SUD). The authors evaluated the psychometric properties of these measures in a sample of people with co-occurring disorders. Participants met DSM-IV criteria for schizophrenia/schizoaffective disorder or non-psychotic affective disorder, and current cocaine dependence or cocaine dependence in remission. Overall, findings support the use of these measures in people with co-occurring disorders. [Journal abstract, ed.]
Chang G, McNamara T, Wilkins-Haug L & Oray EJ 2007 "Stages of change and prenatal alcohol use", Journal of Substance Abuse Treatment, 32:1, pp. 105–109
This study evaluated stage of change as a predictor of alcohol use in a sample of 301 pregnant women who were either in the precontemplation (62%) or in the action (38%) stage of change in their first trimester. Women in both stages of change reduced the quantity and the frequency of their alcohol consumption while pregnant and achieved comparable rates of abstinence.
Field CA, Duncan J, Washington K & Adinoff B 2007 “Association of baseline characteristics and motivation to change among patients seeking treatment for substance dependence”, Drug and Alcohol Dependence, 91:1, pp. 77–84
This study evaluated the bottoming out hypothesis by determining the extent to which composite measures of motivation to change are associated with baseline characteristics among patients seeking treatment for substance dependence. Two hundred treatment-seeking substance-dependent veterans were assessed. Motivation to change was assessed using the composite measures of Readiness to Change (RTC) and Committed Action (CA) derived from the University of Rhode Island Change Assessment. Baseline characteristics included recent life stressors, addiction severity, depression, anxiety and hostility. Findings suggest that motivation to change was negatively, not positively, associated with greater emotional distress and problem severity. With the exception of recent life events, these findings are contrary to the notion of hitting bottom. Composite measures of RTC and CA also appear to represent different types of motivation to change. [Journal abstract, ed.]
Gossop M, Stewart D & Marsden J 2007 "Readiness for change and drug use outcomes after treatment", Addiction, 102:2, Feb., pp. 301–8
No statistically significant associations of any kind were found between readiness for change measures and use of opiates or stimulants at follow-up. A negative association was found between taking steps and benzodiazepine misuse. Readiness for change measures were correlated with heroin use and psychiatric symptom scores at treatment intake.
Segan CJ, Borland R & Greenwood KM 2006 "Can transtheoretical model measures predict relapse from the action stage of change among ex-smokers who quit after calling a quitline?", Addictive Behaviors, 31:3, Mar., pp. 414–28
This study explored whether transtheoretical model measures could predict relapse from the action stage. Cross-sectional analyses showed significant decreases in temptations to smoke and in the use of some of the change processes, which stabilised at about 1 month post-cessation.
Brown V, Melchior L, Slaughter R & Huba G 2005 "Stages of multiple behavior change as a function of readiness for substance abuse treatment among women at risk", Journal of Addictions Nursing, 16:1-2, pp. 23–29
Based on a multidimensional stages-of-change model, the present work examines changes in readiness to modify several types of risk behaviors among women seeking to enter substance abuse treatment. Implications for designing programs to address the needs of women with multiple vulnerabilities are discussed.
DrugInfo resource centre no. vf VIVIAN 05
Brug J, Conner M, Hasrre N, Kremers S, McKellar S & Whitelaw S 2005 "The transtheoretical model and stages of change. A critique. Observations on the paper by Adams J & White M. Why don't stage-based activity promotion interventions work?", Health Education Research, 20:2, pp. 244–58
Adam and White argued that stage based activity promotion interventions are not effective. This paper examines and reviews the evidence and arguments and then discusses whether stage-based thinking in activity promotion may still hold some promise. The conclusion is that although changes in activity promotion is fraught with problems, stage-based interventions have shown some promising results.
DrugInfo resource centre no. vf BRUG 05
Callaghan RC, Hathaway A & Cunningham JA 2005 "Does stage-of-change predict dropout in a culturally diverse sample of adolescents admitted to inpatient substance-abuse treatment? A test of the Transtheoretical Model", Addictive Behaviors, 30:9, Oct., pp. 1834–47
This paper reports findings from a Canadian study of adolescents admitted to a hospital-based, residential substance-abuse treatment program. The study provides important empirical support for the predictive utility of the stage-of-change construct among a culturally diverse sample of adolescents admitted to an inpatient substance-abuse treatment program.
Di Clemente C 2005 "Conceptual models and applied research. The ongoing contribution of the transtheoretical model", Journal of Addictions Nursing, 16:1-2, pp. 5–12
The Transtheoretical Model of Intentional Behavior Change proposes several important dimensions of the change process that include stages or tasks of change, specific processes of change that interact with the stages, and a context of change that broadens the perspective on change to encompass other problems and resources in the life context.
DrugInfo resource centre no. vf DI CLEMENTE 05
Finnell DS 2005 "Building a program of research based on the transtheoretical model", Journal of Addictions Nursing, 16:1–2, pp. 13–21
The concept of patient choice emerges from this program of research. Well-designed randomized control trials need to be conducted to establish the efficacy of stage-based treatment for the target population and to examine the role of choice on treatment outcomes. The article addresses the value of being mentored by experts and mentoring others to address the shortage of addictions nurse researchers. (Taylor and Frances)
DrugInfo resource centre no. vf FINNELL 05
Freyer J, Tonigan JS, Keller S, Rumpf HJ, John U & Hapke U 2005 "Readiness for change and readiness for help-seeking. A composite assessment of client motivation", Alcohol and Alcoholism, 40: 6, Nov.–Dec., pp. 540–44
This study aimed to examine the link between readiness for change and readiness for alcohol related help-seeking. Researchers also looked at measures of dependence severity, use and consequences, in relation to readiness to change.
Migneault JP, Adams TB & Read JP 2005 "Application of the Transtheoretical Model to substance abuse. Historical development and future directions", Drug and Alcohol Review, 24:5 Sept., pp. 437–48
This review focuses not only on the stage of change dimension of the TTM, but also the processes, decisional balance, and self-efficacy dimensions, which have received less attention in earlier reviews. Particular emphasis is placed on the measurement and conceptualization of the stage of change construct.
Nochajski TH & Stasiewicz PR 2005 "Assessing stages of change in DUI offenders: a comparison of two measures", Journal of Addictions Nursing, 16:1–2, pp. 57–67
The current study considered motivation and self-efficacy to change in a sample of 458 convicted driving under the influence offenders who were court mandated to complete a clinical evaluation to determine if further treatment was necessary. Regression results for concurrent drinking-driving indicated that none of the motivation to change measures were significantly associated with drinking-driving. (Taylor and Frances)
DrugInfo resource centre no. vf NOCHAJSKI 05
Velasquez M & von Sternberg K 2005 "The transtheoretical model as a framework for developing substance abuse intervention", Journal of Addictions Nursing, 16:1–2, pp. 31–40
The authors describe several recently developed substance abuse treatment programs based on the TTM constructs and describe the measures used to assess change in the various studies. We also highlight how counseling strategies, such as motivational interviewing, can be incorporated into TTM-based treatments.
DrugInfo resource centre no. vf VELASQUEZ 05
Di Clemente C, Schlundt D & Gemmell L 2004 "Readiness and stages of change in addiction treatment", The American Journal on Addictions, 13, pp. 103–19
This review examines current perspectives on readiness and the stages of change, criticisms and measurement issues, and clinical applications and future research in this area. It aims to help researchers understand the larger process of change where addict and treatment provider meet.
DrugInfo resource centre no. vf DICLEMENTE 04
Davidson R 2001 "The cycle of change", Drug and Alcohol Findings, 5, pp. 19–24
Its simplicity is beguiling, but does Prochaska and DiClemente's ubiquitous model of change simply describe the change process, or help create and accelerate it? This definitive critique tests the practical uses of the world's most popular therapeutic model.
Kinstler DP 2000 "Examining the relevance of the transtheoretical model of change within an alcohol dependency treatment program", Journal of Addictions Nursing, 12:1, pp. 17–22
The purpose of this study was to discover if the stages of the transtheoretical model of change are compatible with the phases of a Navy or Marine Corps rehabilitation program for the treatment of alcohol dependence.
DrugInfo resource centre no. vf KINSTLER 00
Addington J, el Guebaly N, Duchak V & Hodgins D 1999 "Using measures of readiness to change in individuals with schizophrenia", American Journal of Drug and Alcohol Abuse, 25:1, pp. 151–161
This study assessed the suitability of existing measures of readiness to change for use with individuals with schizophrenia. Results suggested that there was no agreement between stages defined by the interviewer and stages defined by self report. The implications are discussed.
DrugInfo resource centre no. ADDINGTON 99
Di Clemente CC, Bellino LE & Neavins TM 1999 "Motivation for change and alcoholism treatment", Alcohol, Research and Health, 23:2, pp. 86–2|This American article reviews how motivation plays an important role in alcoholism treatment by influencing patients to seek, complete, and comply with treatment as well as make successful long term changes in their drinking. Both alcohol-abusing and alcohol-dependent people can be classified into different "stages of change" in terms of their readiness to alter their drinking behavior.
DrugInfo resource centre no. vf DICLEMENTE 99
Campbell WG 1997 "Evaluation of a residential program using the Addiction Severity Index and Stages of Change", Journal of Addictive Diseases, 16:2, pp. 27–39
Fifty six individuals admitted to male residential recovery program/half way house in Canada were evaluated using the Addiction Severity Index (ASI) and Socrates. Stages of Change revealed 27% to be in preparation, 67% action, and 6% in maintenance. Stage of Change did not predict outcome in terms of abstinence or residential status.
Hagman G 1997 "Stages of change in methadone management", Journal of Maintenance in the Addictions, 1:1, pp. 75–91
This American paper explores the dynamics of the treatment process and the dynamics of the treatment process in methadone maintenance from the perspective of the Stages of Change Theory of Prochaska and Di Clemente. Special issues in the treatment of the difficult patient are highlighted.
DrugInfo resource centre no. vf HAGMAN 97
Herrick A, Stone WJ & Mettler MM 1997 "Stages of change, decisional balance, and self-efficacy across four health behaviors in a worksite environment", American Journal of Health Promotion, 12:1, pp. 49–56
This study examined differences in decisional balance and self-efficacy scores during the five stages of change for health behaviours relating to sun protection, exercise, smoking and fat consumption. The findings showed that wellness programs need to focus on stage-specific interventions.
DrugInfo resource centre no. vf HERRICK 97
Prochaska JA & Velicer WF 1997 "Primer on stages of change", American Journal of Health Promotion, 12:1, Sept., pp.1–76
This special issue contains eleven articles on the stages of change, including changing lifestyles, physical health, behaviour change, methods and issues
DrugInfo resource centre no. HZ26 PRO
Miller WR & Tonigan JS 1996 "Assessing drinkers' motivation for change: the stages of change readiness and treatment eagerness scale. SOCRATES", Psychology of Addictive Behaviors, 10:2, pp. 81–9
Discusses recognition, ambivalence, and taking steps. Recognition scores at baseline were found to be mildly related to intensity of alcohol consumption and problems. Comparable scale scores resulted from short and longer forms of the instrument. Normative data are provided for the short form.
Prochaska, JO 1995 "The transtheoretical model of change and HIV prevention. A review", Health Education Quarterly, 21:4, pp. 471–86
Supporting empirical work is presented that reviews the central constructs of the model: the stages of change, processes of change, decisional balance, confidence, and temptation. Model-based applications to a broad range of problem behaviors are summarised. Applications to human immunodeficiency virus (HIV) prevention behavior changes are highlighted for each variable.
Velicer WF 1995 "An empirical typology of subjects within stage of change", Addictive Behaviors, 20:3, pp. 299–320
This American paper reports the results of four cluster analytic studies, one with each of the first four stages of change. The cluster analysis was based on three constructs of the model. Four distinct subtypes were found within Contemplation, Preparation, and Action, and three subtypes were found within Precontemplation.
Prochaska JO, Di Clemente C & Norcross JC 1992 "In search of how people change. Applications to addictive behaviors", American Psychologist, 47:9, pp. 1102–14
This article reviews a number of studies describing the processes which integrate a variety of psychotherapeutic theories. The transtheoretical concepts of these stages of change are examined and their application to a number of addictive behaviors and populations are reviewed. Discussion on why and how people change without assistance or interventions.
DrugInfo resource centre no. vf PROCHASKA 92
Prochaska JO 1991 "Assessing how people change", Cancer, 67, pp. 805–807
This article discusses the stages of change model which describes the progress of an individual through change. This can occur linearly or can include relapse or interruptions to the change process.
DrugInfo resource centre no. vf PROCHASKA 91
Di Clemente C & Hughes S 1990 "Stages of change profiles in outpatient alcoholism treatment", Journal of Substance Abuse 2:2, pp. 217–235
Evaluates a stages of change assessment measure with a group of 224 adults entering outpatient alcoholism treatment. Looks at clasification of individuals, alcohol use inventory subscales, abstinence, self-efficacy and outcome variables.
For more information about how to access material or to subscribe to the Resource Centre:
Phone 1300 85 85 84 (Monday to Friday, 9am to 5pm)
Email us at
Last updated: 31 May 2013