Change rarely happens all at once. For many people, recovery involves shifting levels of readiness, uncertainty, action, and continued effort. Two ideas help make sense of that process: the stages of change model, one framework for describing how people move toward lasting change, and motivational interviewing, a counseling style that helps people explore and strengthen their own reasons for changing. Understanding both can make treatment feel less like pressure and more like a partnership. These approaches are woven into structured programs like our intensive outpatient program in Cedar Rapids. This article is part of our broader addiction therapy resource library. Anyone ready for that step can learn what live in addiction treatment involves.
What Is the Stages of Change Model?
The stages of change model, which is part of the transtheoretical model, describes behavioral change as a process involving several stages rather than a single decision. According to SAMHSA, it treats motivation not as a fixed personality trait but as a dynamic state that can change over time and may be strengthened through collaborative treatment [1]. That reframing matters, because it means someone who is not ready today can become ready later. The model also helps explain why people early on may not yet recognize a problem, feel discouraged about changing, or doubt that change is needed, which connects to related ideas like denial, the difference between a habit and an addiction, and the distinction between addiction and dependence.
The Five Stages of Change
SAMHSA describes five stages, and importantly, movement through them is usually circular rather than a straight line. Someone may reach action, slip back to contemplation, and move forward again, and a person can even be at different stages for different substances or goals. The table below summarizes each stage.
| Stage | What It Looks Like |
| Precontemplation | Not currently considering change, and possibly unaware, unwilling, or discouraged |
| Contemplation | Recognizing concerns and weighing reasons for and against change |
| Preparation | Intending to act soon, making plans, and possibly taking small initial steps |
| Action | Actively implementing changes in behavior and lifestyle |
| Maintenance | Sustaining gains, strengthening coping skills, and managing risks of recurrence |
Setbacks and returns to earlier stages are common and do not mean that all progress has been lost. They should still be taken seriously, since a return to use can carry real risks, and they may signal that the plan needs to be resumed or adjusted. Recognizing this can ease shame and help people spot signs they need to seek help sooner, whether the underlying issues involve trauma, the underlying reasons for addiction, or why some drugs are harder to quit than others.
What Is Motivational Interviewing?
Motivational interviewing (MI) is a collaborative, person-centered but goal-oriented counseling style designed to help people explore ambivalence and strengthen their own motivation and commitment to change [2]. Rather than relying on lectures or confrontation, the counselor works alongside the person, listens for their reasons to change, and offers information or advice in a way that respects their autonomy. Modern MI is often described through its underlying spirit, summarized as PACE: partnership, acceptance, compassion, and evocation. In practice, MI conversations move through four overlapping processes: engaging, focusing, evoking, and planning. Our overview of what motivational interviewing is and how it works for addiction treatment goes deeper on each of these.
Earlier descriptions emphasized expressing empathy, developing discrepancy, and supporting a person’s confidence in their ability to change, though current MI talks about responding to sustain talk and any discord between counselor and client rather than treating a person as resistant. This respectful approach can be especially helpful for people who feel pressured or mandated into treatment, including those arriving through a court-ordered evaluation, as long as the counselor is clear about which parts are legal requirements and which remain the person’s own choice.
For the wider context, see our addiction therapy overview.
The Core Skills of MI: OARS
Counselors trained in MI often use a set of skills captured by the acronym OARS:
- Open-ended questions that invite people to share their experiences and perspectives
- Affirmations that recognize a person’s strengths and efforts
- Reflective listening that shows genuine understanding without judgment
- Summaries that pull together what the person has said and highlight their own reasons for change
These skills create a collaborative conversation in which counselors can evoke and strengthen a person’s own reasons, abilities, and commitments related to change, often called change talk. For a closer look at how counselors put these into practice, see our guide to motivational interviewing techniques.
They pair naturally with education about how substance use affects the brain and mental health, which our guides on whether addiction is a mental disorder, the difference between physical and psychological dependence, and the most common co-occurring disorders with addiction explore.
How the Stages and MI Work Together
The two approaches were developed separately but can complement each other. The stages model can offer a general picture of readiness, while MI provides a collaborative way to explore ambivalence and support movement toward a person’s chosen goals. Considering a person’s readiness can help counselors avoid premature arguments, explore mixed feelings, develop realistic plans, and support ongoing change. Some things this can look like include:
- Focusing on engagement and awareness with people who are not yet considering change
- Helping people in contemplation examine their situation without feeling judged
- Building momentum and a concrete plan as a person moves toward preparation and action
- Supporting coping skills and confidence during maintenance
Readiness can shift even within a single session, so it is best reassessed over time rather than treated as a fixed label. Understanding the primary goal of motivational interviewing helps clarify why meeting people where they are matters so much.
Family members can play a supportive role too, when appropriate and agreed upon, which is why our guides on the importance of family education and what to watch for with a loved one can help. The five stages of addiction, a separate model describing how addiction develops, and the difference between comorbid and co-occurring conditions can also help families follow the process.
How This Fits Into Treatment
Research on MI shows a measured picture. A 2023 Cochrane review found that MI may modestly reduce substance use compared with no intervention, but may make little or no difference compared with usual treatment, and its effects vary by person, substance, and setting [3].
MI may be delivered as a brief standalone intervention or, more often, incorporated into a broader, individualized treatment plan that can also include counseling, group therapy, medication when appropriate, and other medical and social services [4]. Group settings are a common part of that plan, and our overview of the different types of group therapy explains how they work. Education also strengthens engagement, which our guide to how psychoeducation aids addiction recovery explores.
For people with co-occurring conditions, MI can support engagement in integrated care, but it does not by itself replace coordinated assessment and treatment of both the substance use disorder and the mental health condition, which our overview of the 10 signs you may need dual diagnosis treatment and our guide on the most common types of addiction affecting veterans explain.
Frequently Asked Questions
What are the five stages of change?
The five stages are precontemplation, contemplation, preparation, action, and maintenance. They describe how people move toward lasting change, from not yet considering it to sustaining new behavior. People often cycle between stages, and a person can even be at different stages for different substances or goals.
What is motivational interviewing?
Motivational interviewing is a collaborative, person-centered but goal-oriented counseling style that helps people explore ambivalence and strengthen their own motivation to change. Instead of confronting or lecturing, the counselor listens and expresses empathy. It commonly uses skills known as OARS: open-ended questions, affirmations, reflective listening, and summaries.
Does motivational interviewing work for addiction?
Motivational interviewing is a widely used, evidence-informed approach. A 2023 Cochrane review found it may modestly reduce substance use compared with no intervention, but may make little or no difference compared with usual treatment. Results vary by person, substance, and setting, and it is often combined with other care.
Sources
- Substance Abuse and Mental Health Services Administration (SAMHSA), “TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment” (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK571061/
- StatPearls (NCBI Bookshelf), “Motivational Interviewing.” https://www.ncbi.nlm.nih.gov/books/NBK589705/
- Schwenker R, et al., “Motivational interviewing for substance use reduction,” Cochrane Database of Systematic Reviews (2023). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008063.pub3/full
- National Institute on Drug Abuse (NIDA), “Treatment and Recovery.” https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
