Ohio Valley Center for Brain Injury Prevention and Rehabilitation
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Stages and Processes of Change
For persons recovering from traumatic brain injury, the use of alcohol and other drugs can slow recovery and interfere with their ability to work and maintain family and social relationships. That means community professionals, like health care workers and those in human service agencies or vocational rehabilitation, may be called on to help persons change addictive behaviors in substance use or other life areas. One theory of change successfully applied to addictions is the Stages of Change Theory by Prochaska, DiClemente and others. This theory, when combined with insights from Motivational Interviewing, can be used by community professionals to facilitate the change process for persons recovering from injury. (See Motivational Interviewing booklet in this series.)

The Five Stages of Change are:

Precontemplation
In this stage, people are essentially unaware that a problem exists and, as a result, have no intention of changing their behavior in the foreseeable future. However, persons close to them may be aware of the existence of a problem. If a precontemplative individual is in
treatment, it is normally only as a result of coercion by someone in their environment (e.g., spousal insistence, employer requirement, or legal mandate).

Contemplation
People in this stage are becoming aware that a problem exists; they may be considering behavior change but have not made a commitment, such as setting a goal. These individuals often are weighing the pros and cons of the addictive behavior, and may be either over-estimating the pros or under-estimating the cons.

Preparation
In this stage, people have the intention to change but have not established a specific goal. In the Preparation stage, people often reduce an addictive behavior, but not enough to have a qualitative effect on their life.

Action
People in this stage make changes in their behavior and alter their environment in order to attain their goal of modification of an addictive behavior.

Maintenance
In this stage, people strive to consolidate the gains made during the Action stage, in particular to prevent relapse in their addictive behavior. Prochaska and colleagues believe that a person must be beyond six months of having successfully attained a desired
change in order to be considered in the Maintenance versus the Action stage.

The Ohio Valley Center for Brain Injury Prevention and Rehabilitation offers the "Utilities" Series of educational materials for persons with brain injury, families, and professionals. Information on the topics listed below may be accessed throught their website at: http://www.ohiovalley.org/abuse/index.html

Brain Injury/Substance Abuse "Utilities" Series

Whatever It Takes
10 principles for community professionals helping persons with brain injury.

ABUSE Screening
How to screen for substance abuse among persons with brain injury.

TBI Screening
How to screen for traumatic brain injury.

Stages of Change
How people change addictive behavior and what supports the change process.

Motivational Interviewing
A counseling technique to help people make difficult changes.

Community Teams
How community professionals can work together collaboratively.

Prepared with financial assistance form Grant H 235L20001 awarded by the U.S. Department of Education, Rehabilitation Services Administration (RSA) to the Ohio Valley Center for Brain Injury Prevention and Rehabilitation.

Note. From http://www.ohiovalley.org/abuse/pdf/change.pdf by the Ohio Valley Center for Brain Injury Prevention and Rehabilitation. Exerpts reprinted with permission of the Ohio Valley Center.

FOR BRAIN INJURY PREVENTION AND REHABILITATION

1166 Dodd Hall
480 West 9th Avenue
Columbus, OH 43210

614-293-3802
Fax: 614-293-4870
www.ohiovalley.org

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