Review of Substance Abuse Treatment and the Stages of Change

According to the foreword by Barbara McCrady, Substance Abuse Treatment and the Stages of Change is not a “how to do” manual but rather a “how to think” manual. It is also extremely practical – after all, once you know how to think about something, you know what to do about it. Furthermore, this isn’t a dry or abstract textbook; it includes clear direction as to how to apply the model and many illustrative case examples.

The authors begin with a detailed overview of the stages of change model, bolstered by numerous references to the research literature and livened by a case example for each of the five stages. Concepts of “denial” and “resistance” are reframed to help the clinician focus on increasing motivation. They then move on to assessment, in an excellent chapter that includes descriptions of the most commonly used stage-of-change measures. The assessment chapter also reviews in detail several additional measures relevant to early versus later stages of change. For example, in the early stages screening and diagnostic measures are likely to be more relevant than measures of relapse risk. The chapter on treatment planning focuses on developing individualized, stage-relevant treatment goals and strategies.

Once the client stage of change is determined and treatment goals set, then what? The next group of chapters provide guidance as to the kinds of interventions that will help clients progress, with an emphasis on approaches that have received empirical support. Separate chapters outline application of the stage model to individual, group, and couple/family therapy. Motivational interviewing, cognitive-behavioral skills training, community reinforcement approach, behavioral marital therapy, and developing a group culture that supports behavior change are all featured – again, with welcome specificity as to particular strategies to employ at each stage. Management of relapse is also placed within the context of the overall stage model.

A chapter on populations with special needs includes sections on treatment of women and treatment of psychiatric/substance abuse dual-diagnosis patients. The section on treatment of women includes many good ideas for overcoming barriers to treatment entry and retention, but organizes them rather cursorily in the stage model. Oddly, the concept of “denial” reappears here. The section on dual diagnosis is somewhat more useful, but overall the book is more effective at helping the reader learn to assess readiness to change and identify stage-relevant treatment strategies than at targeting specific sub-populations.

Finally, the authors conclude with their evaluation of the strengths and weaknesses of the stages of change model as applied in practice and some suggested future directions for inquiry. I recommend Substance Abuse Treatment and the Stages of Change to clinicians or students seeking both a rigorous evaluation of the stage model and detailed guidance as to how to apply it in practice.

Deborah H. A. Van Horn, Ph. D. August 14, 2005