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Difficulty: MediumSubstance-Related and Addictive Disorders

A 32-year-old man is court-mandated to attend a substance use disorder treatment program following an arrest for possession of cocaine. The clinic utilizes the Transtheoretical Model of Change to tailor motivational interviewing interventions. Over a two-year period, the patient progresses sequentially through the recognized behavioral stages of recovery. Arrange the following patient statements in chronological order, corresponding to the progression from the earliest stage of change to the latest.

  1. 1"My drug use isn't a problem; my boss just has it out for me, and I can quit anytime I want."
  2. 2"I realize that doing cocaine is draining my savings, and I am thinking about trying to stop sometime later this year."
  3. 3"I have deleted my dealer's number from my phone and plan to attend my first recovery group meeting this coming Tuesday."
  4. 4"I have completely stopped using cocaine for the past month and have been actively participating in cognitive behavioral therapy sessions."
  5. 5"It has been over a year since I last used, and I now routinely use exercise to manage my stress instead of turning to drugs."

Answer

The correct chronological progression is: Precontemplation, Contemplation, Preparation, Action, and Maintenance.
The Transtheoretical Model describes a predictable sequence of behavioral change. A patient begins in Precontemplation (denial or ignorance of the problem), moves to Contemplation (weighing pros and cons of quitting), then to Preparation (making firm plans and minor adjustments to quit soon). This is followed by Action (active cessation of substance use for less than 6 months), and finally Maintenance (sustained abstinence for greater than 6 months with active relapse prevention strategies).

Step-by-Step Solution

1
Identify the stage of change represented by the statement denying any problem.
The statement minimizing the problem represents Precontemplation, the first stage.
In Precontemplation, patients lack insight into their substance use disorder and have no intention to change.
2
Identify the statement showing ambivalence and future consideration of change.
The statement about thinking of stopping later this year represents Contemplation, the second stage.
Patients in Contemplation recognize the problem and consider quitting, but have not yet made a firm commitment to immediate action.
3
Locate the statement demonstrating small preparatory steps for imminent change.
The statement about deleting the dealer's number and planning a meeting represents Preparation, the third stage.
Preparation involves concrete planning and small steps intended to lead to definitive action within the next month.
4
Identify the statement describing active, recent cessation of substance use.
The statement about stopping cocaine use for the past month represents the Action stage, the fourth stage.
The Action stage is characterized by active behavior modification and abstinence lasting less than 6 months.
5
Identify the statement describing long-term sustained abstinence and relapse prevention.
The statement about not using for over a year represents the Maintenance stage, the final stage.
Maintenance is defined by sustained abstinence (typically greater than 6 months) and the integration of new, healthy coping mechanisms.

Key Concept

The Transtheoretical Model of Change categorizes readiness to quit a substance into five sequential stages: Precontemplation, Contemplation, Preparation, Action, and Maintenance.
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Topics

Substance-Related and Addictive Disorders

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