Addiction and Change: How Addictions Develop and Addicted People Recover

Prochaska and DiClemente's stages-of-change model is currently a widespread conceptual framework for understanding the process of addiction recovery and has greatly influenced clinical practice, program development, and research in the field of addiction over the past decade (1). The model outlines five stages of addiction: denial of a problem with addiction, a state of ambivalence about changing the problem, a period of exploring possibilities for dealing with addiction and developing a plan, enactment of the plan (the first stage involving behavioral change), and the behavioral practice of long-term recovery from addiction.

By defining stages of recovery from addiction, Prochaska and DiClemente illuminated the shortsightedness of many existing treatment models that focus primarily on addicted individuals who are ready to recognize and actively work on the problem of addiction. The stages-of-change model suggests the necessity of providing treatment interventions during the earlier stages of recovery. In fact, research supports the idea that most people with an addiction are in one of those first three stages at which behavioral change has not begun to occur (1).

In his new book, Addiction and Change: How Addictions Develop and Addicted People Recover, DiClemente broadens the scope of the stages of change, applying the model to the actual process of becoming addicted. Challenging the use of singular, narrowly focused models to explain how people become addicted, the author suggests that complex environmental, psychological, sociological, and physiological factors and vulnerabilities have variable impact on the risk of becoming addicted, depending on one's stage. In using the stages to explain how addiction develops, DiClemente introduces the possibility of improving—and defining more succinctly—addiction prevention efforts.

DiClemente divides Addiction and Change into four main sections: understanding addictions in terms of change, the stages of addiction, the stages of recovery, and interventions to match the process of change. The first section critically reviews existing models for understanding addiction and provides an overview of the stages of intentional human behavioral change. Sections II and III provide in-depth descriptions of the stages of becoming addicted and of recovery, respectively.

Defining characteristics and the context of change for each stage are explored, while case examples help to solidify the reader's understanding and provide a richness to the text that keeps it captivating. The last section examines current prevention and recovery efforts, challenging dichotomous evaluations of program effectiveness based on use versus nonuse paradigms and the use of uniform interventions for heterogeneous populations. Finally, the author provides suggestions for practitioners, policy makers, and researchers on how to enhance addiction prevention and treatment.

With Addiction and Change, DiClemente has succeeded in writing a book that will "assist professionals to help individuals move out of the path leading to addiction and to help those already addicted along the road to recovery," his stated ultimate goal. Easy to read, based on sound clinical research, and critical of singular and simple explanations of addiction, this is a book in which DiClemente admirably expands on the promise of his earlier work.

Ms. Faberman is a clinical social worker and coordinator of the substance abuse treatment program at Worcester State Hospital in Worcester, Massachusetts.