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Answer 3
  1. Contemplation. Prochaska and DiClemente1 have clarified that change is a process that unfolds over time through a series of stages (Table 1) requiring the clinician to tailor motivational attempts.

    Table 1. Stages of Change Related to Substance Abuse

    Stage Description
    Precontemplation   Patients in this stage have no intention of making changes regarding substance use. They may be uninformed or underinformed. The risks of making change in their lives are often overestimated and seen as outweighing the benefits, which are often underestimated or unknown to the patient. There is little insight into the hazardous nature of their substance use. These persons are “resistant” or “unmotivated.”
    Contemplation  Benefits of change are now better recognized and understood but are still outweighed by the apparent risks. Patients in this stage are stuck in a “love-hate” relationship with the substance but may state a desire to make change in next 6 months.
      Patients in this stage state intent to take action within the next month or less. Concrete plan for change arises (eg, attending an Alcoholics Anonymous meeting, buying self-help book).
    Action   Patients in this stage have made specific, concrete changes over the past 6 months, thus reducing their risk for disease (ie, changes have resulted in reduction or cessation of substance use).
    Maintenance   Patients in this stage are engaging in lifestyle changes, which will actively prevent relapse. Relapse risk softens, cravings/temptation lessen, and confidence improves. This stage usually lasts 6 months to 5 years.
    Termination   Patients in this stage have zero temptation and 100% self-efficacy. Most (> 80%) do not reach this stage.
    Relapse   40%–60% of patients will relapse in the first year and may re-enter at any stage above.

    Adapted from Prochaska et al.1

      Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 1983;51:390-5.

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