Addiction and Change

by Carlo C. DiClemente
Guilford Press, 2003
Review by Fred Ashmore on Oct 8th 2003

This is a solid, serious book. DiClemente sets out a framework in which to understand the complexities of addiction, the Transtheoretical Model or TTM. This model aims to bring together ideas from the biological. psychological and social models of addiction to explain the main features of addictive behaviors and in particular of how people acquire, practice and recover from these behaviors. Simple it isn't. Interesting, subtle and convincing, yes.

Those who have read Changing for Good, a self-help book for addicted people, will understand the underlying idea of recovery from addiction as a process with demonstrable stages. Recovering addicts will typically move through stages of Precontemplation, Contemplation, Preparation, Action and Maintenance.

This idea of stages opened new views for me when I first read it. Stages of change are obvious (now). Those stages and how people move between provides a clear and credible explanation of the phenomenon of lapses that are so common among recovering alcoholics. Lapses (alternatively you can call such events a recycle from action to preparation) become understandable, with reasons underlying them, reasons that can be identified and addressed. Not sin, not weakness of will, but a case of not taking enough care in a process. Revelatory!

In Addiction and Change, DiClemente explains how these stages can equally well be used to understand the process of starting an addiction. From a pre teen educated to resist the addictive, comes the adult with a well-maintained addiction. Between the two stages there is again contemplation (I observe that my peers are trying cigarettes and drink) to preparation (Go on, let me try that) to Action (I've decided to buy my own this evening) and Maintenance (I am a regular smoker, but I can give it up any time I want to.

DiClemente sets out the cognitive and behavioral changes that typify each stage, their variety between individuals and the underlying similarities. For example, two teenagers about to try smoking for the first time will have very different specific thoughts on the matter but both will have reached a decisional balance that is in favor of this experiment.

Understanding of the cycle of addiction and recovery and of the processes within each stage gives important insights into recovery process. There is no quick fix or set of magical rules, just tasks to be achieved with more or less efficiency and effectiveness at each stage. Choosing the right approach will help. Focus on what you may want to achieve may help. The Transtheoretical Model provides a framework relevant to professional treatment, education about drugs and self-help. DiClemente provides a fascinating chapter about potential avenues for further research into addictions and addicts.

As DiClemente says, considering stages of change also has important lessons for prevention work. A person who is not even contemplating behaviors (for example, a pre teen child) s likely to be open to different messages from someone whose social culture is imbued with talk and learning.

Who is this for? I think it is primarily aimed at the professional in the field. DiClemente provides references in plenty and a systematic coverage of a large subject. The style is careful, measured, exact in its use of language. It's quite a contrast to some books on addiction, and none the worse for it, I would commend Addiction and Change to anyone who takes a serious interest in the subject of addiction. It takes a bit of persistence, though - this is a dense read. I'm glad to have the review copy and will immediately write my name inside the front cover.

Fred Ashmore is a member of the public with a strong interest in drugs, drink and addiction and how people recover from them. He is active as a meeting host for the SMART Recovery® program, which offers help for people who seek to modify harmful and addictive behavior.

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