Are you ready to change?

Are you ready to change?

We all have bad habits that get in the way of our enjoyment of life. These habits can be highly self-destructive; heroin addiction is an example. Or they can be small things that might hold us back such as watching too much TV. Whatever the case, you may be wondering how people go about changing; understanding change might make it easier to do.

Quite a number of years ago now, Prochaska and DiClemente (1983) came up with a model of change that explains how people modify a problem behavior or acquire a positive behavior. Initially it was applied to smoking cessation and is now used to explain changes in behavior in general. The primary organizing principle in this model is called the Stages of Change; it describes a person’s readiness to change in 5 stages. Let’s look at how this might apply for someone with an alcohol problem.


In this stage a person is not even thinking of stopping their use of alcohol. Either the consequences of use are not grave enough or the person is willing to deny the seriousness of the problem despite evidence to the contrary.


As problems multiply due to excessive alcohol use a person may begin to accept that they have a problem. As a result of their drinking they may have financial, relationship or work difficulties or they may develop a health or mental health issue. Essentially, at some point, negative consequences may allow a person to develop some insight into the nature of the problem.


Contrary to what many people think, most people do not stop drinking in a vacuum. An often overlooked issue is that people have more success when they PREPARE to stop using once they have acknowledged a problem. Preparation could include decreasing how often or how much they drink each day, changing their social circle, changing their everyday routine so they don’t walk by their favorite bar, or beginning a meditation practice. They may decide on a stop date. The manner in which a person decides to prepare to change their drinking habit is as individual as they are.


At a certain point enough supports are in place to enable the drinker to decide to stop or modify their use. This does not only include elimination of a problem behavior but also includes the addition of positive behaviors. In short, a bad habit is replaced by a good habit. For example, it is not unusual for people to become involved in some kind of sport or exercise regimen as a replacement for their alcohol use.


A person becomes more confident about the changes they have made when they have a period of sustained abstinence or non-problematic use of alcohol. They are actively using strategies that they developed in the action phase and are able to maintain and build upon positive changes, preventing relapse.

Relapse is not included in the original model but can be considered to be a sixth stage. It is important to remember that relapse is very common and that a great deal can be learned from what precipitated the relapse. It is advisable to examine what may have preceded a return to problematic drinking so that the person can develop strategies to cope with this in the future.

On the path?
I have described a way that people change that has been validated by the research and by many people’s experiences. If you want to change a behavior it helps to know what the terrain looks like as you move forward. Nothing changes unless you do the footwork….

Norcross JC1, Krebs PM, Prochaska JO. Stages of change. J Clin Psychol. 2011 Feb;67(2):143-54. PMID: 21157930.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.

This information is for educational purposes only and should not in any way be considered a substitute for professional help. If you are in need of immediate help please contact your local psychiatric emergency services.

Positive Changes in Global Mental Health: Year in Review, Part II


World Mental Health Day, October 10, 2014, Gede Foundation

There is a lack of mental health professionals in Nigeria and primary care providers are not trained or inclined to treat those with mental illness due to beliefs that there is a supernatural cause connected with developing a mental health problem. Often persistently mentally ill people are ostracized and may end up shackled and treated by traditional healers in informal settings or may be incarcerated. Only when these treatments have failed do a select few find their way to orthodox biomedical treatment.

In May of 2014 twelve local civil society organizations came together to discuss the new national policy on mental health services delivery. After a second meeting and further discussion in August the group decided to form a coalition to advocate for accessible and quality treatment services, push for policy implementation, conduct research and reduce stigma through promotion of awareness and education. The coalition is now known as the Mental Health Coalition Nigeria and calls for interested groups and professionals to promote mental health, address mental health issues and advocate for those who have mental health problems to join the coalition.


Union Health Minister Dr Harsh Vardhan addressing at the launch of the National Mental Health Policy, in New Delhi on October 10. Dr Nata Menabde, WHO representative to India; Lov Verma, union health secretary; Dr Jagdish Prasad, DGHS; are also seen. (Photo: PIB)

Union Health Minister Harsh Vardhan launched India’s first ever comprehensive Mental Health Policy. It calls for more accessible and affordable mental health treatment through inclusion of psychiatric care in primary health care settings. It recommends compassion and sensitivity as opposed to stigmatization and promotes protection of the rights of those with mental health problems.

It recommends that attempted suicide be decriminalized. In India suicide is considered a major cause of death for those with a mental health problem.

The policy states that, “poverty and mental ill health are inextricably linked in a negative vicious cycle”. This is an acknowledgement that poverty, social exclusion, unequal opportunity and income disparity may worsen mental health problems for vulnerable groups, especially poor and homeless women.

Vardhan also announced the ‘Mental Health Action Plan 365’, which specifies the roles to be played by the central government, state governments, localities and civil society organizations in the next year. In addition he pledged to present the recently developed mental health bill to Parliament. Passage of the bill is critical to the implementation of the policy and plan.


It is estimated that 10.8 million of Syria’s 22 million people have been affected by the conflict in Syria. There are 2.5 million refugees and 6.5 million internally displaced people in need of humanitarian assistance. According to a report by the UN High Commissioner of Refugees, it is believed that the rate of mental health problems has greatly increased due to the stress related to the conflict; extreme social disruption has a profound effect on psychological distress. It is believed that 350,000 people suffer from severe mental health problems and 2 million suffer from mild to moderate problems. In addition, a large percentage of the population is experiencing social/psychological distress and is at risk for developing mental health problems.

Since 2011 the problems inherent in living in such an unstable and potentially traumatizing environment have been recognized and small inroads are being made. Because meeting basic daily needs and mental health are so intertwined providing these basic needs is fundamental to mental well being. The United Nations Office for the Coordination of Humanitarian Affairs has been involved with providing coordination of humanitarian aid as well psychosocial support within Syrian and to refugees outside of Syria’s borders. International Medical Corps. is providing primary health care, mental health care and psychosocial support though their mobile health care units and their assistance to existing health and mental health facilities. They also have geared up provision of services to Syrian refugees residing in neighboring countries. The World Health Organization has been renovating four psychiatric facilities in Syria: a psychiatric hospital, 2 psychiatric units and an outpatient center. It is estimated that these facilities will serve over 11,000 patients who have mental health problems every year.

These are positive efforts to effect change for what the UN calls the “biggest humanitarian crisis of our era”. The UN and its partners are seeking 8.4 billion dollars to fund humanitarian efforts in this region in 2015.

It is hard to imagine what it would be like to have to cope daily with the stress of threats to your safety, security and survival. If you would like to help these organizations continue their work in Syria you can donate here.