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 I

global mental health map

United States

Advances in Mental Health Parity

This marked the beginning of parity for mental health/substance use disorders and medical/surgical benefits covered by Medicare in the United States. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Before this time Medicare beneficiaries were required to pay up to 50% of the approved amount for mental health and substance use disorder services as opposed to 20% copayment for most other outpatient services. This marked the end of the five-year phaseout of the mental health treatment limitation effectively providing nondiscriminatory outpatient mental health coverage to the millions of Medicare recipients throughout the country.

United Kingdom

Mindfulness Solution for Symptom Relief

The University of Oxford in partnership with the Mental Health Foundation found that practicing mindfulness online can reduce stress, anxiety and depression. These researchers reported on BMJ Open that participants in the their study had a 58% reduction in anxiety, 57% reduction in depression and a 40% reduction in perceived stress. In addition there continued to be a reduction in symptoms of stress, anxiety and depression one month after the course was completed indicating that participants continued to practice the techniques they had learned during the study.

The mindfulness class used in this study was developed at the Centre for Mindfulness Research and Practice, Bangor University, UK. It can be found here.

Another useful and free online course, Mindfulness-Based Stress Reduction, has been developed by the University of Massachusetts Medical School in the the United States and can be found here.


Mental Health System at a Crossroads, Australia

A new report by Inspire Foundation based upon a collaboration between EY and assessed the demands on and provision of services for Australians with mental health issues. It estimated that if the mental health system remains the same in Australia it will require 9 billion dollars to increase services in order to meet the current needs of the population. The good news is that the report recommends an overhaul of the entire mental health system with a refocus on prevention and early intervention as well as promotion of self-help options. In this case efficiency and sustainability could translate into more services that help people help themselves and their peers at earlier stages of distress. Sounds like a winning combination.

The entire report can be found here.


Changing the Mindset

A new media guide, Mindset: Reporting on Mental Health, was launched. It is a guide for journalists by journalists and promotes more factual and less stigmatizing coverage of mental health issues. It also encourages journalists to address systemic issues in mental health. It has been issued in both English and French versions. The Canadian Journalism Forum on Violence and Trauma led the effort with additional funding from the Mental Health Commission of Canada.

It can be found here.