Smoking Stages of Change

The first stage of the Transtheoretical Stages of Change model is that of pre-contemplation, in which the client is still not fully committed to the need to taking action to make a necessary change. In the case of a 43-year-old smoker who began smoking in childhood, the smoker may be reluctant to commit to change because of a history of failed attempts. At this stage, the counselor would need to give the smoker options to convince the client that the next time will be different—for example, the use of medications, patches, or supportive group or individual counseling, versus going cold turkey. Asking questions such as, “What needs does smoking serve in your life,” may be useful, to identify the social and physical needs smoking has fulfilled. A typical, Caucasian resident of the United States who has resided in the US for the entirety of his or her life likely knows that smoking is bad but may be unconvinced of his or her future willpower in overcoming the addiction. A lifestyle (such as a musician or bartender) where smoking is acceptable in the culture of the setting may further exacerbate the problem.

During the contemplation stage, the client will begin to weigh the pros and cons of changing and asking the client to specifically list the pros and cons of change may be useful. By age 43, the client has likely begun to experience physical side effects of smoking such as shortness of breath. Presenting the client with objective health evidence supporting change, positive success stories of other smokers, and low-commitment ways to begin tackling the change process (including tapering cigarette use) are all strategies to use.

During the preparation stage, the client will be willing to make another attempt at quitting. The counselor can ask questions of the client to help identify what obstacles have existed in the past to prevent success and breaking the addiction and create proactive strategies to circumvent them. For example, “How have your friends helped you maintain your abstinence,” or “How did you deal with cravings to smoke in the past?” The counselor can also discuss any lingering reservations such as concerns about weight gain, the expense of seeking out medical help, or a loss of friendships based upon smoking.

The action plan may take place with or without the counselor’s ongoing presence. For example, the client may wish to join an online support group specifically for former smokers or attend counseling sessions with someone trained in helping clients with addictive habits. A physician may be able to assist the client with specific prescriptions to ease the difficulty in transitioning away from nicotine. Regardless, it is necessary to have a plan and a goal and to ask the client specifically, “How will you deal with situations where you typically get the urge to smoke, both socially and alone?” These may include simple goals such as finding other things to do to bond with friends versus going on smoke breaks.

The maintenance stage involves maintaining the change in behavior, which in this instance is abstaining from smoking. Maintenance requires regular vigilance, given that relapses are common. The maintenance stage may require somewhat different behavioral changes, given that the client will likely wish to taper off any medications he or she is on. Going to therapy may be less frequent but having some sort of a resource to deal with cravings is still essential. Again, asking the client what junctures of the change process stymied him or her in the past and identifying proactive measures to take such as, “How do you plan to cope when all of your friends are smoking when you go out and you do not?” will still be needed to prevent relapse, which is a very common part of addiction. The stages are not always linear and there may be backtracking over the course of the counselor’s relationship with the client.

Reference
Summers, N. (2016). Fundamentals of case management practice: Skills for the human services
(5th ed.). Boston, MA: Cengage Learning.