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
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
© 2003 Fred Ashmore
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.