Stages of change. A critique.
The famous stages-of-change ladder lacks solid proof, so treat it as a rough guide, not a rule.
01Research in Context
What this study did
Doughty et al. (2002) read 87 studies on the stages-of-change model.
They looked for proof that people move through clear, ordered steps when they try to quit drugs or other habits.
The paper is a narrative review, so they summed up what the whole pile of research said.
What they found
The review found almost no evidence for neat, one-after-another stages.
People did not move from pre-contemplation to contemplation to action in a straight line.
Because the stages are shaky, stage-matched advice may miss the mark.
How this fits with other research
Pisacreta (1982) also warns against tidy labels. That paper says the "fixed-interval scallop" is just as shaky and lists 11 other things that shape the curve.
A-Sutton et al. (2022) offers a fresh view. Their five communication stages are flexible and loop back on themselves, showing stages can still be useful if we let them bend.
Emerson et al. (2023) shows another fix: when tools don’t line up, build a common ruler so studies can be compared. All three papers push us to test, not trust, popular boxes.
Why it matters
If you use stage-of-change worksheets or stage-matched goals, pause. Check if your client really fits one clean step. Track actual behavior instead of the label. Try flexible plans that let people move back and forth. This keeps your treatment tied to data, not to a ladder that may not exist.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Drop the stage label and measure one clear behavior—like days clean—then plan from that number.
02At a glance
03Original abstract
The stages of change proposed by Prochaska and DiClemente have been applied to change efforts within and outside of formal treatment and in relation to virtually any problem behavior. This model has gained widespread popularity in health psychology and addictions and is being used to guide interventions and allocate treatment resources in several fields. In this article, the authors review 87 studies on the stages of change across problem behaviors. Research findings suggest that the proposed stages are not mutually exclusive and that there is scant evidence of sequential movement through discrete stages in studies of specific problem behaviors, such as smoking and substance abuse. Although the stage model may have considerable heuristic value, its practical utility is limited by concerns about the validity of stage assessments. The model's underlying concepts and alternative views of readiness for change are considered, along with directions for future research.
Behavior modification, 2002 · doi:10.1177/0145445502026002006