Registered Nurses' Association of Ontario

Using the Stages of Change in Nursing Practice

The following provides examples of guiding questions for each of the stages of change in the Transtheoretical Model of Change

Assessing and Listening for Readiness to Change – Ask:

1) Tell me about your substance use.

2) How important is it for you to make changes?

3) How confident are you that you could make changes to your substance use?


Stage: Precontemplation

Assessing and Listening for Precontemplation – Ask:

1) Tell me about your substance use?

2) Tell me about a typical day. Where does your drug use fit in?

3) What are the reasons that you take substance X?


Stage: Contemplation

Assessing and Listening for Contemplation – Ask:

1) What concerns do you have about your use of substance X?

2) What are the pros and cons of substance use from your perspective?

3) Create a decisional balance sheet: “What do you like/hate about substance X?”

4) How does your current substance use fit in with how you see yourself in two, three, five years?

5) What might happen if nothing was to change?


Stage: Preparation

Supporting the Person in Preparation – Consider:

1) Review decisional balance sheet: discuss medications, counseling options

2) Explore harm reduction strategies & coping strategies

3) Review commitment to change


Stage: Action

Supporting the Person in Action – Consider:

1) Remember that change is a process not an event

2) Plan for slips and lapses


Stage: Maintenance

Supporting the Person in Maintenance – Consider:

1) Review accomplishments and provide positive reinforcement

2) Explore stimulus control, reinforcement management & counter conditioning

3) Talk about ongoing harm reduction strategies and barriers


Stage: Relapse Prevention

Relapse Prevention – Plan:

1) Safety planning: identify triggers, coping strategies, support systems, dealing with different levels of distress

2) Chain analysis after relapse

3) Teach coping and social skills

Addiction and Mental Health
Engaging Clients who Use Substances
Point of Care Resources