The five stages change model

Behavioural support is an important part of any smoking cessation attempt and should be recommended to all individuals who intend to stop smoking.


If we consider that 40% of nicotine users make a cessation attempt annually, but only 4-6% manage to maintain abstinence, a mere 2% of nicotine users reach full cessation per annum.

One third of successful cessation attempts necessitate either medical or psychological therapy to result in a successful outcome.

Practitioners must be supportive and understanding of the patient’s wishes, alongside understanding that utilisation of the ‘3A’s,’ approach of brief cessation advice can offer some benefit. Understanding the ‘Stages of Change,’ model allows healthcare practitioners to intervene appropriately.

The suggestion that smoking cessation could be split into five different stages was first described by Prochaska and DiClemente (1983), with potential interventions to progress individuals through the 5 stages listed in the table below.

5 Stages of Change Model


This is the stage where an individual has no intention to alter their habit in the near term, which is normally deemed to be within the next six months. In this stage, individuals are often defensive, avoiding thinking or talking about their high-risk behaviour.

They may not be considering change because they are demoralised at previous quit attempts, do not understand the consequences of their actions or believe the consequences are insignificant. Simply put, at this stage the pros of smoking are outweighing the cons of smoking for the individual. To progress from this stage, an individual must accept their actions are problematic and potential harmful to themselves and others

In this state, the individual intends to change their ‘at risk,’ behaviour within the next 6 months. Whilst in this stage, the individuals are becoming more disillusioned with their current actions, and how it may be detrimental to their health.

Whilst in this stage, the individual will be aware of the inherent risks of their actions, but is ultimately unwilling to change. Whilst in this stage, the individual is in a state of flux, weighing up the pros and cons.



In this stage, the individual plans to make the change away from their harmful behaviour within one month. This stage of change usually consists of individuals who have attempted to change from their ‘at risk’ behaviour in the last 12 months, but have relapsed and are still engaging in the activity.

The individual must decide on a strategy which results in the desired outcome. As many in this stage have attempted to change their behaviour once (or more times) before, they will often adopt a different method of progressing into the action phase.



In this stage, the individual has made the move to alter their harmful behaviour within the last 6 months. During this stage, the individual will both receive the greatest plaudits for their efforts from others, but also find this stage the most difficult due to withdrawal symptoms.

The individual must remain in the action state until they move towards a state of ‘self-efficacy,’ and this is stronger than their temptation to revert to the problem behaviour.

This stage of smoking cessation can simply be defined as that the individual has not engaged in their harmful behaviour for over 6 months. Continued cessation focusses on the individual’s satisfaction on cessation. If temptation to smoke is too great, or the pros of smoking begin to be outweighed, the individual will relapse from the maintenance state.

It is shown that a majority of relapses from maintenance state happen in the presence of other smokers and to be successful individuals tend to avoid social situations with other smokers. Those who never smoke again remain in the maintenance stage.

For an addict, there is always a potential of relapse.


Whilst not one of the five stages in the change model, it is important to note that not every individual manages to reach the maintenance stage, and those that do may not remain there. All individuals in either of these categories are said to have ‘relapsed.’ Those that relapse tend to be individuals who do not have good self-belief or conviction.

To reverse relapse, it is important for the individual to remember why they quit in the first place. Relapses are a normal part of the change process and those that have relapsed should be reassured as such.

An individual may relapse as many as 30 times during their attempt to stop smoking.

How to interact with a smoker

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Did you Know

Smoking hand rolled cigarettes is just as dangerous as pre-made cigarettes. Indeed, there is evidence to suggest poorer health outcomes in those who roll their own cigarettes.