Preparation Pitfalls – Why Many Patients Fail After Saying They're Ready
Why Preparation Is the Most Overlooked Stage
The preparation stage is often mistaken for action. Patients appear ready, but lack the critical scaffolding to succeed. Without planning, commitment wavers. Studies show that poor preparation correlates with higher relapse rates across substance use, lifestyle change, and medication adherence (DiClemente et al., 1991).
Common Pitfalls in the Preparation Stage
Vague plans ('I’ll try to quit')
Unrealistic timelines ('Cold turkey tomorrow')
Missing support systems
No accountability or structure
Ambivalence still lingering
Micro-Assessments: Is the Patient Really at the Optimal Level of Preparedness?
Ask:
Tell me what you will you do specifically.
Tell me when and where.
Tell me what might get in the way.
Tell me who will support you.
Tell me how confident you are on a 1–10 scale?
Tool: The P.R.E.P. Checklist
P.R.E.P. = Plan, Resources, Expectations, Protection
Role of the Prescriber in Strengthening Preparation
Normalize the need for structure.
Address ambivalence openly.
Encourage writing the plan down.
Schedule follow-up.
Reinforce small wins before action.
Quick Script for Prescribers
“You sound ready—let’s make sure your plan sets you up for success.”
“Tell me what will make this easier on a hard day.”
Scientific References
DiClemente, C. C., Prochaska, J. O., Fairhurst, S. K., Velicer, W. F., Velasquez, M. M., & Rossi, J. S. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59(2), 295–304. https://doi.org/10.1037/0022-006X.59.2.295