The Stages of Change at the Bedside: A Prescriber’s Guide to Fast and Effective Behavior Change
Clinical Vignette
Mr. J, a 42-year-old man with a history of alcohol use disorder, hypertension, and poor sleep hygiene, comes in for medication follow-up. His labs are worsening. When asked about his drinking, he shrugs: “It’s not that bad. I only drink on weekends now.”
As a prescriber with 15 minutes, what can you realistically do to move the needle?
Why Behavior Change Matters for Prescribers
Whether it's substance use, medication adherence, poor diet, sedentary lifestyle, or treatment resistance, behavioral change is at the heart of health outcomes. Yet prescribers are often under-equipped and over-scheduled. Unlike therapists, you don’t have an hour, but you do have influence.
The Stages of Change Model (Prochaska & DiClemente, 1983) gives you a fast and powerful lens to:
Spot level of preparedness in under 5 minutes
Deliver the right intervention at the right time
Avoid premature action that leads to patient failure
Reinforce small wins to prevent relapse
The 6 Stages of Change (Quick Refresher)
Tool: The Stage Spotting Checklist (2-Minute Assessment)
Ask one or more of the following:
“Tell me if you have thought about changing this behavior”
“Tell me what makes you think now might be the optimal time.”
“Tell me what you have tried in the past.”
“Tell me what’s getting in the way of changing it now.”
Then, match their responses to the stage. Please refer to the Go-To Scripts below.
The Preparation Phase is the Linchpin
Most prescribers skip from contemplation to action, but here’s the problem: without preparation, patients are set up to fail.
Preparation is where:
Goals are clarified
Barriers are named
Tiny habits are formed
Motivation is solidified
You can say: “Let’s take 2 minutes to sketch out the first small step you could take this week. Tell me what feels doable.”
Go-To Scripts for Busy Prescribers: Matching Your Responses to the Stage of Change
Scientific Citations
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.
Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing: Helping People Change (3rd ed.). Guilford Press.
Norcross, J. C., Krebs, P. M., & Prochaska, J. O. (2011). Stages of change. Journal of Clinical Psychology, 67(2), 143–154.
Reflection Prompt for Prescribers
“How often do I match my intervention to the patient’s stage of change?”
“Where might I be assuming someone is at the optimal level of preparedness, when they’re not?”
“What one phrase or tool can I practice using more intentionally this week?”