"What we have outlined are a series of stages of change that people go through to make a change and sustain it. Why say 'I'm going to wake up at 5 o'clock in the morning and run' when you're not a morning person? That's not an acceptable plan. You may try it for a few days, but it is going to fail."

UMBC: What brought you to UMBC in 1995?

C.D.: My family is from Delaware so we wanted to move to this area, but I was also looking for a place where I could do research and that would present the next challenge to my career. The fit with the psych department and my own philosophy was nice, although I wasn't sure about UMBC - I didn't know how big it was or what it was like. Then when I came to visit I fell in love with the place and the people and the atmosphere. It was a very exciting place to come into. There was a lot of energy in terms of the administration and their efforts to build a first-class university; we were just in the throes of becoming an honors university. And the department was a good department with an energetic and productive faculty.

UMBC: You are a co-founder of the Transtheoretical Model of Change. Can you provide a layperson description of what the model entails?

C.D.: It's a model of how people move through the process of making intentional behavioral changes in their lives. It really focuses on how people change. What we have outlined are a series of stages of change that people go through to make a change and sustain it. The model came from the work that my major professor was doing at the University of Rhode Island in the early 1980s, and my dissertation. What we have done is create steps to outline this process of change that seem more understandable, that identify critical tasks in order to make change happen and to sustain it.

By understanding where people are in this process it may help us move people forward better. When we first began working in this area, most interventions both in health and in psychotherapy were very action-oriented, but most of the people coming into treatment were not ready to change. They were in earlier stages of change. These individuals need to move out of what we call "pre-contemplation" to "contemplation," where they begin a risk reward analysis. Then they need to move into what we call the preparation stage were they have to build their commitment and a sustainable plan. Then they have to implement the plan, which represents the action phase and takes at least three to six months before the change or new behavior can be integrated into a lifestyle.

UMBC: Now that the model is well established, what are its applications in the mainstream?

C.D.: This model is being used all over the world as a framework for creating health interventions as well as for organizing addiction treatment. I have recently had invitations to talk in New Zealand, Taiwan and Germany. So it is being used all around the world to help people think about the process of change for health and addictive behaviors. It's also used in research. There are a number of research projects using both the model and the measures created by the model to study various health behavior changes. We just completed an intervention at the Shock Trauma Unit in Baltimore trying to reduce drinking in problem drinkers. In another project, my collaborators and I have been working with WIC women in the "Food for Life" program on changing dietary behaviors in women. Colleagues in pediatrics and I are trying to prevent obesity by changing diet and physical activity in adolescents.

UMBC: Can you apply the model to a hypothetical real-world case scenario?

C.D.: We published a self-help book, Changing for Good, that outlines how people can use this in their daily life. The one I think everyone can identify with is physical activity. Let's say we have a couch potato who sits around watching TV with little or no interest in becoming physically active. That person is in pre-contemplation, so the challenge for that person is to be convinced that physical activity will enhance his or her life. Until there is some interest in physical activity, he or she will not get out of precontemplation.

Once you have some interest you begin to consider the pros and cons of the change: "I'm not comfortable with what I do now," or "my knees hurt when I run," that type of thing. For change to happen, the individual had to go through this risk-reward analysis until the pros for making the change become larger than the cons against it. Then he or she would have to go to the next stage, which is called the preparation stage. Here's where the contemplated change has to become a priority in your life, it's got to move to the top of the "to do" list and would need a plan that is Accessible, Acceptable and Effective. To say "I'm going to wake up at 5 o'clock in the morning and run" when you're not a morning person is not an acceptable plan. You may try it for a few days, but it is going to fail.

The action phase is the actual follow through on the plan. Now, all plans have problems, so in the action phase the main challenge is to revise your plan. You need to say, "I thought I could work out in the basement, but that's not fun and the treadmill is boring. I need to be outside so I will plan to walk outside and when it rains, I'll use the treadmill downstairs." So now you have revised the plan to make it much more probable that you will continue to make the behavior change.

UMBC: How long does it take for a change to be integrated into your lifestyle?

C.D.: There are two answers. Part one of the answer is that to establish a habit takes three to six months of regular engagement in the new behavior. After that, the challenge is to integrate it into your life so that it becomes part of who you are and how you live your life. Using the physical activity example, you reach a point where you don't travel without your sneakers and your shorts. It seems that it takes at least one or two years to build something into your life until you can say "I can now exit this process of change" without going back or relapsing.

UMBC: What direction is your research on this topic taking now?

C.D.: Where we're going now is trying to understand how this process works with multiple behaviors, with people who have to change two or more problem behaviors. We're looking at individuals with cocaine problems who are also schizophrenic. We're also expanding the model to new behaviors and have a project with a colleague in Pittsburgh working with adolescent girls where we're staging abstinence from sex as well as condom use and birth control use. I'm also looking at how medication impacts the process of change. There are more medications being developed for problems like alcoholism and we need to know how do these medications interact with the process of change? Sometimes people take drugs instead of trying to change so the question is, once they stop using the drug to help them change, do they go back to drinking? How do you get sustained change by using medications as well as behavioral interventions and treatment?

We're also looking at mandated treatment. Society can mandate that you go to treatment, but can't mandate you to change. Punishment can force you to change by putting you in jail, but the challenge is on release where we have tremendous recidivism after people get out of prison because they haven't made the change internal. I've been working with pregnant women smokers too, who stop smoking during pregnancy but really don't quit. So we're looking at the phenomenon of suspending a behavior versus really changing the behavior.

Here at UMBC I have a lab where some of my students are working on a subcontract with the Department of Health and Mental Hygiene in Maryland to look at some of the Maryland smoking cessation data and youth surveys to understand where our adolescents are in the process of smoking initiation. This topic is also a central one in my new book, Addiction and Change: How Addictions Develop and Addicted People Recover. It looks at the stages people go through to become addicted and the stages they go through to get off.

UMBC: You have been interviewed and published in everything from renowned scientific journals to pop-culture articles on the television show "Queer Eye for the Straight Guy." What has been your most memorable press request?

C.D.: The one for "Queer Eye" was interesting since it asked how long those changes made during the program are going to last after the visitors leave. My thought was not very long. Once the motivation of the TV show is gone, the participants will probably go back to being messy. I also get requests for strange applications of the model. I've seen where people are using this model to examine earthquake preparedness in California.

UMBC: Do you have any addictive behaviors of your own?

C.D.: Actually, when I was working on my dissertation that focused on how people quit smoking, I was a smoker. I couldn't do that for too long, though, so my research actually helped me change my smoking behavior. Yes, I look at myself and see that I need to look at my own physical activity and try to create a viable plan that I will stick with. I also use the model to figure out how I can change my diet to lower fat and increase fruits and vegetables. I use myself as an example quite often when I give talks. That's the nice thing about the model is that it's relevant for everyone.