The Predictive Validity of the University of Rhode Island Change Assessment Questionnaire in a Heroin-Addicted Polysubstance Abuse Sample

Stage-of-change Assessment Predicts Short-term Treatment Engagement for Opioid Use Disorder Patients Initiated on Buprenorphine

Introduction

The emergency department (ED) is an effective setting for initiating medication for opioid use disorder (MOUD); however, predicting who will remain in treatment remains a central challenge. We hypothesize that baseline stage-of-change (SOC) assessment is associated with short-term treatment retention outcomes.

Methods

This is a longitudinal cohort study of all patients enrolled in an ED MOUD program over 12 months. Eligible and willing patients were treated with buprenorphine at baseline and had addiction medicine specialist follow-up arranged. Treatment retention at 30 and 90 days was determined by review of the Prescription Drug Monitoring Program. We used uni- and multivariate logistic regression to evaluate associations between patient variables and treatment retention at 30 and 90 days.

Results

From June 2018–May 2019, 279 patients were enrolled in the ED MOUD program. Of those patients 151 (54.1%) and 120 (43.0%) remained engaged in MOUD treatment at 30 and 90 days, respectively. The odds of treatment adherence at 30 days were significantly higher for those with advanced SOC (preparation/action/maintenance) compared to those presenting with limited SOC (pre-contemplation/contemplation) (60.0% vs 40.8%; odds ratio 2.18; 95% confidence interval 1.15 to 4.1; P <0.05). At 30 days, multivariate logistic regression determined that advanced SOC, age >40, having medical insurance, and being employed were significant predictors of continued treatment adherence. At 90 days, advanced SOC, non-White race, age > 40, and having insurance were all significantly associated with higher likelihood of treatment engagement.

Conclusion

Greater stage-of-change was significantly associated with MOUD treatment retention at 30 and 90 days post index ED visit.

Impact of patient motivation on compliance and outcomes for incontinence

OBJECTIVES

Physiotherapeutic treatment of pelvic floor dysfunction in women has variable outcomes, and identification of the predictors of outcomes is important in developing service provision and treatment planning. This study explored whether patient motivation affects treatment compliance and outcomes of physiotherapeutic treatment in a cohort of patients with pelvic floor dysfunction.

DESIGN, SETTING AND PARTICIPANTS

A prospective observational study of 141 adult female patients referred consecutively to the physiotherapy clinic of an urogynaecological outpatients unit at a UK hospital.

INTERVENTION

A 6-month (one group session per month) pelvic floor muscle training programme, which included a home exercise programme.

MAIN OUTCOME MEASURES

Modified Oxford Grading System and Queensland Pelvic Floor Questionnaire ratings of pelvic floor function were taken pre- and post-intervention, and the University of Rhode Island Change Assessment Scale assessed patient motivation to change pre-intervention.

RESULTS

Motivation to change predicted attendance at the intervention sessions and patient-rated improvements in function. Patients with higher baseline motivation to change also reported greater improvements in pelvic symptoms, given the same pelvic floor muscle strength improvement.

CONCLUSIONS

Patient motivation affects physiotherapeutic treatment adherence and outcomes, and should be considered as part of future assessment/screening procedures.

CLINICAL TRIAL REGISTRATION

NCT02549157.

Applying the Rasch Model to the University of Rhode Island Change Assessment

Purpose: Measuring readiness for change is an important part of the treatment planning process for individuals with addiction and co-occurring disorders. The University of Rhode Island Change Assessment (URICA) is a commonly used instrument in conjunction with motivational interviewing and has been endorsed by federal and several state substance abuse agencies. This study provides an alternative to classical test theory in determining the extent to which the URICA measures the complex concept of motivation for change in determining the stage of change of participants.Method: The Rasch model analysis was used to determine model-fit of the URICA in measuring motivation for change among participants (N=256) in a web-based recovery program.Results: The URICA did not exhibit model-fit. Items do not provide a step-wise difficulty level in measuring motivation for change. Category responses did not support a clear distribution between categories and responses.Discussion: Findings suggest that significant adaptations to the instrument are needed to ensure the specificity of items and discrete endorsement of more specific motivational factors among individuals seeking aftercare services.Conclusion: It is vital that social workers utilize standardized measures to support clinical decision-making. While the URICA is a commonly used instrument to measure motivation for change, the Rasch analysis supported findings from other analyses that the URICA failed to adequately predict motivation for change among participants.

Stages of change and psychotherapy outcomes: A review and meta-analysis

The transtheoretical model and the stages of change are often used to adapt treatment to the individual client. The aims of this study were to review the stages of change and popular measures of change readiness in psychotherapy and to conduct a meta-analysis of the relation between readiness measures and psychotherapy outcomes. We report data from 76 studies, encompassing 25,917 patients. Moderate-sized effects (d = 0.41) were found for the association among multiple disorders, including substance and alcohol use, eating disorders, and mood disorders. Outcomes were a function of the pretreatment stage of change; that is, the farther a patient along the stages, the better the treatment outcomes. This review added 37 studies to the data reported in 2010, further strengthening the link between readiness and therapy outcomes. The article concludes with limitations of the research, diversity considerations, and therapeutic practices for stage matching in psychotherapy specifically and behavioral health more generally.

Does change in readiness influence retention among African American women and men in substance abuse treatment?

African Americans are less likely than other racial groups to engage in and complete outpatient substance abuse treatment. The current study, conducted as a secondary analysis of a multisite randomized clinical trial, examined whether readiness to change (RTC) over time influences retention and whether gender moderates the relationship between changes in RTC and retention among 194 African American women and men. Participants completed the University of Rhode Island Change Assessment at baseline and at the end of the 16-week study. Findings revealed a significant relationship between RTC over time and retention. Specifically, the more RTC increased throughout the 16-week study, the longer participants remained in treatment. In addition, gender moderated the relationship between changes in RTC and retention, with a stronger association between changes in RTC and retention among men relative to women. One approach to improving substance abuse treatment retention rates is to focus on increasing RTC during treatment, especially among African American men.

Motivation to quit or reduce gambling: Associations between Self-Determination Theory and the Transtheoretical Model of Change

Motivation for change and recovery from addiction has been commonly assessed using the Transtheoretical Model's stages of change. Analogous to readiness for change, this measure of motivation may not recognize other elements of motivation relevant to successful change. The aim of this study was to examine the relationship between stages of change and reasons for change according to the Self-Determination Theory among problem gamblers motivated to quit. Motivations for change were examined for 200 adult problem gamblers with intent to quit in the next 6 months (contemplation stage) or 30 days (preparation stage). Analyses revealed that higher autonomous motivation for quitting gambling predicted greater likelihood of being in the preparation stage, whereas those with higher external motivation for change were less likely to be farther along the stage of change continuum. The findings suggest that autonomous motivations relate to readiness for quitting gambling, and may predict successful resolution from problem gambling.

A conceptual model of patient-professional communication as a self-management skill: A latent growth change modeling

BACKGROUND

Patient Communication with healthcare professionals is an integral self-management skill. Yet the underlying mechanisms explaining how such communication might be enhanced across time have not been well studied.

OBJECTIVES

Based on the transtheoretical model, the study aimed to develop an across-time Attitude-Social Influence-Efficacy model in order to explain changes in participants' patient-professional communication behaviors in the Chronic Disease Self-management Program (CDSMP). Readiness-to-change construct was hypothesized to be the overall predictors of psychological and behavioral parameters. It was hypothesized that social norm and attitude toward behaviors would be the indirect predictors of communication behavior.

METHODS

One hundred and thirty-six Chinese participants with chronic diseases underwent a 6-week CDSMP. Their attitude toward behavior, self-efficacy, social norm, readiness to change and communication behavior were obtained at 1st, 4th and 6th week of the structured program.

RESULTS

A modified latent growth change curve model yielded satisfactory model fit (χ(2)/df = 1.32; RMSEA = 0.063 (90% CI = 0.018-0.96)). The results showed that readiness to change had a positive influence on attitude and self-efficacy. Both attitude and social norm positively affected self-efficacy. Attitude and self-efficacy in turn positively influenced communication behavior at the beginning of the program. Across 6 weeks, self-efficacy imposed a negative influence on communication behavior while social norm exerted a positive influence on the behavior.

CONCLUSION

This study revealed possible underlying mechanisms influencing CDSMP participants' communication with professionals. The results could shed light on further improvement of the structured program.

Assessing motivation and readiness to change for weight management and control: an in-depth evaluation of three sets of instruments

It is highly recommended to promptly assess motivation and readiness to change (RTC) in individuals who wish to achieve significant lifestyle behavior changes in order to improve their health, overall quality of life, and well-being. In particular, motivation should be assessed for those who face the difficult task to maintain weight, which implies a double challenge: weight loss initially and its management subsequently. In fact, weight-control may be as problematic as smoking or drugs-taking cessation, since they all share the commonality of being highly refractory to change. This paper will examine three well-established tools following the Transtheoretical Model, specifically assessing RTC in weight management: the University of Rhode Island Change Assessment Scale, the S-Weight and the P-Weight and the Decisional Balance Inventory. Though their strengths and weaknesses may appear to be rather homogeneous and similar, the S-Weight and P-Weight are more efficient in assessing RTC in weight management and control. Assessing motivation and RTC may be a crucial step in promptly identifying psychological obstacles or resistance toward weight-management in overweight or obese hospitalized individuals, and it may contribute to provide a more effective weight-control treatment intervention.

Group motivational interviewing for adolescents: change talk and alcohol and marijuana outcomes

OBJECTIVE

Little is known about what may distinguish effective and ineffective group interventions. Group motivational interviewing (MI) is a promising intervention for adolescent alcohol and other drug use; however, the mechanisms of change for group MI are unknown. One potential mechanism is change talk, which is client speech arguing for change. The present study describes the group process in adolescent group MI and effects of group-level change talk on individual alcohol and marijuana outcomes.

METHOD

We analyzed 129 group session audio recordings from a randomized clinical trial of adolescent group MI. Sequential coding was performed with the Motivational Interviewing Skill Code (MISC) and the CASAA Application for Coding Treatment Interactions software application. Outcomes included past-month intentions, frequency, and consequences of alcohol and marijuana use; motivation to change; and positive expectancies.

RESULTS

Sequential analysis indicated that facilitator open-ended questions and reflections of change talk increased group change talk. Group change talk was then followed by more change talk. Multilevel models accounting for rolling group enrollment revealed group change talk was associated with decreased alcohol intentions, alcohol use, and heavy drinking 3 months later; group sustain talk was associated with decreased motivation to change, increased intentions to use marijuana, and increased positive alcohol and marijuana expectancies.

CONCLUSIONS

Facilitator speech and peer responses each had effects on change and sustain talk in the group setting, which were then associated with individual changes. Selective reflection of change talk in adolescent group MI is suggested as a strategy to manage group dynamics and increase behavioral change.

A latent class approach to treatment readiness corresponds to a transtheoretical ("Stages of Change") model

Motivation for treatment among people with substance use problems is an important aspect of treatment success. Models for treatment motivation are widely debated. Latent Class Analysis can help to demonstrate the appropriateness of available models. The current study utilizes Latent Class Analysis to analyze treatment readiness statements as they relate to the reduction or cessation of marijuana, cocaine, and opioid use among 539 cocaine and opioid users recruited from the community of Baltimore, MD, USA. Participants completed an in-person structured interview including demographic questions, a treatment readiness questionnaire with items on Intention to Stop Use (ISU) and Problem Recognition (PR), current substance abuse treatment utilization, and urinalysis testing for marijuana, cocaine, and heroin. Latent class models were fit to the treatment readiness questionnaire. A four-class model provided the best fit with one class low on both ISU and PR ("Pre-contemplative"), a second class low on ISU but high on PR ("Contemplative"), a third class high on both ("Preparation/Action"), and a final class high on ISU but low on PR ("Post-Action"). Compared to the "Contemplative" class, the "Pre-contemplative" class was significantly more likely to be positive for marijuana, and the "Post-Action" class was significantly less likely to be positive for opioids. The "Preparation/Action" class was significantly more likely to be in treatment. With the exception of the "Post-Action" class, the analysis appears similar to the "Stages of Change" model and suggests that problem recognition and intention to stop use are important domains in the model. However, further longitudinal research is needed to assess predictive validity of model.

Problem recognition, intention to stop use, and treatment use among regular heroin injectors

This study investigated frequency of recent use as an explanatory variable in problem recognition and intention to stop use among regular injection heroin users. Data from the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors for HIV and hepatitis A, B, and C among injection and noninjection drug users, were used in the analyses. Participants (N = 337) consisted of those who reported injecting heroin daily or nearly daily for a period of 3 months. Multiple linear regression analysis revealed that frequency of recent injection drug use predicted problem recognition (β = .17), but not intention to stop use; although marginal, being female (β = .15), and homeless (β = .14) contributed to intention to stop use. Past 6-month treatment participation was 48%, and current treatment enrollment was 26% among study participants. This study highlights the importance of capitalizing on injection drug users' recent use as a mechanism for treatment interventions.

Attention-deficit/hyperactivity disorder subtypes in adolescents with comorbid substance-use disorder

BACKGROUND

Little is known about the relationship between attention-deficit/hyperactivity disorder (ADHD) subtypes and substance-use disorder (SUD). As there is literature suggesting different subtype phenotypes, there may be subtype differences in regard to the risk for developing SUD and substance treatment response.

OBJECTIVES

To characterize the sample in a Clinical Trials Network (CTN) study according to ADHD subtypes and baseline psychosocial and substance-use characteristics and to compare subtypes on response to treatment.

METHODS

Secondary analyses on data collected from adolescents (n = 276) diagnosed with ADHD and SUD (non-nicotine) and treated with stimulant medication or placebo and cognitive behavioral therapy (CBT) for substance use. Participants were characterized as inattentive or combined ADHD subtype and compared on baseline characteristics and treatment outcome.

RESULTS

The combined subtype presented with more severe SUDs and higher rates of conduct disorder. There were a greater proportion of boys with inattentive subtype. The inattentive subtype appeared less ready for treatment (greater University of Rhode Island Change Assessment precontemplation scores) with poorer coping skills (poorer problem-solving and abstinence focused coping) at baseline. However, the two subtypes responded equally to treatment even after controlling for baseline differences.

CONCLUSIONS

Findings from this large community sample indicate that there were no subtype differences in treatment response, although there were differences in terms of substance use, antisocial behavior, readiness for treatment, and gender prior to treatment.

SCIENTIFIC SIGNIFICANCE

This study is the first to report on subtype differences for treatment response for non-nicotine SUD in a comorbid ADHD-SUD population. Despite some baseline differences, both subtypes responded equally to treatment, suggesting limited relevance for subtype designation on treatment planning.

Stages of change

The transtheoretical model, in general, and the stages of change, in particular, have proven useful in adapting or tailoring treatment to the individual. We define the stages and processes of change and then review previous meta-analyses on their interrelationship. We report an original meta-analysis of 39 studies, encompassing 8,238 psychotherapy patients, to assess the ability of stages of change and related readiness measures to predict psychotherapy outcomes. Clinically significant effect sizes were found for the association between stage of change and psychotherapy outcomes (d = .46); the amount of progress clients make during treatment tends to be a function of their pretreatment stage of change. We examine potential moderators in effect size by study outcome, patient characteristics, treatment features, and diagnosis. We also review the large volume of behavioral health research, but scant psychotherapy research, that demonstrates the efficacy of matching treatment to the patient's stage of change. Limitations of the extant research are noted, and practice recommendations are advanced.

Reliability and confirmatory factor analysis of the arabic version of the University of Rhode Island Change Assessment (URICA)

AIM

To develop an Arabic version of the University of Rhode Island Change Assessment (URICA), and to examine its internal reliability and factor structure.

METHODS

Participants were 175 substance abuse/dependent male patients recruited from Al-Amal Hospital of Substance Abuse in Dammam, Saudi Arabia. The URICA was administered to all subjects by two experienced psychologists working at the detoxification and rehabilitation units.

RESULTS

All subscales showed good internal reliability and factorial validity. Coefficient alphas for each of the four scales of the URICA (precontemplation, contemplation, action and maintenance) revealed that each scale has adequate and acceptable internal consistency (ranging between 0.76 and 0.89). The correlation coefficients between all subscales confirmed the expected prediction in that scores for adjacent stages of changes showed significantly higher correlations than the scale scores for nonadjacent stages. Confirmatory factor analysis revealed an adequate to reasonable fit to the intended subscales and replicated the four-factor model of the original work.

CONCLUSION

The Arabic version of the URICA has shown encouraging psychometric properties, supporting the validity and reliability of the four factors of the scale. The implications of these findings, and recommendation for future research, are described.

Reasons for quitting among emerging adults and adolescents in substance-use-disorder treatment

OBJECTIVE

Understanding developmental differences in reasons for quitting substance use may assist clinicians in tailoring treatments to different clinical populations. This study investigates whether alcohol-disordered and problem-drinking emerging adults (i.e., ages 18-25 years) have different reasons for quitting than younger adolescents (i.e., ages 13-17 years).

METHOD

Using a large clinical sample of emerging adults and adolescents, we compared endorsement rates for 26 separate reasons for quitting between emerging adults and adolescents who were matched on clinical severity. Then age group was regressed on total, interpersonal, and personal reasons for quitting, and mediation tests were conducted with variables proposed to be developmentally salient to emerging adults.

RESULTS

Among both age groups, self-control reasons were the most highly endorsed. Emerging adults had significantly fewer interpersonal reasons for quitting (Cohen's d = 0.20), and this association was partially mediated by days of being in trouble with one's family. There were no differences in personal reasons or total number of reasons for quitting.

CONCLUSIONS

Our findings are consistent with developmental theory suggesting that emerging adults experience less social control, which here leads to less interpersonal motivation to refrain from alcohol and drug use. As emerging adults in clinical samples may indicate few interpersonal reasons for quitting, one challenge to tailoring treatments for them will be identifying innovative ways of leveraging social supports and altering existing social networks.

The association between executive functioning and motivation to enter treatment among regular users of heroin and/or cocaine in Baltimore, MD

This study explored the association between readiness to enter treatment and performance on the Wisconsin Card Sorting Test (WCST), a measure of problem solving ability and executive functioning. Data for this analysis was collected on 258 current regular users of heroin and/or cocaine as part of an epidemiologic study on executive function and drug use. A structural equation model was used to test the hypotheses that poorer performance on the WCST would predict lower scores on two latent constructs measuring motivation to change drug use. Specifically, poorer performance on the WCST was associated with lower recognition of problem use. Associations between treatment enrollment within the past six months and regular use of more than one drug were also observed. Findings highlight the importance of considering cognitive impairment in programs targeting active drug users and promoting treatment participation.

Motivation, readiness to change, and weight loss following adjustable gastric band surgery

High levels of readiness to change (RTC) are considered critical to the long-term success of weight management programs including bariatric surgery. However, there are no data to support this assertion. We hypothesize that RTC level will not influence weight outcomes following surgery. In 227 consecutive patients undergoing adjustable gastric banding surgery, we recorded reasons for seeking surgery, and RTC measured with the University of Rhode Island Change Assessment. Scores were blinded until study completion. The primary outcome measure was percentage of excess BMI loss at 2 years (%EBMIL-2); others included compliance and surgical complications. Of 227 subjects, 204 (90%) had weight measurement at 2 years. There was no significant correlation between RTC score and %EBMIL-2 (r = 0.047, P = 0.5). Using the median split for RTC score the lowest 102 subjects mean %EBMIL-2 was 52.9 +/- 26.9% and the highest 52.2 +/- 28.3%, P = 0.869. There was no weight loss difference between highest and lowest quartiles, or a nonlinear relationship between weight loss and RTC score. There was no significant relationship between RCT score and compliance, or likelihood of complications. Those motivated by appearance were more likely to be younger women who lost more weight at 2 years. Poor attendance at follow-up visits was associated with less weight loss, especially in men. Measures of RTC did not predict weight loss, compliance, or surgical complications. Caution is advised when using assessments of RTC to predict outcomes of bariatric surgery.

Convergent and discriminant validity of three measures of stage of change

The University of Rhode Island Change Assessment (E. A. McConnaughy, J. O. Prochaska, & W. F. Velicer, 1983), the Stages of Change Readiness and Treatment Eagerness Scale (W. R. Miller & J. S. Tonigan, 1996), and the Readiness to Change Questionnaire (S. Rollnick, N. Heather, R. Gold, & W. Hall, 1992) are commonly used multidimensional measures of stage of change. The authors examined the convergent and discriminant validity of drug-use versions of these 3 measures through multitrait-multimethod analysis in a population of indigent, out-of-treatment drug users (N = 377). Agreement in stage-of-change assignment and the relationship between stage of change and drug-use behaviors were also examined. Confirmatory factor analysis suggests that the Stages of Change Readiness and Treatment Eagerness Scale may have questionable convergent validity with the University of Rhode Island Change Assessment and Readiness to Change Questionnaire. There was moderate agreement in stage assignment. Analysis of behavior did provide some support for the construct validity of the measures. The results suggest that these drug-use stage-of-change measures may not be equivalent.

Adaptação brasileira da University of Rhode Island Change Assessment (URICA) para usuários de substâncias ilícitas

Este estudo apresenta a validação do University of Rhode Island Change Assessment (URICA) para usuários de substâncias psicoativas ilícitas no Brasil. A amostra foi de 214 sujeitos dos sexos masculino (n=194) e feminino (n=20), com faixa etária entre 13 e 44 anos de idade (M=22,93; DP=7,94). A coleta ocorreu em Porto Alegre (RS), em ambulatórios para tratamento da dependência química (n=89) e locais de internação (n=125). As análises estatísticas evidenciaram uma boa consistência interna da escala de 24 itens (a=0,657). A partir de análises estatísticas foi construído o escore T, realizando a normatização brasileira da URICA para drogas ilícitas, que apresentou bons resultados psicométricos, podendo ser usada em estudos que proponham investigar a motivação para mudança de comportamentos-problema.

Assessing the validity of a single-item HIV risk stage-of-change measure

This study examined the validity of a single-item measure of HIV risk stage of change that HIV prevention contractors were required to collect by the California State Office of AIDS. The single-item measure was compared to the more conventional University of Rhode Island Change Assessment (URICA). Participants were members of Los Angeles County-defined behavioral risk groups recruited from a mobile HIV testing program (N = 123). The study found low correspondence between participants' stage of change on the single-item and the URICA, suggesting that they do not assess the same construct, and that the single item may not provide a valid measure. The current data suggests that the single-item measure should be revised or abandoned in favor of more conventional stage-of-change measures.

Readiness for change and drug use outcomes after treatment

AIMS

The present study represents the first large-scale test of the capacity to predict illicit drug treatment outcomes of an instrument [Stages of Change and Treatment Eagerness Scale (SOCRATES)] purporting to measure processes underlying stages of change. The main hypothesis was that 'taking steps' should be predictive of less frequent use of illicit opiates (heroin and non-prescribed methadone) at follow-up.

DESIGN

The sample comprised 1075 people seeking treatment for drug abuse problems in 54 treatment agencies in England. The study uses a longitudinal, prospective cohort design. Structured interviews were conducted at treatment intake and at 1-year follow-up. Data were collected about illicit drug use (frequency of use of heroin, non-prescribed methadone, cocaine and amphetamines, and non-prescribed benzodiazepines) and other problems.

FINDINGS

Results failed to support the hypothesis that taking steps should be associated with less frequent use of illicit opiates at follow-up. No statistically significant associations of any kind were found between readiness for change measures and use of opiates or stimulants at follow-up. A negative association was found between taking steps and benzodiazepine misuse. Readiness for change measures were correlated with heroin use and psychiatric symptom scores at treatment intake.

CONCLUSIONS

Readiness for change measures were not associated with illicit drug use outcomes. Of the 12 hypothesized relationships between readiness for change measures and outcomes, our results show only one 'hit' and 11 'misses'.

Does contingency management affect motivation to change substance use?

Although substantial evidence favors the efficacy of contingency management (CM) for substance use disorders, few studies have examined the effect of CM on one's motivation to change substance use. One way of conceptualizing motivation to change is by using the stages of change model [Prochaska, J.O., DiClemente, C.C., 1983. Stages and processes of self-change of smoking: toward an integrative model of change. J. Consult. Clin. Psychol. 51, 390-395]. We assessed motivation to change substance use as conceptualized by the stages of change model using the University of Rhode Island Change Assessment (URICA [McConnaughy, E.A., Prochaska, J.O., Velicer, W.F., 1983. Stages of change in psychotherapy: measurement and sample profiles. Psychother. Theor. Res. 20, 368-375]) in 115 patients in community treatment clinics before they were randomized to receive standard treatment or standard treatment plus CM. Motivation was also assessed 3 months later. Patients in both conditions evidenced significant decreases in their motivation scores from pre- to post-treatment. CM neither increased nor decreased motivation relative to the standard treatment condition. Pre-treatment motivation scores were also not related to treatment outcome. Assignment to the CM condition was associated with better treatment outcome as defined by longest duration of abstinence during treatment (LDA). Higher post-treatment motivation was also modestly associated with LDA, but not in all analyses. These findings suggest that CM neither increases nor decreases motivation to change substance use in outpatients receiving treatment at community-based drug-free clinics. Future studies should further examine motivation change in CM treatment using different assessment tools and conceptualizations of motivation, extending these effects to other treatment settings and populations.

The Readiness Ruler as a measure of readiness to change poly-drug use in drug abusers

Readiness to change is a crucial issue in the treatment of substance use disorders. Experiences with methadone maintenance treatment (MMT) has shown that continuous drug and alcohol use with all its consequences characterize most MMT programs. In a prospective study of drug abusers seeking opiate agonist maintenance treatment in the City of Copenhagen, subjects were administered the Addiction Severity Index, and the Readiness Ruler for each of 11 different licit and illicit drugs by research technicians. Data was collected upon admission to the program and at a 18 month follow-up. Subjects who indicated they wanted to quit or cut down upon admission, reported less drug use at 18 month follow-up, after controlling for severity of drug problems at intake. Subjects who expressed readiness to change their drug use upon admission decreased their drug use. It is concluded that the Readiness Ruler measures a construct related to actual readiness, supporting its use in the clinical context.

Predicting sex offender treatment entry among individuals convicted of sexual offense crimes

This study examined what factors were predictive of who volunteers for sex offender treatment (self-selection) as well as who enters treatment after volunteering (administration selection). Research participants included 404 treatment volunteers and 387 nonvolunteers to treatment who were convicted of a sexual offense involving minors within the federal prison system. Maximum likelihood probit estimation procedures indicated that when compared with nonvolunteers, treatment volunteers were more likely to be recommended by a judge to receive treatment at the time of sentencing, had received prior treatment for sexually deviant behavior, reported higher levels of motivation to change their sexually deviant behavior, and had lower rates of a substance use disorder in the year prior to incarceration. Of those persons who initially volunteered, 62% were accepted and entered treatment, 16% were denied entry to treatment by program staff, and 22% refused treatment after being accepted to the waiting list. When compared with those who were accepted and entered treatment, motivation was the only predictor of being denied admission into treatment by program staff and for refusal of treatment once accepted. The findings emphasize the need to control for selection bias in treatment outcome studies and the importance of examining the role of motivation in treatment volunteerism and treatment entry for sexual offenders.

Does stage-of-change predict dropout in a culturally diverse sample of adolescents admitted to inpatient substance-abuse treatment? A test of the Transtheoretical Model

The Transtheoretical Model (TTM) () proposes that the stages-of-change construct can serve as useful tool for identifying those most at-risk of treatment dropout [Prochaska, J. O. (1999). How do people change, and how can we change to help many more people? In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change (pp. 227-255). Washington: American Psychological Association]. While researchers have found mixed support for this claim in adult samples, studies have not yet tested this issue in adolescent substance-abuse treatment settings. This paper reports findings from a Canadian study of adolescents (n = 130: 80 Caucasians, 50 Aboriginals) admitted to a hospital-based, residential substance-abuse treatment program. Two approaches were used to test the TTM's claim: (1) a hierarchical logistic regression model of dropout was developed using the subscales of the University of Rhode Island Change Assessment instrument (URICA), demographic variables, and subscales of the Addiction Severity Index (ASI); and (2) a chi-square analysis was employed to test the hypothesized relation between stage-of-change and dropout status. The findings demonstrated that the best predictive model of dropout included only the Precontemplation subscale of the URICA (OR: 4.3; 95% CI: 2.0-9.0). In addition, adolescents assigned to the Precontemplation stage manifested significantly higher rates of treatment attrition than individuals in the Contemplation or Preparation/Action stages. This study provides important empirical support for the predictive utility of the stage-of-change construct among a culturally diverse sample of adolescents admitted to an inpatient substance-abuse treatment program.