Objective-The high rates of comorbid substance use disorders among persons living with severe and persistent mental illness (SPMI) have increased interest in assessing and enhancing motivation to change substance misuse in this population. This study provides evidence for the psychometric adequacy of three self-report measures of readiness-to-change.Method-The sample consisted of 84 persons (65% men) with co-occurring substance abuse or dependence and an SPMI. After a psychiatric assessment, participants completed three measures of readiness-to-change, which yielded seven subscales: (1) the Stages of Change Readiness and Treatment Eagerness Scale (ambivalence about change, recognition of substance-related problems, taking steps), (2) Decisional Balance Scale (pros of using, cons of using) and (3) the Alcohol and Drug Consequences Questionnaire (costs of quitting, benefits of quitting).Results-All of the subscales were stable over time, and 6 of the 7 subscales demonstrated excellent internal consistency. Reliability indices were comparable when analyses were repeated on subsets of participants defined by diagnosis, cognitive function, positive symptoms and negative symptoms. A pattern of theoretically meaningful intercorrelations provided convergent evidence of validity, and a general lack of relationships with demographic variables and indices of psychiatric status provided discriminant evidence of validity. These findings support efforts to quantify readiness-to-change substance misuse among persons with an SPMI.Substance use disorders are highly prevalent among persons with schizophrenia and other major mental illnesses. Persons with major (Axis I) mental disorders have three times the risk of drug or alcohol diagnoses compared to the rest of the population (Regier et al., 1990). Persons with schizophrenia represent a particularly high risk group for problems related to substance use. Among all persons with a diagnosis of schizophrenia, 47% meet lifetime criteria for a substance use disorder (Regier et al., 1990). This prevalence rate is often higher in samples of schizophrenic patients in treatment (Mueser et al., 1990;Test, Wallisch, Allness, & Ripp, 1989).A diagnosis of substance abuse or dependence impairs both the process and outcome of mental health treatment. Symptom exacerbation and psychiatric admissions have both been linked to acute drug use in outpatients with a severe and persistent mental illness (SPMI), such as schizophrenia (Haywood et al., 1995;Shaner et al., 1995). Individuals enrolled in outpatient treatment and "dually diagnosed" with psychiatric and substance use disorders exhibit poor (Keck, McElroy, Strakowski, Bourne, & West, 1997;Owen, Fischer, Booth, & Cuffel, 1996;Pristach & Smith, 1990), report more severe psychiatric symptoms (Carey, Carey, & Meisler, 1991), and involve themselves minimally in structured treatment programs Lehman, Herron, Schwartz, & Myers, 1993;Richardson, Craig, & Haugland, 1985). This pattern of poor treatment compliance and exacerbated symptoms leads ...
This literature review summarizes the psychometric properties of 12 measures used to assess readiness to change substance abuse. Assessment methods vary, and indude algorithms, self-administered questionnaires, and clinical ratings. We describe each and summarize reliability and validity information. Some measures have poor psychometric properties, whereas limited psychometric data are available for others. No single measure emerges as best for use in clinical settings, and promising candidates dlffer regarding target population and assessment method. Atthough the Transtheomtical Model inspired much of the empirical work on readiness to change, the psychometric Iiterature provides inconsistent support for the stages of change. Readiness to change may best be conceptualized as a multidimensional and continuous construct with complex relationships to behavior, cognition, and environmental context.
The influence of interpersonal communication on sexual adjustment in cohabiting heterosexual couples was investigated. Male and female partners from 76 heterosexual couples independently completed measures of their own and their partners' sexual preferences, as well as measures of sexual and general relationship adjustment, sexual difficulties, marital role preferences, depression, and social desirability. Results indicated that sexual satisfaction in both partners was associated with men's understanding of their partner's preferences and agreement between their preferences. The influential role of men's understanding was supported by hierarchical regression, convergent and discriminant evidence, and multiple regression models that accounted for 51% and 63% of variance in men's and women's sexual satisfaction. General relationship adjustment of both partners was associated with women's understanding of men's marital role preferences. An explanation of understanding's function is proposed, accounting for gender differences within and across sexual and general realms of relating.
Use of brief motivational interventions can enhance patients' readiness to change substance use to better prepare them for drug treatment programs. Future interventions might benefit from the integration of the intervention with ongoing treatment to ensure that motivational gains are maintained.
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