The authors examined life stress and self-efficacy as predictors of time to relapse for 113 adults with comorbid major depressive disorder and alcohol and/or substance dependence in a randomized clinical trial comparing 2 psychotherapy interventions (integrated cognitive- behavioral therapy and 12-step facilitation therapy). Life stress, self-efficacy, and substance use were assessed at treatment entry, 12 weeks (mid-treatment), and 24 weeks (end of treatment). Time to relapse was defined as the number of days from treatment initiation until first alcohol and/or drug use. Half of the sample relapsed within the study period of 24 weeks. There was no significant difference between treatment groups. Individuals experiencing life stressors were more likely to relapse early than those not experiencing life stressors. Lower self-efficacy also predicted earlier relapse. Chronic stress levels and self-efficacy were stable across time for most individuals. In contrast, acute stress events occurred at differing times, and survival analyses provided evidence of heightened relapse risk in the month following acute stressors. The interaction of self-efficacy and life stress was not significant. The results highlight the significance of life stress and self-efficacy as predictors of early relapse.

This study provides foundational information on the epidemiology of substance misuse among Veterans. (Am J Addict 2017;26:357-365).

We compared three measures of readiness to change alcohol use commonly used in clinical research and practice with adolescents: the Readiness Ruler, the SOCRATES (subscales of Recognition and Taking Steps), and a Staging Algorithm. The analysis sample consisted of 161 male and female adolescents presenting for intensive outpatient alcohol who reported current alcohol use at the initial assessment. Evidence for concurrent validity was assessed by computing simple correlations of each readiness measure with the other three, and of each readiness measure with drinking behavior (percentage of days abstinent (PDA) and drinks per drinking day (DDD), respectively, in the last 30 days) at the start of treatment and at the 6-month follow-up assessment. Evidence for predictive validity was based on percentage of independent variance accounted for by each of the readiness measures in predicting drinking behavior at six months from the start of treatment, and then in predicting drinking behavior at 12 months from the readiness assessment at 6 months. The results showed that all but Recognition had good concurrent validity, the Readiness Ruler score showed consistent evidence for predictive validity, and the Staging Algorithm showed good predictive validity for DDD at 6 and 12 months. For the 82 participants with an alcohol use disorder diagnosis, the findings for the Ruler and Recognition were similar, but the Staging Algorithm had poorer prediction of DDD at 12 months, and Taking Steps was a better predictor of 6- and 12-month PDA and DDD. Research and clinical implications of the findings are discussed.

ABSTRACT. Objective:The measurement of readiness to change has become common practice in alcohol and drug treatment of both adults and adolescents. Nevertheless, there is relatively little research on the validity of measures of readiness to change among treated adolescents. The purpose of this study was to compare three measures of readiness to change marijuana use commonly used in clinical research and practice with adolescents: the Readiness Ruler, the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES; Factors 1 and 2, Recognition and Taking Steps, respectively), and a staging algorithm. Method: The participants were 174 adolescents presenting for intensive outpatient alcohol and drug treatment who reported current marijuana use at the initial assessment. Evidence for concurrent validity was assessed by computing simple correlations among readiness measures, and correlations of each readiness measure with marijuana involvement (percentage of days abstinent in the last 30 days, problem severity score, and marijuana abuse and dependence symptom count [based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria]) at both the initial/baseline assessment and at a 6-month follow-up assessment. Evidence for predictive validity was based on the results of multilevel regression models of the readiness measures in predicting frequency of marijuana use, symptoms, and problems at 6 months from the initial readiness assessment and then in predicting marijuana use, symptoms, and problems at 12 months from the readiness assessment at 6 months. Results: The results showed evidence for good concurrent and predictive validity for the ruler, the staging algorithm, and Taking Steps but poor evidence for the validity of Recognition. The ruler emerged as the measure with the most clinical utility when brevity and ease of administration are taken into account. Conclusions: Research and clinical implications of the fi ndings are discussed. (J. Stud. Alcohol Drugs, 72, 592-601, 2011)