Assessing readiness to change substance abuse: A critical review of instruments.

Abstract

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.

Computer-based brief motivational intervention for perinatal drug use

“…We conceptualized change readiness as a statelike and continuous variable, rather than as a distinct trait-like stage; the approach we took may be more consistent with available findings and may also be preferable for use of motivation as an outcome variable (Carey et al, 1999). Other measures of self-reported motivation regarding drug or alcohol use have shown good ability to predict behavior (e.g., Joe et al, 1998).…”

“…No existing measure of motivation to change-most of which have not been well-validated (Carey, Purnine, Maisto, & Carey, 1999)-was appropriate for our application. Previously successful measures of this construct have either used continuous scores derived from multiple items (e.g., Joe, Simpson, & Broome, 1998) or a single item representing a broad continuum of motivation (e.g., Biener & Abrams, 1991).…”

Correlates of problem recognition and intentions to change among caregivers of abused and neglected children

“…An overall measure of readiness for change that included both PR and ITC predicted significant reductions in the risk of out-of-home placement within a 1-year period, although the separate PR and ITC scales did not (Littell & Girvin, 2005). Although the URICA has important conceptual and methodological limitations (Carey et al, 1999;Littell & Girvin, 2002), the scales we derived from it appear to measure constructs that are important to practitioners and may have some predictive validity in child welfare samples.…”

“…It has been described as a single continuum (e.g., of "motivation; " Carey, Purnine, Maisto, & Carey, 1999;Davidson, 1998;Sutton, 1996;Project MATCH Research Group, 1997;Weinstein, Rothman & Sutton, 1998); as a function of distinct affective, cognitive, and/or behavioral processes (e.g., Bandura 1997Bandura , 1998Miller & Tonigan, 1996); and as an underlying concept in the popular "stages of change" model Prochaska & DiClemente, 1984, 1986. Single, continuous measures of motivation have not been consistent predictors of outcomes or treatmentmatching effects in treatment for alcoholism (Project MATCH Research Group, 1997).…”

“…Recent reviews of the voluminous literature on stages of change suggest that there is little evidence for the stage model (Carey et al, 1999;Littell & Givin, 2002) or the effectiveness of stage-based interventions (Reisma et al, 2002).…”