Measuring readiness-to-change substance misuse among psychiatric outpatients: I. Reliability and validity of self-report measures.

Abstract

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 ...

Temporal stability of the timeline followback interview for alcohol and drug use with psychiatric outpatients.

“…Less accurate self-reports may arise due to acute distress, exacerbated symptoms, impaired reality orientation, confusion and cognitive impairment, in addition to frequent and excessive substance use. However, the mere presence of a co-occurring psychiatric diagnosis does not compromise the psychometric soundness of substance-related assessments, as has been demonstrated in previous empirical reports (Carey et al, 2001;Cocco and Carey, 1998;Maisto et al, 2000;Teitelbaum and Carey, 2000).To our knowledge, only two studies examined the test-retest reliability of the TLFB when used with persons with a severe psychiatric disorder. Carey (1997) sampled psychiatric outpatients and reported evidence of test-retest stability of responses to two alcohol use variables on 1-month and 6-month TLFBs.…”

Does substance use disorder affect clinical expression in first-hospitalization patients with schizophrenia? Analysis of a prospective cohort

“…Although SCID-I is considered a valid and consistent assessment tool for diagnose DSM-IV-TR Axis I disorders (Skre et al, 1991;Carey et al, 2001), urine drug test could be used to confirm the patientreported abuse of illicit drugs and thus to increase the accuracy of group selection.…”

Application of the Transtheoretical Model of change: Psychometric properties of leading measures in patients with co-occurring drug abuse and severe mental illness

“…Negative symptoms associated with schizophrenia that involve the experience of a lack of energy and/or will to engage in behaviors may make TTM measures inappropriate since they are based on a motivational construct (Carey, Maisto, Carey, & Purnine, 2001). …”

“…For example, the ability to self-report intention to change may be impacted by deficits in self-awareness and abstract thinking that often accompany SMI. Negative symptoms associated with schizophrenia that involve the experience of a lack of energy and/or will to engage in behaviors may make TTM measures inappropriate since they are based on a motivational construct (Carey, Maisto, Carey, & Purnine, 2001). …”