Analysis of the Stages of Change Model of Drug and Alcohol Treatment Readiness Among Prisoners

Abstract

A classification and regression tree (CART) analysis was applied to data for 237 male participants (M = 31.93 years, SD = 7.64) in a prison-based substance abuse treatment program to study the integrity of the Stages of Change model of treatment readiness. Using the Stages of Change Questionnaire (STOCQ), participants were assigned to Contemplation (102), Action (118), or Maintenance (17) groups. A CART analysis then examined differences in the overall group profiles on the basis of scores on the Psychological Inventory of Criminal Thinking, the Situational Confidence Questionnaire, and the Carlson Psychological Survey. The assumption of discrete stages of change was not supported. Alternative models are suggested: one based on states of change and one on personality characteristics. A focus on equal attention to both cognitive and behavioral aspects of substance abuse treatment readiness is suggested.

A Model of Engagement for Correctional Practice

“…Most research has focused on the validity of the stages of the model and some have found the model applies to other health-related behaviours (Levy, 1997;Miller & Tonigan, 1996;Prochaska et al, 2005) Since its conception, empirical support for the TTM has been inconsistent. The TTM is a descriptive model based on stage-theory, the construct validity of which has been questioned (Armitage, 2009;Callaghan, 2004;Casey, Day, & Howells, 2005;D'Sylva, Graffam, Hardcastle, & Shinkfield, 2012;Davidson, Roe, Andres-Hyman, & Ridgway, 2010;Drieschner et al, 2004;Littell & Girvin, 2002;Sutton, 2001;West, 2005;Williamson, Day, Howells, Bubner, & Jauncey, 2003). The stage theory of the TTM has been challenged for being an over-simplification of a naturally complex, multi-dimensional process (D'Sylva et al, 2012;Sutton, 2001).…”

“…The actual number of stages has also been challenged (Carney & Kivlahan, 1995;Miller & Tonigan, 1996). Others, still have been unable to find support for discrete, mutually exclusive stages proposed by the TTM and rather advocate for a continuous process (Armitage, 2009;D'Sylva et al, 2012;Drieschner et al, 2004;Sutton, 2001;Williamson et al, 2003).…”

“…Inconsistent application of these measures, as well as inconclusive support for their psychometric properties has led to difficulties in the interpretation and generalisation of findings (Armitage, 2009;Casey et al, 2005;D'Sylva et al, 2012;Littell & Girvin, 2002;Sutton, 2001;West, 2005). For example, the University of Rhode Island Change Assessment Scale (URICA; McConnaughy, Prochaska, & Velicer, 1983) has been adapted to offending behaviour (Anstiss, Polaschek, & Wilson, 2011) and has produced mixed results for validity and reliability (Polaschek & Ross, 2010;Yong, Williams, Provan, Clarke, & Sinclair, 2015), suggesting the measure and the stages of change construct should only be applied to offending populations with caution (Yong et al, 2015).…”

A Model Of Engagement For Correctional Practice

“…The TTM is a descriptive model based on stage-theory, the construct validity of which has been questioned (Armitage, 2009;Callaghan, 2004;Casey, Day, & Howells, 2005;D'Sylva, Graffam, Hardcastle, & Shinkfield, 2012;Davidson, Roe, Andres-Hyman, & Ridgway, 2010;Drieschner et al, 2004;Littell & Girvin, 2002;Sutton, 2001;West, 2005;Williamson, Day, Howells, Bubner, & Jauncey, 2003). The stage theory of the TTM has been challenged for being an over-simplification of a naturally complex, multi-dimensional process (D'Sylva et al, 2012;Sutton, 2001). The actual number of stages has also been challenged (Carney & Kivlahan, 1995;Miller & Tonigan, 1996).…”

“…Furthermore, non-linear change processes, such as that experienced by mental health clients, are unable to be explained by the TTM model (McMurran et al, 1998). Finally, the body of empirical research is difficult to interpret with any degree of certainty due to the use of different measures to assess what stage an individual is at (Armitage, 2009;Casey et al, 2005;D'Sylva et al, 2012;Littell & Girvin, 2002;Sutton, 2001;West, 2005).…”