Stages of change profiles in outpatient alcoholism treatment

DiClemente, Carlo C.; Hughes, Sheryl O.

doi:10.1016/s0899-3289(05)80057-4

Cited by 563 publications

(355 citation statements)

References 16 publications

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“…A variety of Axis I disorders was represented in this sample, including major depressive disorder, schizophenia, and bipolar disorder. These investigators reported acceptable alpha coefficients for measures of the pros of drinking (.90), the cons of drinking (.91), and the readiness-to-change score (.91) derived from University of Rhode Island Change AssessmentAlcohol version (DiClemente & Hughes, 1990). This preliminary evidence suggests that the presence of an Axis I mental disorder may not be associated with poor internal consistency of instruments designed to assess readiness-to-change substance misuse.…”

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confidence: 96%

“…Within their Transtheoretical Model, they posit five stages to represent the continuous and cyclic process by which people change addictive behaviors (precontemplation, contemplation, preparation, action, and maintenance), and note that the vast majority of persons addicted to substances are not in the action stage . Even persons admitted to alcohol and drug treatment programs vary in their level of motivation for change (DiClemente & Hughes, 1990;Project Match Research Group, 1997). Consistent with these findings, when Ziedonis and Trudeau administered a staging algorithm to 224 outpatient dually diagnosed with schizophrenia-spectrum and substance use disorders, they found that 50% were in the precontemplation stage with respect to changing their substance use behavior; 2% were in contemplation stage; 8% in preparation; 4% in action; and 36% in maintenance (Ziedonis & Trudeau, 1997).…”

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

et al. 2001

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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 ...

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

et al. 2001

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“…Women who disclosed IPV and were enrolled in the study were asked to complete the University of Rhode Island Change Assessment (URICA), a flexible 32-item self-report instrument that includes four subscales measuring the stages of change: precontemplation (PC), contemplation (C), action (A), and maintenance (M). [10][11][12] The subscales were then combined arithmetically (C + A + M -PC) to yield a second-order continuous readiness to change score used to assess readiness to change at entrance to treatment. Whereas the URICA is primarily designed to assess addictive and deleterious behaviors, such as smoking, we employed a modified URICA to help determine how each participant felt about making changes with regard to her violent intimate relationship.…”

Section: Methodsmentioning

confidence: 99%

“…9 The TTM, originally applied to smoking cessation, weight loss, and alcoholism, theorizes that most people move in a predictable fashion through stages of change (precontemplation, contemplation, action, and maintenance) as they progress toward ending a deleterious behavior. [10][11][12] The TTM represents a promising theory to measure and provide stage-matched interventions for women at different levels of readiness to change with regard to their experience with IPV. Socioeconomic and demographic differences likely influence a woman's ability to benefit from screening and interventions based on the TTM, but this has not thoroughly been explored.…”

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Does Stage of Change Predict Improved Intimate Partner Violence Outcomes Following an Emergency Department Intervention?

Schrager

Smith

Heron

et al. 2013

Academic Emergency Medicine

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Objectives: The objective was to assess the effect of an emergency department (ED)-based computer screening and referral intervention on the safety-seeking behaviors of female intimate partner violence (IPV) victims at differing stages of change. The study also aimed to determine which personal and behavioral characteristics were associated with a positive change in safety-seeking behavior. The hypothesis was that women who were in contemplation or action stages of change would be more likely to endorse safety behaviors during follow-up.Methods: This was a prospective cohort study of female IPV victims at three urban EDs, using a computer kiosk to deliver targeted education about IPV to provide referrals to local resources. All noncritically ill adult English-speaking women triaged to the ED waiting room during study hours were eligible to participate. Women were screened for IPV using the validated Universal Violence Prevention Screening Protocol (UVPSP), and all IPV-positive women further responded to validated questionnaires for alcohol and drug abuse, depression, and IPV severity. The women were assigned a baseline stage of change using the University of Rhode Island Change Assessment (URICA) scale for readiness to change their IPV behaviors. Study participants were contacted at 1 week and 3 months to assess a variety of predetermined safety behaviors to prevent further IPV during that period. Descriptive analyses were performed to determine if stage of change at enrollment and a variety of specific sociodemographic characteristics were associated with taking protective action during follow-up.Results: A total of 1,474 women were screened for IPV; 154 (10.4%) disclosed IPV and completed the full survey. Approximately half (47.4%) of the IPV victims were in the precontemplation stage of change, and 50.0% were in the contemplation stage. A total of 110 women returned at 1 week of follow-up (71.4%), and 63 (40.9%) women returned for the 3-month follow-up. Fifty-five percent of those who returned at 1 week and 73% of those who returned at 3 months took protective action against further IPV. Stage of change at enrollment was not significantly associated with taking protective action during follow-up. There was no association between demographic characteristics and taking protective action at 1 week or 3 months.Conclusions: Emergency department-based kiosk screening and health information delivery is a feasible method of health information dissemination for women experiencing IPV and was associated with a high proportion of study participants taking protective action. Stage of change was not associated with actual IPV protective measures.ACADEMIC EMERGENCY MEDICINE 2013; 20:169-177 © 2013 by the Society for Academic Emergency Medicine W ith an estimated 28.9% of women experiencing intimate partner violence (IPV) during their lifetime, 1 at an annual medical and mental health care cost of $4.1 billion, 2 IPV represents a significant problem with personal and societal consequences. The hospital emergency de...

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“…No mesmo sentido, Bardsley e Beckman 10 encontraram que um dos dois únicos elementos do modelo de crenças em saúde 11 associados positivamente com a procura de tratamento por alcoolistas foi exatamente a percepção da gravidade; o outro elemento relaciona-se à percepção dos desencadeantes circunstanciais da procura. Na terminologia do modelo transteórico 12,13 , esta percepção contribuiria para a passagem do estágio de pré-contemplação para contemplação 9 e, daí, para o estágio de ação.…”

Section: Percepção Da Síndrome De Dependência Artigo Originalunclassified

Percepção da síndrome de dependência por pacientes em tratamento

Fontanella

Mello

Demarzo

et al. 2008

J. bras. psiquiatr.

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A percepção da dependência de substâncias psicoativas é um dos principais motivadores da procura de tratamento por pessoas com este quadro clínico e a compreensão de seus significados constitui uma questão relevante em saúde. objetivos: Levantar e compreender os significados pessoais atribuídos pelos pacientes que procuraram tratamento à síndrome de dependência. método: Pesquisa qualitativa com entrevistas semidirigidas com amostra intencional de 13 dependentes de substâncias que procuraram tratamento. resultados: Os atuais critérios para dependência de substâncias foram abordados espontaneamente pelos pacientes. Atribuíram variados significados pessoais à questão do desejo intenso, da compulsão e do descontrole quanto ao uso, e também à síndrome de abstinência, à tolerância, ao abandono de outros interesses e prazeres e à percepção das conseqüências nocivas do uso. conclusão: Os entrevistados mostram compreensão própria do processo de procura de tratamento, avaliando meticulosa e subjetivamente o desconforto dos sintomas de dependência. Tais significados requerem especial atenção dos profissionais de saúde, sobretudo, nos atendimentos em atenção básica e, uma vez abordados, poderão facilitar a procura de tratamento. ABstrActThe perception of the dependence symptoms is a key factor on the treatment seeking process by people who suffer from it, and its understanding is a relevant health issue.

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Stages of change profiles in outpatient alcoholism treatment

Cited by 563 publications

References 16 publications

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

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

Does Stage of Change Predict Improved Intimate Partner Violence Outcomes Following an Emergency Department Intervention?

Percepção da síndrome de dependência por pacientes em tratamento

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