Substance Abuse in America The objective of this study is to apply change theory and the Transtheoretical Model of Behavior Change to health promotion activities in the health care environment and examine how the 'readiness to change' factor impact the success of a change in behavior.

Substance abuse in America is a prevalent problem and a challenge faced by health care provides in terms of identifying and applying effective modes of treatment to bring about behavior change in those with substance abuse problems.

Transtheoretical Model Stages of Change

The Transtheoretical Model Stages of Change was developed at the University of Rhode Island by James O. Prochaska in the latter part of the 1970s and is comprised by four components: (1) stages of change; (2) processes of change; (3) decisional balance; and (4) self-efficacy. (Inspire Malibu, 2015, p. 1) The reason for the name 'Transtheoretical" being assigned to this model is because "it blends different psychotherapy theories into one effective treatment modality" stated to be highly effective in treating individual with drug and alcohol abuse problems. (Inspire Malibu, 2015, p. 1)

There are reported to be five Transtheoretical model stages of change including the following:

(1) Precontemplation is the stage at which there is no intention to change behavior in the foreseeable future. Many individuals in this stage are unaware or under aware of their problems.

(2) Contemplation is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a commitment to take action.

(3) Preparation is a stage that combines intention and behavioral criteria. Individuals in this stage are intending to take action in the next month and have unsuccessfully taken action in the past year.

(4) Action is the stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. Action involves the most overt behavioral changes and requires considerable commitment of time and energy.

(5) Maintenance is the stage in which people work to prevent relapse and consolidate the gains attained during action. For addictive behaviors this stage extends from six months to an indeterminate period past the initial action. (Inspire Malibu, 2015, p. 1)

Reported as processes of changes are "activities that the patient uses, consciously or subconsciously, to move through the stages of change" (Inspire Malibu, 2015, p. 1) and are stated to be inclusive of the following:

(1) Consciousness raising;

(2) Dramatic relief;

(3) Self re-evaluation;

(4) Environmental re-evaluation;

(5) Social liberation;

(6) Self-liberation;

(7) Helping relationships;

(8) Counter-conditioning;

(9) Reinforcing management;

(10) Stimulus control. (Inspire Malibu, 2015, p. 1)

Decision balance is described as a process involving the patient's weighing of the "pros and cons of making changes and will vary at each level of the stages of change." (Inspire Malibu, 2015, p. 1)

II. Previous Studies

Reisenhofer (2013)

Reisenhofer (2013) reports a study with the objective of reviewing the effectiveness of the Transtheoretical model and reports that the experiences of women in crating change "can be located within a stages of change continuum by identifying dominant behavioral clusters. The processes of change and constructs of decisional-balance and turning-points are evident in women's decision-making when they engage in change." (p.1) The study concludes that the use of the transtheoretical model can be used to "provide a means of assessing women's movement toward their nominated outcomes, and the processes of change, decisional-balance and turning-points." (Reisenhore, 2013, p. 1)

Zemore and Ajze (2014)

The work of Zemore and Ajze (2014) reports the examination of a nine items scaled that was formulated on the basis of the theory of planned behavior and whether this theory served in the prediction of "substance abuse treatment completion. Data were collected at a public, outpatient program among clients initiating treatment (N=200). Baseline surveys included measures of treatment-related attitudes, norms, perceived control, and intention; discharge status was collected from program records. As expected, TPB attitude and control components independently predicted intention (model

R-squared=.56), and intention was positively associated with treatment completion even including clinical and demographic covariates (model R-squared=.24). TPB components were generally associated with the alternative readiness scales as expected, and the TPB remained predictive at higher levels of coercion" (p.1) However, the study reports that "none of the standard measures of readiness...

Results suggest promise for application of the TPB to treatment completion and support use of the intention component as a screener, though some refinements are suggested." (Zemore and Ajze, 2014, p. 1)
Harrell, et al. (2013)

The work of Harrell, et al. (2013) reports the fact that treatment motivation among those with problems with substance use is a critical aspect of the success of treatment. The specific motivations associated with treatment is a source of debate in this study which reports that "Latent Class Analysis can help to demonstrate the appropriateness of available models. The current study utilizes Latent Class Analysis to analyze treatment readiness statements as they relate to the reduction or cessation of marijuana, cocaine, and opioid use among 539 cocaine and opioid users recruited from the community of Baltimore, MD, USA. Participants completed an in-person structured interview including demographic questions, a treatment readiness questionnaire with items on Intention to Stop Use (ISU) and Problem Recognition (PR), current substance abuse treatment utilization, and urinalysis testing for marijuana, cocaine, and heroin. Latent class models were fit to the treatment readiness questionnaire. A four-class model provided the best fit with one class low on both ISU and PR ("Pre-contemplative"), a second class low on ISU but high on PR ("Contemplative"), a third class high on both ("Preparation/Action"), and a final class high on ISU but low on PR ("Post-Action")." (Harrell, et al., 2013, p. 1) It is reported that when the pre-compemplative class was compared to the contemplative class that the pre-contemplative class was "significantly more likely to be positive for marijuana, and the "Post-Action" class was significantly less likely to be positive for opioids." (Harrell, et al., 2013, p. 1) The preparation/action class was reported as being "significantly more likely to be in treatment. With the exception of the "Post-Action" class, the analysis appears similar to the "Stages of Change" model and suggests that problem recognition and intention to stop use are important domains in the model.

However, further longitudinal research is needed to assess predictive validity of model." (Harrell, et al., 2013, p. 1)

Ward and Scielke (2011)

The work of Ward and Scielke (2011) reports a study that conducted an examination of the capacity of the Transtheoretical model to "describe and predict alcohol consumption-related behaviors. Data from 321 first-year students were collected on the first day of classes and the week before finals. Three structural models consistent with the TTM were evaluated and tested. The three models fit the data well and indicated that stage of change was a good predictor of alcohol consumption-related behaviors, current and future, and change in alcohol consumption-related behaviors. These results suggest that interventions aimed at first-year students that concentrate on stage of change and the cons of alcohol use may be effective." (Ward and Scielke, 2011, p. 1)

Summary and Conclusion

As noted in this present study the transtheoretical model is characterized by four stages of change including those of stages of change, processes of change, decisional balance and self-efficacy.

The studies reviewed in this present study indicate that the use of the Transtheoretical model in treating substance abuse disorders has a great level of efficacy in terms of its effectiveness and indicate that the use of this model in treating substance abuse through use of the model focused on behavior change is effective.

The four stages of change include the per-contemplation stage at which time there exists no intention of behavioral change and a stage in which the problems are not recognized by the individual. The second stage of change is the stage described as the stage of contemplation involving the individual acknowledging the existence of a problem and giving serious through to how they will overcome their problems. The third stage of change has been identified as that of preparation signifying that that there will be a combination of behavioral criteria and intention and with a set date for taking of action. The action stage is one in which behavioral modification begins or environmental changes begin. While the maintenance stage is one in which the individual works toward the prevention of relapse.

Bibliography

Zemore, SE, and Ajze, I. (2014) Predicting substance abuse treatment completion using a new scale based on the theory of planned behavior. J Subst Abuse Treat. 2014 Feb;46(2):174-82. doi: 10.1016/j.jsat.2013.06.011. Epub 2013 Aug 15.

Reisenhofer S (2013) Women's journey to safety - the Transtheoretical model in clinical practice when working with women experiencing Intimate Partner Violence: a scientific review and clinical guidance. Patient Educ Couns. 2013 Dec;93(3):536-48. doi: 0.1016/j.pec.2013.08.004. Epub 2013 Aug 19. PubMed

Harrell PT (1), Trenz RC, Scherer M, Martins SS, Latimer WW. (2013) A latent class approach to treatment readiness corresponds to a transtheoretical ("Stages of Change") model. J Subst Abuse Treat. 2013 Sep;45(3):249-56. doi: 10.1016/j.jsat.2013.04.004. Epub 2013 May 22.

Ward RM (1), Schielke HJ. (2011) Assessing the predictive ability of the transtheoretical model's heavy episodic drinking constructs among a population…