Three and Six Month Predictive Validity of Readiness to Change Measures for Emerging Adults in Substance Use Disorder Treatment

Objectives: Few studies have examined which measures of readiness to change predict relapse for young adults with substance use disorders.  For example, young adults in residential treatment agreed to the importance of quitting, but expressed low confidence in their ability to quit.  Also, a single item measuring self efficacy to remain abstinent was a better predictor of abstinence after residential treatment when compared to multi-item self-efficacy scales (Hoeppner et al., 2011, Ludwig et al., 2013).  It is unclear if self-efficacy is the best predictor of follow up outcomes for those receiving treatments in outpatient settings.  Thus, the purpose of this study was to extend findings to young adults in outpatient settings by determining which measures of readiness predict change. 

Method. Data were obtained from a national dataset of adolescents and young adults receiving outpatient substance use disorder treatments who completed a single-item abstinence readiness measure and were due for their three and six month follow up visits at the time of the study (n=1663).  Follow up retention was 88.2% and 79.9% at three and six months, respectively.  Logistic regression was used to predict which young adults were in early remission at three and six months post-intake.  Predictor variables included a single readiness to quit item (i.e., percent readiness from 0% to 100%), a self efficacy scale, a treatment resistance scale, a treatment motivation scale, and a 26-item reasons for quitting scale.  Both models controlled for baseline values of the dependent variable, as well as a measure of global clinical severity.

Results.  At three months, significant predictors of early remission included the single readiness to quit item (B = .011, p<.001), treatment resistance, (B = -.16, p<.05 ) , and self-efficacy ( B = .12, p<.05).  However, at six months, the single readiness to quit item (B = .013, p<.001) and self-efficacy (B = .15, p<.01) were significant predictors of early remission. 

Conclusion.  We failed to replicate prior findings from studies conducted in residential settings which showed that single item indicators of self- efficacy were superior predictors of relapse compared to longer measures of self-efficacy.  For those receiving outpatient treatments a single abstinence readiness item accounted for some variance, but other and longer measures of related constructs accounted for unique variance in remission outcomes.  Differences in severity between those treated in residential settings and those treated in outpatient settings may have accounted for these findings.  We discuss the findings in context of such differences and make suggestions for future research.