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The present study examined psychiatric functioning, substance use and consequences, and motivation to change in people with schizophrenia and affective disorders and current or remitted cocaine dependence. Data were collected as part of a naturalistic, longitudinal study examining substance use, motivation to change, and the process of change in people with schizophrenia and affective disorders who were currently dependent or in remission from cocaine dependence. We examined the following questions: (1) Do those in remission show better psychiatric functioning than those who are currently dependent? (2) How do people with schizophrenia and current cocaine dependence differ in terms of substance use and consequences from people with schizophrenia in remission and people with affective disorders and current drug dependence? (3) What internal factors and external factors are associated with changes in substance use in schizophrenia and how do these compare to those in nonpsychotic affective disorders? Results indicated that people with schizophrenia and current dependence reported higher levels of positive and negative symptoms than those in remission. Remission status was related to less use of other drugs, fewer days of drug problems, less distress from drug problems, and more lifetime drug-related consequences. Those with current dependence reported more days of drinking and drinking to intoxication, as well as higher rates of current alcohol use disorders than the remitted group. When compared to those with affective disorders and cocaine dependence, those with schizophrenia and current dependence reported fewer days of problems associated with their drug use, less distress from drug problems, and fewer recent and lifetime consequences associated with their drug use. The schizophrenia dependent group generally showed the lowest readiness to change, fewest efforts being made to change, and lowest confidence in the ability to change. Implications of these findings are discussed.

Treatment programming for individuals diagnosed with a chronic mental illness and an alcohol use disorder could be enhanced by employing techniques that focus on those change process variables that are most strongly related to psychiatric distress. Prochaska and DiClemente's transtheoretical model (TTM) provides a useful framework within which to study these relations. The associations between psychiatric severity and the TTM constructs of stages and processes of change, decisional balance, temptation, and self-efficacy were measured among 132 alcohol-dependent patients in a public mental health clinic's outpatient dual diagnosis program. Participants' scores on the Temptation subscale of the Alcohol Abstinence Self-Efficacy Questionnaire are strongly related to psychiatric severity: The more psychiatric distress a person is experiencing, the more he or she is tempted to drink, particularly in situations that trigger negative affect. Decisional balance considerations are also related to psychiatric severity: The higher participants scored on the Global Severity Index of the Brief Symptom Inventory, the more importance they placed on the negative aspects, or cons, of drinking. Subjects with more psychiatric distress also scored higher on the maintenance stage of change subscale, possibly indicating an increased fear of relapse and struggle to maintain sobriety.

The transtheoretical model of behavior change postulates five distinct, well-defined stages of change: Precontemplation, Contemplation, Preparation, Action, and Maintenance. Each stage has been regarded as reflecting a motivational posture and treated as if it is homogenous with respect to membership. This paper reports the results of four cluster analytic studies, one within each of the first four stages of change. The cluster analysis was based on three constructs of the model. Four distinct subtypes were found within Contemplation, Preparation, and Action, and three subtypes were found within Precontemplation. External validation for the clusters was provided using the 10 Processes of Change and 8 behavioral measures as dependent measures. At least one subtype corresponded to the existing stage definition but the other subtypes suggested alternative intervention strategies.

This study examines the degree of transfer of smoking cessation innovation from research to health care settings by comparing frequency-of-practice ratings by a national sample of family practice physicians (n = 903, response rate = 70%) and importance ratings by smoking cessation and prevention experts (n = 58, response rate = 84%) for 14 counseling techniques. The physician survey elicited a profile that combines traditional and behavioral techniques--discussing smoking with patients, encouraging goal setting, suggesting specific steps for quitting, and presenting pamphlets. They refer to others infrequently and rarely report planning for follow-up about smoking. The experts rated these selected techniques as moderately to highly important. They favored a behavioral approach coupled with active follow-up. The major differences between physician and expert rankings were that the experts placed higher priority on planned follow-up and a lower priority on pamphlets. The uneven quality of counseling reported by physicians suggests that weighting their responses according to expert opinion would provide a more sensitive profile. Scaled weighting produced scores that may help researchers define a composite quality-quantity measure of activity.

Researchers studying relapse for an addictive behavior have employed two different conceptual models. Researchers concerned with typologies of relapse situations have developed a variety of discrete classes of high risk situations. Researchers who have employed a Self-efficacy approach have typically assessed different situations but scored the measure as a single general construct. Using structural modeling, this paper evaluates five alternative measurement models, representing alternative conceptualizations. A hierarchical model which integrates the previously competing models provided the best fit to the data and serves to explain a large body of previous findings. The model includes three first order constructs (Positive/Social; Negative/Affective; and Habit/Addictive) and one general second-order factor. The results were replicated across two different response formats and two different subject samples.

Fourteen different measures were investigated as predictors of change in smoking status for self-change efforts at smoking cessation. Adult subjects (N = 866) were classified into five stages of change: precontemplation, contemplation, action, maintenance, and relapse. Subjects were assessed on 10 change processes, self-efficacy, temptations to smoke, and their decisions weighing the advantages and disadvantages of smoking; and these 14 variables were used as predictors of change in smoking status 6 months later. Six significant functions were found which predicted movement for each of the stages. These predictors are of both theoretical interest and practical significance because they may be modified in self-change efforts to overcome addictive behaviors. Overall, the change processes of self-reevaluation and the helping relationship and the self-efficacy and decisional balance variables were the most efficacious predictor variables. A general pattern emerged in which processes oriented more toward environmental events, such as dramatic relief and social liberation, tended to predict failure or no progress whereas more experientially oriented processes predicted progress.

Subject characteristics served as predictors of smokers' success or failure in their self-change efforts at smoking cessation over a 6-month period. Seven hundred and three adult subjects represented five stages of change based on the transtheoretical model: precontemplation, contemplation, action, maintenance, and relapse. Step-wise multiple discriminant functions were used to predict movement across the stages. Health problems, problem duration, daily cigarettes, previous attempts to quit, and smoking for pleasure predicted movement through various stages of change. The stronger the smoking habit, the less apt the smoker is to quit or maintain a nonsmoking status. Smokers with higher incomes and more years of education are more likely than persons of lower socioeconomic levels to be successful in their self-change efforts. The advantages of process-oriented rather than static variables for predicting self-change are discussed.

Cigarette smokers who quit on their own (n = 29) were compared with subjects from two commercial therapy programs: Aversion Group (n = 18) and Behavior Management Group (n = 16). Subjects were administered a Change-Process Questionnaire and a demographic and smoking-history questionnaire within seven weeks of successful cessation, then interviewed again in five months. Using a transtheoretical model of change developed by Prochaska (1979) six verbal and four behavioral processes of change and three stages of change (Decision to Change; Active Change; Maintenance) were analyzed. Subjects in each treatment group were middle class, heavy-smoking adults. The change-process analysis of cessation discriminated between the self-quitters and therapy quitters and between the two groups of therapy subjects on five variables. Stages of change interacted with the processes of change in the cessation of smoking behavior. Verbal processes were seen as important in making the decision to change while action processes were critical for breaking the actual smoking habit. Maintenance of cessation was related to, but not dependent on, how subjects actively changed smoking behavior.