Does progressive stage transition mean getting better? A test of the Transtheoretical Model in alcoholism recovery.
OBJECTIVE
To test two central assumptions of stage movement in the Transtheoretical Model (TTM) vis-à-vis alcoholism recovery: (assumption 1) individuals making a forward transition to the action-oriented stages (i.e. preparation/action) will manifest relatively greater drinking improvements than their counterparts remaining in the pre-action stages (i.e. pre-contemplation, contemplation); and (assumption 2) individuals remaining in the pre-action stages across time will not demonstrate clinically relevant improvement in drinking outcomes.


METHODS
Secondary data analyses of data from Project MATCH, a large multi-site alcoholism treatment-matching study.


METHODS
At baseline and 3 months post-treatment, the following variables were measured: stage-of-change (based on the University of Rhode Island Change Assessment measure and the most recent stage assignment algorithm), drinks per drinking day (DDD) and percentage days abstinent (PDA).


RESULTS
Six of the eight tests of assumptions 1 and 2 failed to support the basic tenets of the TTM. Our study demonstrated that individuals making a progressive stage transition to the action-oriented stages (i.e. preparation/action) do not necessarily manifest greater improvements in drinking-related behavior than individuals remaining in the pre-action stages (i.e. pre-contemplation, contemplation), and that individuals remaining in the pre-action stages over time actually do manifest statistically significant and clinically important improvements in drinking-related behavior.


CONCLUSIONS
Our findings challenge not only the criterion validity associated with stage movement in the TTM account of alcoholism recovery, but also recent TTM-based substance abuse treatment approaches which systematically promote forward stage transition as a primary clinical goal and marker of therapeutic success.
Callaghan
Russell C
RC
Centre for Addiction and Mental Health, Toronto, ON, Canada. russell_callaghan@camh.net
Taykor
Lawren
L
Cunningham
John A
JA
D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation*; D016739:Behavior, Addictive / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008960:Models, Psychological; D008962:Models, Theoretical; D009042:Motivation; D013997:Time Factors