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Application of the transtheoretical model of behavior change to cessation of alcohol use in patients with schizophrenia
by Hagedorn, Hildi J., Ph.D., University of Maryland Baltimore County, 2000

The purpose of this study was to revise the Decisional Balance Scale, which measures the pros and cons of alcohol use, to insure coverage of content relevant to schizophrenia patients with alcohol use disorders and to provide initial validation of Stages of Change measures with this population. Pilot items for the revision of the Decisional Balance Scale were generated by reviewing videotapes of a group for the treatment of substance abuse in schizophrenia. The pilot items were completed by ten participants diagnosed with schizophrenia and alcohol abuse or dependence. The ten pros and the ten cons that were most highly endorsed were added to the Decisional Balance Scale. The original and new Decisional Balance items were completed by an additional 40 subjects also diagnosed with schizophrenia and alcohol abuse or dependence. The five original and five new pro items with the highest item-total correlations were selected for the Decisional Balance Scale-Revised. Con items for the Decisional Balance-Revised were selected in the same manner. The revised scale demonstrated higher item endorsement, greater variability of item endorsement, and higher coefficient alphas than the original scale. Initial validity of the Decisional Balance Scale-Revised was examined by comparing its relationship to measures of readiness to change and recent alcohol use behaviors. As hypothesized, the decisional balance score, which reflects the subject's relative weighting of pro and con items, was negatively correlated to readiness to change indicating that the more highly a subject rates pro items relative to con items, the lower they will score on readiness to change. As hypothesized, the revised pro scale was positively correlated with recent drinking behaviors. The relationship between the decisional balance scores and recent drinking behaviors was not significant. However, the correlations where of a magnitude which would reach significance with a larger sample size. These results indicate that patients with schizophrenia can understand the concepts assessed by the Stage of Change measures and can complete them in a consistent manner. The results provide strong evidence for the applicability of the Stages of Change model to the assessment and treatment of alcohol use disorders in schizophrenia patients.