A transtheoretical analysis of change among cocaine users

Cocaine use is on the rise, with an estimated 2-3 million people currently dependent on the drug (Adams & Kozel, 1985), and an additional 3,000-5,000 users each day (Gold, 1985; NIDA, 1986). A wide array of intervention strategies have been implemented in treating cocaine addiction, but success rates across treatment modalities are typically modest, as with other addictive behaviors (Oxford, 1985). New approaches are being investigated in hopes of uncovering more effective treatment strategies. The following study applies the Transtheoretical Model of change (Prochaska & DiClemente, 1984) as a way to better understand the way in which people in treatment work towards and maintain abstinence from cocaine. In Study I, subjects were evaluated using self-report inventories assessing Stages of Change, Processes of Change, Decisional Balance, and Self-Efficacy. Each of these instruments was developed with content reflecting special issues characteristic of cocaine using populations, within the guiding framework provided by the Transtheoretical Model. Principal components analyses were performed to develop the measures and assess their factor structure. Study II involved a cross-sectional approach comparing groups using the staging variable, with a focus on differentiation of subjects on measures of change. Multivariate analyses (MANOVA\u27s) were conducted with the four stages of change (precontemplation, contemplation, action, and maintenance) as the independent variable and instruments developed in Study I as the dependent variables. Results revealed global trends analogous to previous Model investigations on the dimensions of Process use, Decisional Balance, and Self-Efficacy. Each, of these has been demonstrated to be an important variable in predicting behavior change. Study III examined differences across the four treatment settings, including in-patient, out-patient, residential and methadone maintenance with the above-mentioned dimensions. Subjects differed on each of these variables across treatment settings. In-patient subjects reflected earlier stage profiles, while those from residential treatment were in later stages but demonstrated continued need for a structured setting. This was indicated by elevated levels of temptation to use cocaine and low levels of confidence, even following extended periods of abstinence, demonstrating considerable and ongoing risk for relapse. Other group differences are also discussed