Dissertation Abstract - A Transtheoretical Analysis Of Change Among Cocaine Users
Dissertation by Dena Rosenbloom
University of Rhode Island, 1991
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's) 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 measures. 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.
Martin, R.A., Rossi, J.S., Rosenbloom, D., Monti, P.M., &
Rohsenow, D.J. (1992, November). Stages and processes of change for quitting cocaine.
Prochaska, J.O., Velicer, W.F., Rossi, J.S., Goldstein,
M.G., Marcus, B.H., Rakowski, W., Fiore, C., Harlow, L., Redding, C.A.,
Rosenbloom, D., & Rossi,
S.R. (in press). Stages of change and decisional balance for twelve problem behaviors.
Rosenbloom, D. (1991). A Transtheoretical Analysis of Change Among Cocaine Users.
Unpublished dissertation, University of Rhode Island, Kingston, RI.
Rossi, J.S. (1992, August). Common processes of change across nine problem behaviors.
Paper presented at the 100th annual convention of the American Psychological Association,
Rossi, J.S., Rosenbloom, D., Monti, P., & Prochaska, J.O. (1992). Stages and processes
of change for cocaine use. Manuscript in preparation.