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Biomedical subjects

C C DiClemente

Publications and source records attributed to C C DiClemente.

At least 19 recordsLinked to original sources
PubMed1999

Treating substance abuse among patients with schizophrenia.

Although substance abuse has reached epidemic proportions among people with schizophrenia, relatively little is known about the critical elements of effective treatment of substance abuse in this population. The authors discuss common assumptions about treatment of substance abuse and review the features of the transtheoretical model of change, which is based on the view that behavior change is a longitudinal process consisting of several stages. In this model, substance abusers must first be persuaded to reduce substance use and then be engaged in treatment before they can be taught the skills necessary to become and remain abstinent. The authors suggest an adaptation of the model that attempts to minimize the impact of the cognitive and motivational deficits associated with schizophrenia. The six-month treatment protocol contains four modules focusing on social skills and problem solving, education about the causes and dangers of substance use, motivational interviewing and goal setting for decreased substance use, and training in behavioral skills for relapse prevention. In the 90-minute, twice weekly sessions, behavioral rehearsal is emphasized, and complex social repertoires, such as refusing substances, are divided into smaller behavioral elements.

Awareness↗
PubMed1998

Internal validity of Project MATCH treatments: discriminability and integrity.

Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) is a multisite collaborative project designed to evaluate patient-treatment interactions in alcoholism treatment. To evaluate whether major threats to the internal validity of the independent (treatment) variable in Project MATCH could be ruled out, we investigated several aspects of treatment integrity and discriminability. In this study, 1,726 alcohol-dependent participants at 10 sites were randomized to 3 treatments: cognitive-behavioral treatment (CBT), motivational enhancement therapy (MET), and 12-step facilitation (TSF). Participants received treatment either as outpatients or as aftercare following a more intensive inpatient or day hospital treatment. For both the outpatient and aftercare arms of the study, treatments were discriminable in that therapists implemented each of the treatments according to manual guidelines and rarely used techniques associated with comparison approaches. Participants received a high level of exposure to their study treatments, and the intended contrast in treatment dose between MET and the 2 more intensive treatments (CBT and TSF) was obtained. Alcoholics Anonymous involvement was significantly higher for participants assigned to TSF versus MET or CBT, whereas the treatments did not differ in utilization of other nonstudy treatments. Nonspecific aspects of treatment such as therapist skillfulness and level of the therapeutic alliance were comparable across treatment conditions.

Adult↗
PubMed1998

Short- and long-term effects of a pilot prevention program to reduce alcohol consumption.

This study examined the effects of a brief, pilot alcohol prevention intervention for 211 disadvantaged 6th grade school children at posttest and 1-year follow-up. Process data indicated that the intervention was successfully implemented and well received by youth and parent/guardian participants. ANCOVA analyses indicated a significant difference on alcohol use frequency for drinking subjects at 1-month posttest, with less frequent use reported by intervention subjects than subjects receiving the minimal control materials, F(1,22) = 5.37, p = .03. No differences were found between intervention and control subjects on alcohol use measures at 1-year follow-up. Critical issues to be resolved related to the success of future prevention research and practice are discussed.

Adolescent↗
PubMed1998

Compliance with treatment and follow-up protocols in project MATCH: predictors and relationship to outcome.

Treatment and follow-up session attendance data from Project MATCH, a multisite clinical trial investigating patient-treatment matching, were analyzed to study compliance. High rates of compliance to both therapy and research protocols were achieved, enhancing treatment integrity and data quality. Strong baseline predictors of compliance did not emerge, and the small relationships found were consistent with reports from previous studies. Attendance at therapy sessions was moderately correlated with research follow-up participation. Treatment compliance predicted drinking outcome, underscoring the importance of retaining patients in treatment. Future studies should examine the associations between compliance and structural features of the treatment environment, treatment delivery, and context-features that are often under the control of the clinician/investigator.

Adult↗
PubMed1997

The therapeutic alliance and its relationship to alcoholism treatment participation and outcome.

The relationship between the therapeutic alliance and treatment participation and drinking outcomes during and after treatment was evaluated among alcoholic outpatient and aftercare clients. In the outpatient sample, ratings of the working alliance, whether provided by the client or therapist, were significant predictors of treatment participation and drinking behavior during the treatment and 12-month posttreatment periods, after a variety of other sources of variance were controlled. Ratings of the alliance by the aftercare clients did not predict treatment participation or drinking outcomes. Therapists ratings of the alliance in the aftercare sample predicted only percentage of days abstinent during treatment and follow-up. The results document the independent contribution of the therapeutic alliance to treatment participation and outcomes among alcoholic outpatients.

Adult↗
PubMed1997

Stages of change: interactions with treatment compliance and involvement.

Current perspectives on compliance and involvement in treatment often overlook the fact that treatment occurs in the context of a process of change and not vice versa. Each individual moves at a unique pace through a series of stages of change and in a cyclical fashion over a substantial period of time. Treatment personnel and programs should recognize the diversity of stage status in their clients and address each one in a manner compatible with the client's current stage of change, the tasks needed to move forward in the process of change, and an understanding of the course of change. Such considerations should assist the therapist in developing strategies to increase the engagement of a wide variety of clients, to improve retention of these clients in a realistic course of treatment, and to foster participation in stage-appropriate tasks that promote successful movement through the stages to sustained, long-term change.

Humans↗
PubMed1996

Gender and smoking cessation: a factor structure comparison of processes of change.

This study examined gender differences in the pattern of process use for smoking cessation using the Processes of Change Questionnaire (J. O. Prochaska, W. F. Velicer, C. C. DiClemente, & J. Fava, 1988). The goals were (a) to determine the degree to which the covariance structure of the Processes of Change Questionnaire is invariant across gender, (b) to test the existence of the theoretical 2-factor process model using confirmatory factor analysis, and (c) to explore mean differences, if found, in the use of the 10 processes of change across 4 stages of change (precontemplation, contemplation, preparation, and action). The sample (N = 516) had an equal distribution of men and women across the stages of change. Results demonstrated that the structure of the measure for men and women was invariant at the level of the variance-covariance matrices and that the hypothesized 2-factor model fit the data. Only stage of change predicted the experiential and behavioral process factors.

Adult↗
PubMed1996

Doing the right thing at the right time? The interaction of stages and processes of change in successful smoking cessation.

Research on the transtheoretical model has provided substantial support for both stages of change and processes of change (coping strategies influencing successful behavior change). This study examined whether timing of process use (using particular change processes during one stage and not during others) influences quit success. Hypothesized patterns of optimal process use were those marked by more use of experiential processes and less use of behavioral processes during contemplation and preparation and by the reverse pattern during action. Participants (N = 388) began in contemplation or preparation and took action during a 4-6 week period. Multivariate analyses of covariance examined the relationship between patterns of process use and success in staying quit both at 1-month follow-up and 5-6 months later. For the most part, results supported the hypothesis that successful stage transitions involve doing the right thing at the right time: engaging in experiential process activities during contemplation and preparation stages and shifting to behavioral process activities during action.

Adaptation, Psychological↗
PubMed1996

Brief nurse consultations for preventing alcohol use among urban school youth.

This study examined the effects of brief nurse consultations in preventing alcohol use among inner-city youth. Participants included 138 sixth-eighth grade students attending an inner-city public school in Jacksonville, Florida. Subjects were randomly assigned by computer to either the intervention (STARS program) or a control group. Baseline and three-month post-tests were conducted at the target school site. A significant difference was found on heavy alcohol use with intervention subjects showing a reduction and control subjects an increase in heavy drinking (t = -2.33, 120df, p = .02). No differences were found between groups on other alcohol use measures. This study's findings indicate that a series of brief nurse consultations appear to reduce heavy alcohol consumption among urban school youth.

Adolescent↗
PubMed1994

Stages of change in adopting healthy diets: fat, fiber, and correlates of nutrient intake.

The stages of change construct, which addresses the readiness to change, has only recently been applied to dietary behavior, such as fat consumption. This article describes the application of the stages of change construct to dietary fat and fiber consumption and examines the association of dietary stages to eating practices and related demographic and psychosocial factors in a large, geographically diverse population of workers. We present results from the baseline survey of 17,121 employees in the Working Well Trial. We assessed stage from an algorithm based on seven items and measured dietary intake with an 88-item food frequency questionnaire. Findings indicated that a greater proportion of the population has actively tried to reduce fat intake than to consume more fiber. Stage of change was associated with fat, fiber, and fruit and vegetable intake in a stepwise manner, as predicted. In multivariate analyses that controlled for demographic characteristics, stage of change predicted between 8 and 13% of the variance in dietary intake, and more than demographic variables. These findings have implications for the design of nutrition interventions and for the evaluation of intermediate outcomes.

Adult↗
PubMed1994

The Alcohol Abstinence Self-Efficacy scale.

This study describes the development and the initial psychometric properties of a 20-item, self-report measure to assess Bandura's construct of self-efficacy applied to alcohol abstinence. Efficacy expectations are theorized to mediate behavior change and moderate effort and effective action. The sample was 174 male and 92 female subjects who came to an outpatient alcoholism treatment clinic. Abstinence efficacy was assessed with subject ratings on a 5-point Likert scale of confidence to abstain from alcohol across 20 different high-risk situations. A parallel set of items assessed subjects' temptation to drink in each situation. This Alcohol Abstinence Self-Efficacy scale (AASE) demonstrated a solid subscale structure and strong indices of reliability and validity. The four 5-item subscales measured types of relapse precipitants labeled negative affect, social positive, physical and other concerns, and withdrawal and urges. Both in structure and mean scores the AASE demonstrated no substantive gender differences. The AASE represents a brief, easily usable and psychometrically sound measure of an individual's self-efficacy to abstain from drinking.

Adolescent↗
PubMed1994

Issues in the selection and development of therapies in alcoholism treatment matching research.

There are a large number of possible approaches to the treatment of alcohol abuse and dependence. From a practical and methodological standpoint, however, only a limited number of interventions can realistically be included in research studies of treatment matching. A key question in planning studies of matching is what treatments to include. The recent book by Beutler and Clarkin on systematic treatment selection in general psychotherapy provides a framework within which to discuss alcoholism treatment matching and the criteria applied to decisions concerning (1) modes of treatment, (2) treatment format, (3) specific therapeutic strategies and the (4) treatment setting. The methodological and practical issues raised and the decisions reached in Project MATCH are presented in each of these areas. The therapies chosen for Project MATCH, based on these criteria, are described.

Alcoholism↗
PubMed1994

Process assessment in treatment matching research.

A complete understanding of the effects of treatment requires an examination of the process by which the treatment produces the outcome as well as a thorough assessment of the outcomes. Process assessment assumes even greater importance in matching research than in other types of treatment research, since client-treatment interactions are hypothesized to be moderated or mediated by specific treatment components. The role of process assessment in treatment matching research is examined using Project MATCH as an illustrative example. Four process domains, including dose of treatment, within-session treatment activities, the therapeutic alliance and extra-session activities, are described in terms of their role as mediators or moderators of treatment outcome and the perspectives by which they are assessed in Project MATCH.

Alcoholism↗
PubMed1994

Issues in the development of client-treatment matching hypotheses.

This article discusses observations and insights that were gained in the course of critiquing the a priori client-treatment matching hypothesis that were developed for Project MATCH. A matching taxonomy is offered that differentiates eight types of ordinal and disordinal interactions and discusses their clinical and substantive implications. Previously reported alcohol treatment studies are used to illustrate many of these. Various issues in matching studies, such as power versus complexity, prediction versus explanation, matches versus mismatches and capitalization versus compensation, are discussed. Selective issues in choosing treatment and client-matching variables as they affect matching hypotheses are also addressed. The importance of developing a putative "causal chain" for testing the theory underlying matching processes is explicated and a procedure for testing this causal chain is outlined.

Alcoholism↗
PubMed1994

Assessment issues and strategies in alcoholism treatment matching research.

Sensitive and comprehensive client assessment entails complex conceptual and methodological considerations. Such activity is at the heart of matching clients to appropriate treatments. This article begins by specifying the goals and functions of assessment to support matching. This is followed by a discussion of the strategies employed in Project MATCH to identify matching and outcome variables. The assessment battery used in Project MATCH is next described. Finally, an overview of issues surrounding administration of assessment measures is provided. Particular attention is given to the topics of sequencing and timing of measures.

Alcoholism↗
PubMed1993

Standardized, individualized, interactive, and personalized self-help programs for smoking cessation.

Smokers (N = 756) were randomly assigned by stage of change to (a) standardized self-help manuals (ALA+ condition), (b) individualized manuals matched to stage (TTT condition), (c) interactive expert-system computer reports plus individualized manuals (ITT condition), or (d) a personalized condition with 4 counselor calls, stage manuals, and computer reports (PITT condition). Over 18 months, the ITT group's results more than doubled those of the ALA+ group on abstinence measures. The ALA+ and TTT conditions were equivalent over 12 months, but at 18 months the TTT condition was more effective. The ITT condition was the best or comparable with the best treatment at all follow-ups for smokers at all stages of change. Results suggest that an effective expert system has been developed, and discussion focuses on delivering this system to entire populations of smokers.

Adult↗
PubMed1992

In search of how people change. Applications to addictive behaviors.

How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.

Aftercare↗