Psychiatric severity and behavior change in alcoholism: The relation of the transtheoretical model variables to psychiatric distress in dually diagnosed patients

Treatment programming for individuals diagnosed with a chronic mental illne ss and an alcohol use disorder could be enhanced by employing techniques th at focus on those change process variables that are most strongly related t o psychiatric distress. Prochaska and DiClemente's transtheoretical model ( TTM) provides a useful framework within which to study these relations. The associations between psychiatric severity and the TTM constructs of stages and processes of change, decisional balance, temptation, and self-efficacy were measured among 132 alcohol-dependent patients in a public mental heal th clinic's outpatient dual diagnosis program. Participants' scores on the Temptation subscale of the Alcohol Abstinence Self-Efficacy Questionnaire a re strongly related to psychiatric severity: The more psychiatric distress a person is experiencing, the more he or she is tempted to drink, particula rly in situations that trigger negative affect. Decisional balance consider ations are also related to psychiatric severity: The higher participants sc ored on the Global Severity Index of the Brief Symptom inventory, the more importance they placed on the negative aspects, or cons, of drinking. Subje cts with more psychiatric distress also scored higher on the maintenance st age of change subscale, possibly indicating an increased fear of relapse an d struggle to maintain sobriety. (C) 1999 Elsevier Science Ltd.