Alcohol Decisional Balance Scales

Abstract

The Alcohol Decisional Balance Scales (ADBS) are a set of psychometric instruments derived from the Transtheoretical Model (TTM) of behavior change, developed by Prochaska and DiClemente. The primary function of the ADBS is to quantify an individual’s subjective evaluation of the perceived benefits (Pros) versus the perceived costs (Cons) associated with continued alcohol consumption or changing drinking behavior. This balance is a crucial indicator of an individual’s readiness to move through the stages of change related to problematic alcohol use. The scales typically employ a Likert-type rating to assess the importance of various statements concerning the consequences of drinking, offering valuable insight for tailoring motivational interventions in alcoholism treatment settings.

Keywords

Decisional Balance, Transtheoretical Model, TTM, Alcohol Use Disorder, Motivation, Readiness to Change, Substance Abuse, Pros and Cons, Psychometrics

Authors

Carlo C. DiClemente, James O. Prochaska, Wayne F. Velicer, Susan E. Collins, Kate B. Carey

Purpose

The primary purpose of the Alcohol Decisional Balance Scales is to measure the relative weight assigned by an individual to the positive and negative aspects of their drinking behavior. This measurement is fundamental to the Transtheoretical Model (TTM), which posits that a shift in the balance—where the Cons begin to outweigh the Pros—is necessary for an individual to progress from the Precontemplation stage toward the Preparation and Action stages of change. The scales help clinicians and researchers assess an individual’s current motivational state regarding alcohol reduction or cessation.

By providing distinct scores for the Pros (benefits) and Cons (costs) of drinking, the ADBS allows for a nuanced understanding of ambivalence. The results are used to predict movement between the stages of change and to guide the selection of appropriate intervention strategies, such as motivational interviewing, tailored to the specific decisional balance profile of the patient.

Construct

The ADBS directly measures the construct of Decisional Balance. This construct reflects the cognitive process of weighing the potential gains associated with maintaining a problem behavior (alcohol use) against the disadvantages, burdens, and risks of that behavior. In the context of alcohol misuse, the Pros factor typically includes items related to social facilitation, stress reduction, and positive mood enhancement, while the Cons factor encompasses negative social, physical, occupational, and psychological consequences.

The theoretical foundation dictates that in earlier stages of change (Precontemplation), the Pros of drinking are substantially more important than the Cons. As an individual moves toward Contemplation and Preparation, the Cons factor increases in importance, eventually surpassing the Pros factor, thereby facilitating movement into the Action stage. The ADBS provides a quantitative index of this dynamic cognitive shift.

Validity

Evidence for the validity of the Decisional Balance construct, and specifically the ADBS, is rooted in its ability to differentiate between individuals in different stages of change (construct validity). Studies have consistently shown that the scale scores align with the predictions of the TTM; specifically, Cons scores are significantly higher in the later stages (Action, Maintenance) compared to the earlier stages (Precontemplation).

Furthermore, the ADBS has demonstrated good predictive validity, indicating its capacity to forecast future changes in drinking behavior and treatment outcomes. For example, a high Cons score relative to a Pros score is often predictive of successful engagement in treatment and subsequent reduction in alcohol consumption, particularly when used with populations struggling with alcoholism or at-risk college drinking.

Reliability

The Alcohol Decisional Balance Scales generally exhibit strong internal consistency, which is a measure of reliability indicating that the items within the Pro factor and the Con factor are measuring the same underlying construct. Research utilizing various versions of the ADBS, including the reduced forms, has reported acceptable to high Cronbach’s alpha coefficients for both the Pros subscale and the Cons subscale, typically ranging above 0.70.

The robust internal consistency suggests that the instruments are reliable self-report measures for assessing the cognitive processes related to alcohol use. This reliability is critical for ensuring that observed changes in scores over time, often tracked during longitudinal studies or treatment protocols, genuinely reflect shifts in the individual’s motivational state rather than measurement error.

Factor Analysis

Factor Analysis conducted on the Decisional Balance Scales across various problem behaviors, including alcohol use, consistently supports a two-factor structure. This structure separates the items into two orthogonal dimensions: the Pros of Drinking and the Cons of Drinking. These two factors are generally found to be independent of each other, confirming the theoretical distinction required by the TTM.

The factorial invariance of the scale has been examined across different populations and time points, confirming that the two-factor model remains stable. This stability is essential for the clinical application of the scale, ensuring that the scores derived from the Pros and Cons subscales are meaningful and comparable across diverse groups, ranging from psychiatric outpatients to at-risk college drinkers.

Instrument

Test Type: Self-report Psychometrics Scale

Format: Likert Scale (5-point range, 1=Not important at all to 5=Extremely important)

Language Available: Primarily English (Translations may exist based on application studies)

Population Group: Individuals engaged in problematic alcohol consumption, including those seeking treatment for alcohol use disorder and at-risk populations (e.g., college students).

Age Group: Typically utilized with adolescents and adults.

Population Details: Used in clinical, research, and intervention settings to assess motivational readiness for behavioral change regarding alcohol.

Test Methodology: Respondents rate the importance of 20 statements (Standard Version) or 10 statements (DELTA Version) regarding the positive and negative effects of drinking on a 5-point scale.

Keywords

Decisional Balance Inventory, Alcohol Misuse, Addiction Treatment, Motivational Enhancement Therapy, TTM Constructs, Health Behavior Change

Authors

Author ORCID Identifier: N/A (Information not provided in source material)

Affiliation Email addresses: N/A (Information not provided in source material)

Correspondence Address: N/A (Information not provided in source material)

Permissions & Fee and Test Year

The Decisional Balance construct and associated scales, including the ADBS, originated from the work of Prochaska and DiClemente in the 1980s, applying the TTM concepts initially developed for smoking cessation (Velicer, DiClemente, and Prochaska, 1985) to alcoholism treatment (DiClemente and Hughes, 1990). The scales are often made available for research and non-commercial clinical use, frequently found through research groups associated with the TTM developers (e.g., the Habits Lab at UMBC, as referenced in the source content: http://habitslab.umbc.edu/decisional-balance-scales/). Specific fee information and formal testing year details for published commercial versions may vary.

Reference’s

• Velicer‚ W.F.‚ DiClemente‚ C.C.‚ and Prochaska‚ J.O. (1985). Decisional balance measure for assessing and predicting smoking status. Journal of Personality and Social Psychology‚ 48‚ 1279-1289.

• DiClemente‚ C.C.‚ and Hughes‚ S.O. (1990). Stages of Change Profiles in Outpatient Alcoholism Treatment. Journal of Substance Abuse‚ 2‚ 217-235.

• DiClemente‚ C.C.‚ Carbonari‚ J.P.‚ & Velasquez‚ M.M. (1992). Alcoholism treatment mismatching from a process of change perspective. Drug and Alcohol Abuse Reviews: Vol 3‚ Alcohol Abuse Treatment. Watson‚ R.R.‚ ed. Totowa‚ NJ: The Humana Press‚ pp. 115-142.

• Prochaska‚ J.O.‚ Velicer‚ W.F.‚ Rossi‚ J.S.‚ Goldstein‚ M.G.‚ Marcus‚ B.H.‚ Rakowski‚ W.‚ Fiore‚ C.‚ Harlow‚ L.L.‚ Redding‚ C.A.‚ Rosenbloom‚ D.‚ and Rossi‚ S.R. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology‚ 13‚ 39-46.

• Werch‚ C.E. (1997). Expanding the Stages of Change: A Program Marched to the Stages of Alcohol Acquisition. American Journal of Health Promotion‚ 12 (1)‚ 43-37.

• Carey‚ K.B.‚ Maisto‚ S.A.‚ Carey‚ M.P.‚ and Purnine‚ D.M. (2001). Measuring readiness to change substance misuse among psychiatric outpatients: Reliability and validity of self-report measures. Journal of Studies on Alcohol‚ 62‚ 79-88.

• Ward‚ R.M.‚ Velicer‚ W.F.‚ and Rossi‚ J.S. (2004). Factorial invariance and internal consistency for the decisional balance inventory – short form. Addictive Behaviors‚ 29‚ 953-958.

• DiClemente‚ C.C. (2007). Mechanisms‚ Determinants and Process of Change in the Modification of Drinking Behavior. Alcoholism: Clinical and Experimental Research‚ 31(S3)‚ 13S-20S.

• Collins‚ Susan E.‚ Carey‚ Kate B.‚ and Otto‚ Jacqueline M. (2009). A New Decisional Balance Measure of Motivation to Change Among At-Risk College Drinkers. Psychol Addict Behav‚ 23(3): 464–471. doi: 10.1037/a0015841

Items of the Alcohol Decisional Balance Scales

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Alcohol Decisional Balance Scale

How important is this to me?

1. My drinking causes problems with others.
2. I like myself better when I am drinking.
3. Because I continue to drink some people think I lack the ch‎aracter to quit.
4. Drinking helps me deal with problems.
5. ha‎ving to lie to others about my drinking bothers me.
6. Some people try to avoid me when I drink.
7. Drinking helps me to have fun and socialize.
8. Drinking interferes with my functioning at home or/and at work.
9. Drinking makes me more of a fun person.
10. Some people close to me are disappointed in me because of my drinking.
11. Drinking helps me to loosen up and express myself.
12. I seem to get myself into trouble when drinking.
13. I could accidentally hurt someone because of my drinking.
14. Not drinking at a social gathering would make me feel too different.
15. I am losing the trust and respect of my coworkers and/or spouse because of my drinking (drug use).
16. My drinking helps give me energy and keeps me going.
17. I am more sure of myself when I am drinking.
18. I am setting a bad example for others with my drinking.
19. Without alcohol‚ my life would be dull and boring.
20. People seem to like me better when I am drinking.

Alcohol Decisional Balance Scale

Reduced Drinking—DELTA Version

How important is this to me?

1. My drinking causes problems with others.
2. Drinking helps me deal with problems.
3. Drinking helps me to have fun and socialize.
4. Drinking interferes with my functioning at home or/and at work.
5. Some people close to me are disappointed in me because of my drinking.
6. Drinking helps me to loosen up and express myself.
7. I seem to get myself into trouble when drinking.
8. I could accidentally hurt someone because of my drinking.
9. I am more sure of myself when I am drinking.
10. Without alcohol‚ my life would be dull and boring.

Scoring Key (Standard 20-Item Version):

• Pros of Drinking: Items 2, 4, 7, 9, 11, 14, 16, 17, 19, 20
• Cons of Drinking: Items 1, 3, 5, 6, 8, 10, 12, 13, 15, 18

Scoring Key (DELTA Version):

• Pros of Drinking: Items 2, 3, 6, 9, 10
• Cons of Drinking: Items 1, 4, 5, 7, 8