CMRS Scales for Substance Abuse Treatment (CMR)

Abstract

The Circumstances, Motivation, and Readiness Scales for Substance Abuse Treatment (CMRS) is a brief, self-report instrument developed by George DeLeon and colleagues in the early 1990s. Designed primarily for use at intake, the CMRS assesses key psychological and environmental factors that influence a patient’s engagement and subsequent retention in substance abuse treatment programs. It operationalizes three core constructs—Circumstances, Motivation, and Readiness—which are crucial predictors of treatment outcome, particularly within the context of therapeutic community settings.

Keywords

Substance abuse, addiction, motivation, readiness, treatment retention, therapeutic community, intake assessment, psychometric scale, George DeLeon.

Authors

George DeLeon, Gerald Melnick, D. Kressel, N. Jainchill.

Purpose

The primary purpose of the CMRS is to facilitate accurate assessment and prediction of client behavior immediately following entry into a substance abuse treatment program. Specifically, the scale was developed to predict treatment retention, which is a critical intermediate outcome measure strongly associated with long-term recovery success in treating substance use disorders.

By measuring a client’s external pressures (Circumstances), internal desire for change (Motivation), and commitment to the treatment process (Readiness), clinicians can utilize the CMRS to identify patients who may be at high risk for premature drop-out. This early identification allows for timely clinical intervention and tailored therapeutic strategies designed to improve patient engagement and adherence to the program.

Construct

The CMRS is theoretically grounded in the literature concerning stages of change and client preparedness in addiction treatment, focusing on three distinct, yet interrelated, psychological constructs:

• Circumstances: This factor measures the external pressures or coercive factors compelling the client to enter treatment, such as legal mandates, family pressure, or financial constraints. High scores on this factor often indicate external, rather than internal, drivers for seeking help, which can sometimes negatively impact sustained commitment.
• Motivation: This factor assesses the client’s internal desire for change, recognition of the severity of their substance use disorder, and genuine self-awareness related to their problematic behavior. It reflects the emotional and cognitive acknowledgment of the problem, often involving feelings of remorse or self-disgust.
• Readiness: This factor measures the client’s immediate commitment and willingness to engage actively in the treatment process. This includes accepting the need for professional help and demonstrating an intention to adhere to specific program requirements. Readiness is often viewed as the behavioral commitment stemming from internal motivation.

Validity

The original research validating the CMRS (DeLeon et al., 1994) established strong criterion-related validity, particularly in predicting retention within structured therapeutic community settings. The scale’s ability to differentiate between clients who successfully completed treatment and those who dropped out early supports its predictive utility.

The study found that scores on the Motivation and Readiness subscales are highly predictive of sustained engagement. While external Circumstances (like legal involvement) may successfully compel initial entry into substance abuse treatment, lasting retention is primarily driven by high intrinsic motivation and a strong sense of readiness to change.

Reliability

The CMRS demonstrates acceptable levels of internal consistency, which is a key measure of reliability for multi-item scales. Research involving the CMRS has consistently confirmed the internal reliability of the subscales, ensuring that items within each factor (Circumstances, Motivation, Readiness) measure a unified underlying construct.

The scale’s continued application in diverse addiction treatment research settings over decades further suggests adequate stability and consistency, supporting its utility as a reliable measure for predicting treatment outcomes at the point of intake.

Factor Analysis

The development of the CMRS was supported by factor analysis, which successfully isolated the three distinct components: Circumstances, Motivation, and Readiness. This analysis confirmed the conceptual framework that these three domains, while interrelated, operate as separate factors influencing treatment prognosis.

This robust factor structure ensures that the 18 items load appropriately onto their respective factors, providing clinicians with a clear, multidimensional assessment of the client’s position relative to external pressures, internal desire, and behavioral commitment.

Instrument

Test Type: Self-report questionnaire / Psychological assessment scale

Format: 18 items, utilizing a 5-point Likert scale response format (1=Strongly Disagree to 5=Strongly Agree), plus an option for 9=Not Applicable. Items 4, 5, 6, and 12 are reverse scored.

Language Available: English (Original development language).

Population Group: Individuals entering substance abuse treatment programs.

Age Group: Typically utilized with adults and adolescents requiring treatment for substance use disorders.

Population Details: Used across various treatment modalities (residential, outpatient, methadone maintenance) and with clients reporting diverse primary drugs of abuse (cocaine, opiates, alcohol, poly drug use).

Test Methodology: Designed as an intake assessment tool to be administered early in the treatment process to gauge pre-treatment characteristics and predict potential treatment length or retention.

Keywords

Addiction treatment, therapeutic community, patient readiness, coercion, clinical intake, psychological measurement, substance dependence.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected] (Gerald Melnick, Center for Therapeutic Community Research).

Correspondence Address: George DeLeon / Gerald Melnick. Center for Therapeutic Community Research (CTCR). 2 World Trade Center, 16th Fl. New York, NY 10048.

Permissions & Fee and Test Year

The CMRS scale was developed in 1993, with primary validation published in 1994. Information regarding current usage fees or specific licensing permissions should be sought directly from the corresponding author, Gerald Melnick, or the Center for Therapeutic Community Research (CTCR).

The instrument is publicly referenced by organizations such as the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The original instrument reference can be found here: http://www.emcdda.europa.eu/html.cfm/index3597EN.html

Reference’s

DeLeon, G., Melnick, G., Kressel, D., Jainchill, N. Circumstances, motivation, readiness and suitability (The CMRS Scales): Predicting retention in therapeutic community treatment. American Journal of Drug and Alcohol Abuse, 20(4), 495-515, (1994).

Items of the CMRS Scales for Substance Abuse Treatment (CMR)

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

PRIMARY DRUG

• 1=Non-crack cocaine
• 2=Crack
• 3=Opiates
• 4=Marijuana
• 5=Alcohol
• 6=Poly Drug
• 8=Other

TREATMENT MODALITY

• 1=Drug Free Outpatient
• 2=Day Treatment
• 3=Methadone Maintenance
• 4=Short Term Residential
• 5=Long Term Residential
• 6=No Treatment Entered
• 7=Detoxification Only
• 8= Detoxification as Entry into Treatment
• 9=Hospital Inpatient
• 10=Referral Center
• 11=Other

CIRCUMSTANCES

1. I am sure that I would go to jail if I didn’t enter treatment.
2. I am sure that I would have come to treatment without the pressure of my legal involvement.
3. I am sure that my family will not let me live at home if I did not come to treatment.
4. I believe that my family/relationship will try to make me leave treatment after a few months.
5. I am worried that I will have serious money problems if I stay in treatment.
6. Basically, I feel I have too many outside problems that will prevent me from completing treatment (parents, spouse/relationship, children, loss of job, loss of income, loss of education, family problems, loss of home/place to live, etc.).

MOTIVATION

7. Basically, I feel that my drug use is a very serious problem in my life.
8. Often I don’t like myself because of my drug use.
9. Lately, I feel if I don’t change, my life will keep getting worse.
10. I really feel bad that my drug use and the way I’ve been living has hurt a lot of people.
11. It is more important to me than anything else that I stop using drugs.

READINESS

12. I don’t really believe that I have to be in treatment to stop using drugs, I can stop anytime I want.
13. I came to this program because I really feel that I’m ready to deal with myself in treatment.
14. I’ll do whatever I have to do to get my life straightened out.
15. Basically, I don’t see any other choice for help at this time except some kind of treatment.
16. I don’t really think I can stop my drug use with the help of friends, family or religion, I really need some kind of treatment.
17. I am really tired of using drugs and want to change, but I know I can’t do it on my own.
18. I’m willing to enter treatment as soon as possible.

SCORING KEY

1= Strongly Disagree, 2= Disagree, 3= Neither Agree or Disagree, 4= Agree, 5=Strongly Agree, 9=Not Applicable.

Reverse scoring applies to questions 4, 5, 6 and 12.