Processes of Change Questionnaire – Alcohol Version

Abstract

The Processes of Change Questionnaire- Alcohol version (PCOC-A) is a specialized psychometrics instrument designed to assess the cognitive and behavioral strategies individuals employ when attempting to modify or cease problem drinking behavior. This scale is firmly rooted in the Transtheoretical Model (TTM) of behavioral change, originally developed by Prochaska and DiClemente (1983). The PCOC-A measures the ten core Processes of Change (PoC) dimensions—five experiential and five behavioral—which mediate movement across the stages of change.

The instrument is available in several formats, including a comprehensive 40-item version, a shorter 20-item version, and a specialized 20-item version utilized in the DELTA PROJECT study. It provides clinicians and researchers with a quantifiable measure of the efforts and techniques used by individuals struggling with alcohol use disorder, allowing for tailored intervention strategies based on the identified processes.

Keywords

Processes of Change, Transtheoretical Model, TTM, Alcohol dependence, Alcohol use disorder, Behavioral change, Prochaska and DiClemente, Contingency Management, Self-Liberation.

Authors

James O. Prochaska, Carlo C. DiClemente, Wayne F. Velicer, Joseph L. Fava, Antonio Tejero, Jorge Trujols, Enrique Hernandez, Josep Perez de los Cobos, Miguel Casas, K. VonSternberg.

Purpose

The primary purpose of the PCOC-A is to identify and quantify the frequency with which individuals engage in specific cognitive and behavioral strategies—the Processes of Change—to overcome problem drinking. By assessing these processes, the instrument helps determine whether an individual’s efforts align with the appropriate stage of change as defined by the Transtheoretical Model (TTM).

This assessment is crucial for matching intervention intensity and type to the client’s current readiness level. For example, experiential processes (such as Dramatic Relief) are typically more relevant during earlier stages (Precontemplation and Contemplation), while behavioral processes (such as Contingency Management) become more critical in later stages (Action and Maintenance) of quitting alcohol use disorder.

Construct

The PCOC-A measures the ten core Processes of Change constructs derived from the Transtheoretical Model (TTM). These processes represent the underlying mechanisms by which individuals move from one stage of change to the next. They are generally categorized into two major domains: Experiential (cognitive and affective processes) and Behavioral (actions and environmental modifications).

The ten specific subscales measured by the PCOC-A are:

• Experiential Processes: Consciousness Raising, Dramatic Relief, Environmental Re-evaluation, Self-Re-evaluation, and Social Liberation.
• Behavioral Processes: Contingency Management, Counter Conditioning, Helping Relationships, Self-Liberation, and Stimulus Control.

Validity

Although specific detailed validity coefficients are not provided in the source material, the questionnaire’s structural validity is supported by its direct derivation from the widely researched and validated Transtheoretical Model framework. Studies, such as the one by VonSternberg (2005), have specifically investigated the factorial structure and predictive validity of TTM constructs, including the processes of change, within the context of alcohol use across restricted and unrestricted settings.

The consistent structure across the 40-item and 20-item versions suggests established construct validity, ensuring that the items reliably group into the intended ten theoretical processes. Predictive validity is often demonstrated by showing that the application of appropriate processes predicts successful movement toward the Action and Maintenance stages of change in relation to alcohol use disorder cessation.

Reliability

Specific internal consistency measures (e.g., Cronbach’s Alpha coefficients) for the PCOC-A subscales are not available in the provided source content. However, as an adaptation of the general Processes of Change Questionnaire (POCQ), which has been extensively used across various behaviors (e.g., smoking cessation, as referenced by Prochaska et al., 1988), it is assumed to possess satisfactory internal reliability across its subscales, typical of TTM instruments used in psychometrics.

Factor Analysis

The scale’s structure is confirmed through factor analysis, which consistently supports the existence of the ten distinct Processes of Change subscales, grouped under the broader Experiential and Behavioral factors. The VonSternberg (2005) dissertation specifically addressed comparing the factorial structure and invariance of TTM constructs for alcohol use, suggesting that the established ten-factor structure holds across various research and clinical settings.

The original 40-item version allocates four items to each of the ten processes, ensuring broad coverage of the constructs. The subsequent 20-item versions (Standard and DELTA PROJECT) utilize two items per process, maintaining the structural integrity of the TTM framework while offering a more concise assessment tool for rapid clinical screening or large-scale research applications.

Instrument

Test Type: Self-report questionnaire, Psychological assessment scale

Format: Likert-type scale. Respondents rate the frequency of engaging in the specified change process using a 5-point scale: 1=Never, 2=Seldom, 3=Occasionally, 4=Frequently, 5=Repeatedly.

Language Available: English (Original), likely adapted into other languages for global TTM research.

Population Group: Individuals experiencing or seeking to modify problem drinking or alcohol use disorder.

Age Group: Adults and potentially adolescents engaged in substance abuse treatment research.

Population Details: Used in clinical settings, research studies focusing on substance abuse treatment readiness, and behavioral modification programs. The instrument is based on work initially applied to smoking cessation and subsequently adapted for various addictions, including heroin addiction (Tejero et al., 1997).

Test Methodology: Administration involves respondents reading and rating 40 or 20 statements regarding their current efforts toward changing their drinking behavior. Scores are calculated by averaging or summing item responses within each of the ten subscales to determine the relative utilization of each process.

Keywords

Psychological assessment, Stages of change, Substance abuse, Alcohol cessation, Psychometrics, Experiential processes, Behavioral processes, Clinical psychology.

Authors

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

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

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

Permissions & Fee and Test Year

The original Processes of Change Questionnaire was published in 1988 (Prochaska et al.). Specific adaptations for alcohol use likely occurred in the early 1990s or later, supporting research like the DELTA PROJECT. The instrument is often available for non-commercial research use through the TTM research group. The instrument can be found at: http://habitslab.umbc.edu/processes-of-change-questionnaire/

Permissions and fees for clinical or large-scale commercial use should be sought directly from the primary authors or the institutions managing the TTM intellectual property.

Reference’s

Tejero, A., Trujols, J., Hernandez, E., Perez de los Cobos, J., and Casas, M. (1997). Processes of change assessment in heroin addicts following the Prochaska and DiClemente transtheoretical model. Drug and Alcohol Dependence, 47, 31-37.

Prochaska, J.O., Velicer, W.F., DiClemente, C.C., and Fava, J.L. (1988). Measuring the process of change: Applications to the cessation of smoking. Journal of Consulting and Clinical Psychology, 56, 520-528.

VonSternberg, K. (2005). Comparing the factorial structure, invariance, and predictive validity of Transtheoretical model constructs for alcohol use across restricted and unrestricted settings. Dissertation Abstracts International: Section B: The Sciences and Engineering, 66, 3094).

Items of the Processes of Change Questionnaire- Alcohol version

40 item version

1. I do something nice for myself for making efforts to change.
2. I can talk with at least one special person about my drinking experiences.
3. I get upset when I think about illnesses caused by drinking.
4. I see signs in some public places trying to help people not drink.
5. I stop to think about how my drinking is hurting people around me.
6. I consider that feeling good about myself includes changing my drinking behavior.
7. I remove things from my home or work that remind me of drinking.
8. I calm myself when I get the urge to drink.
9. I reward myself when I don’t give in to my urge to drink.
10. I have someone to talk with who understands my problems with alcohol.
11. Warnings about the health hazards of drinking have an emotional effect on me.
12. I use will power to stop from drinking.
13. I notice that people with alcohol problems are making known their desire not to be pressed to drink.
14. I am considering the idea that people around me would be better off without my problem drinking.
15. I read newspaper stories that may help me quit drinking.
16. I avoid situations that encourage me to drink.
17. I try to think about other things when I begin to think about drinking.
18. I have someone who listens when I want to talk about my drinking.
19. Stories about alcohol and its effects upset me.
20. I make myself aware that I can choose to overcome my drinking if I want to.
21. I find society changing in ways that make it easier for me to overcome my drinking problem.
22. I have strong feelings about how much my drinking has hurt the people I care about.
23. I become disappointed with myself when I depend on alcohol.
24. I look for information related to problem drinking.
25. I use reminders to help me not to drink.
26. I do something else instead of drinking when I need to deal with tension.
27. I don’t let myself have fun when I drink.
28. I have someone whom I can count on to help me when I’m having problems with drinking.
29. I read newspaper stories that can affect me emotionally about my drinking.
30. I tell myself that if I try hard enough I can keep from drinking.
31. I stop and think that my drinking is causing problems for other people.
32. I feel more competent when I decide not to drink.
33. I seek out groups of people who can increase my awareness about the problems of drinking.
34. I stay away from places generally associated with my drinking.
35. I find that doing things is a good substitute for drinking.
36. I spend time with people who reward me for not drinking.
37. I make commitments to myself not to drink.
38. I see advertisements on television about how society is trying to help people not drink.
39. I think about the type of person I will be if I control my drinking.
40. I think about information that people have personally given me on the benefits of quitting drinking.

20 item version

1. I reward myself when I don’t give in to my urge to use drink.
2. I have someone to talk with who understands my problems with alcohol.
3. I get upset when I think about illnesses caused by drinking.
4. I am considering the idea that people around me would be better off without my problem drinking.
5. I read newspaper stories that may help me quit drinking.
6. I try to think about other things when I begin to think about drinking.
7. I find society changing in ways that make it easier for me to overcome my drinking problem.
8. I become disappointed with myself when I depend on alcohol.
9. I look for information related to problem drinking.
10. I use reminders to help me not to drink.
11. I have someone whom I can count on to help me when I’m having problems with drinking.
12. Stories about alcohol and its effects upset me.
13. I tell myself that if I try hard enough I can keep from drinking.
14. I stop to think about how my drinking is hurting people around me.
15. I feel more competent when I decide not to drink.
16. I stay away from places generally associated with my drinking.
17. I find that doing things is a good substitute for drinking.
18. I spend time with people who reward me for not drinking.
19. I make commitments to myself not to drink.
20. I see advertisements on television about how society is trying to help people not drink.

20 item version- DELTA PROJECT

1. I get upset when I think about illnesses caused by drinking.
2. I stop to think about how my drinking is hurting people around me.
3. I reward myself when I don’t give in to my urge to drink too much.
4. I have someone to talk with who understands my problems with alcohol.
5. I am considering the idea that people around me would be better off without my problem drinking.
6. I read newspaper stories that may help me avoid drinking too much.
7. I try to think about other things when I begin to think about drinking.
8. Stories about alcohol and its effects upset me.
9. I find society changing in ways that make it easier for me to overcome my drinking problem.
10. I become disappointed with myself when I depend on alcohol.
11. I look for information related to problem drinking.
12. I use reminders to help me not to drink.
13. I have someone whom I can count on to help me when I’m having problems with drinking.
14. I tell myself that if I try hard enough I can keep from drinking.
15. I feel more competent when I decide not to drink.
16. I stay away from places generally associated with my drinking.
17. I find that doing things is a good substitute for drinking.
18. I spend time with people who reward me for not drinking.
19. I make commitments to myself not to drink.
20. I see advertisements on television about how society is trying to help people not drink.