Serafini Kelly, Shipley Leandra, Stewart David G
Yale University School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States.
VA Puget Sound Health Care System, Seattle, WA 98108, United States.
Addict Behav. 2016 Feb;53:74-9. doi: 10.1016/j.addbeh.2015.10.004. Epub 2015 Oct 9.
The stages of change (Precontemplation, Contemplation, Preparation, Action, and Maintenance) have been well studied in adult populations. However, fewer studies have examined how the stages of change are related to adolescent substance use. Furthermore, there have been no studies that have examined how the stages of change relate to outcomes in a school-based intervention. To better capture adolescent motivation, we added an additional group to the Transtheoretical Model of Change, which we titled Coerced Action, to represent adolescents that made changes to their substance use despite low problem recognition (representing the internal motivation of Precontemplation and the change behaviors of the Action group). We then examined how the stages of change were related to a thorough assessment of substance use at baseline and corresponding treatment outcomes. Our sample consisted of 264 adolescents (mean age: 16.1, 44.5% Caucasian, 37.5% female) who participated in an 8-week, school-based Motivational Enhancement intervention. Results indicated significant group differences across the stages of change in substance use patterns (alcohol use, negative consequences, affective dysregulation), as well as treatment outcomes (alcohol use and negative consequences). For instance, adolescents in the Action group demonstrated more negative consequences at 16weeks follow-up than those in Precontemplation and Coerced Action, F(1, 3)=8.23, p<.001. The Coerced Action group reported the most alcohol use at 16weeks follow-up, although the finding was not significant when post-hoc tests were conducted. This study provides meaningful support for the assessment of motivation among adolescent substance users within school-based settings.
行为改变阶段（前思考期、思考期、准备期、行动期和维持期）在成年人群体中已得到充分研究。然而，较少有研究探讨行为改变阶段与青少年物质使用之间的关系。此外，尚无研究考察行为改变阶段与基于学校的干预措施的结果之间的关联。为了更好地把握青少年的动机，我们在跨理论行为改变模型中增加了一个额外的组别，我们将其命名为“强制行动组”，以代表那些尽管对问题的认知程度较低，但仍对其物质使用行为做出改变的青少年（这代表了前思考期的内在动机和行动组的改变行为）。然后，我们考察了行为改变阶段与基线时对物质使用的全面评估以及相应治疗结果之间的关系。我们的样本包括264名青少年（平均年龄：16.1岁，44.5%为白种人，37.5%为女性），他们参与了一项为期8周的、基于学校的动机增强干预。结果表明，在物质使用模式（饮酒、负面后果、情感失调）的行为改变阶段以及治疗结果（饮酒和负面后果）方面存在显著的组间差异。例如，行动组的青少年在16周随访时表现出比前思考组和强制行动组更多的负面后果，F(1, 3)=8.23, p<.001。强制行动组在16周随访时报告的饮酒量最多，尽管在进行事后检验时这一发现并不显著。本研究为在基于学校的环境中评估青少年物质使用者的动机提供了有意义的支持。
