SOCRATES

Stages of Change Readiness and Treatment Eagerness Scale

Assessment for Judicial Alcohol Offenders
Fall 2004 & Spring 2005

Introduction
Change Theory and The Office of Judicial Affairs
The Five Stages of Change
Sample Assessment Tool
More about the SOCRATES
Guidelines for Interpreting the SOCRATES
Results
Action Plan Based on Results

Introduction

The Mission of the Office of Judicial Affairs at James Madison University states: We are committed to promoting student learning, civic responsibility and, in partnership with others, developing the environment necessary for the university to best achieve its educational mission.

Part of the purpose of any discipline system would be to hopefully modify behavior or, at best, change behavior to meet the acceptable guidelines of the given community. In the beginning we were told you can not assess judicial affairs. There are too many other factors going on. There is no way to tell if judicial affairs has any effect on a student’s behavior. In an ongoing effort (seems more like a life long quest) to give an overall assessment of the behavior change that occurs through the entire judicial process, that is the hearing through completion of educational sanction, the office adopted the SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) assessment.

The SOCRATES instrument is designed to assess an individual’s motivation to change behavior regarding alcohol use. This assessment of motivation to change as opposed to actual behavior change seems to fit well with the population entering the judicial process. Remember, these students do not choose to enter our office and complete our educational programs. Motivation is a key factor in influencing them to begin to make some lifestyle changes in regards to alcohol use. The Office of Judicial Affairs administers this pre-assessment the moment a student comes into the office for an administrative option hearing regarding alcohol. The post assessment is given upon completion of the any educational programs, including: By the Numbers alcohol workshop, Calling the Shots alcohol workshop, Back on Track, and Civic Learning. All of these programs are described on our website under “Educational Programs.”

Change Theory and The Office of Judicial Affairs

For students violating the alcohol policy, the Office of Judicial Affairs incorporates components of the Transtheoretical Model of Behavior Change (Prochaska and DiClemente) in both the judicial process and educational sanctions. Judicial hearing officers and program facilitators are trained in the Stages of Change Model. Below is a description of the major tenants of the theory.

Transtheoretical Model of Behavioral Change
(Prochaska and DiClemente, 1984)

Some Assumptions:

1. Change does not happen all at once—it is a process.
2. We can exert some power over the course of our lives.
3. We can change behaviors, thoughts and feelings.
4. All change is self-change.

1. The change process starts with a person who is unaware of any need to change—if there is a problem. The person probably ignores it or considers it unimportant
(We feel that this fits well with the students who enter the Office of Judicial Affairs for an alcohol violation. First and foremost they are NOT coming in by choice.)

2. When the problem can no longer be ignored, he or she then considers what can be done about it.

3. If the problem continued to grow in importance, definite plans to change are made.

4. Once the person’s mental, physical, and social forces have been gathered, he or she begins to struggle with the problem, taking action to make a change.

5. If the person succeeds, he or she works at maintaining the new behavior.

Sometimes people “slip” (relapse) back into the problem behavior.

“Decisional balance” is a person’s assessment of the positives (good things) and the negatives (less good things) of a specific behavior.

 

The Five Stages of Change

Precontemplation – not seeing a problem
Contemplation – seeing a problem and considering whether to act
Preparation – making concrete plans to act soon
Action – doing something to change
Maintenance – working to maintain the change

“Do the right thing at the right time.” (intentional and matched interventions)

Source: Velasquez, M. M., Maurer G. G, Crouch, C. & DiClemente, C. C. (2001). Group treatment for substance abuse: A stages-of-change therapy manual (pp. 7-13). New York: Guilford Press.

Common Characteristics of Individuals in the PRECONTEMPLATION Stage
• Defensive
• Resistant to suggestion of problem associated with their alcohol or drug use
• Uncommitted or passive in treatment
• Consciously or unconsciously avoiding steps to change their behavior
• Lacking awareness of problem
• Often pressured by others to seek treatment
• Feeling coerced by significant others

(We feel that this stage is common among the students who enter the Office of Judicial Affairs for violating JMU’s alcohol policy. Remember they are NOT here by choice.)

Common sentiments among students for minor alcohol violations are:
“Every one else is doing it!”
“I just got unlucky and got caught!”
“The police in this town hate college students!”
“The RA is out to get me, that’s the only reason I got in trouble.”

Common Characteristics of Individuals in the CONTEMPLATION Stage
• Seeking to evaluate and understand their behavior
• Distressed
• Desirous of exerting control or mastery
• Thinking about making a change
• Have not begun to take action and are not yet prepared to do so
• Frequently have made attempts to change the past
• Evaluating pros and cons of their behavior and of making changes in it

Common Characteristics of Individuals in the PREPARATION Stage
• Intending to change their behavior
• Ready to change in terms of both attitude and behavior
• On the verge of taking action
• Engaged in the change process
• Prepared to make a firm commitment to follow through on the action option they choose
• Making or having made the decision to change

Common Characteristics of Individuals in the ACTION Stage
• Individual has decided to make a change
• Individual has verbalized or otherwise demonstrated a firm commitment to making change
• Efforts to modify behavior and/or one’s environment are being taken
• Individual presents motivation and effort to achieve behavioral change
• Individual has committed to making change and is involved
• Individual is willing to follow suggested strategies and activities to change

Common Characteristics of Individuals in the MAINTENCE Stage
• Individual is working to sustain changes achieved to date
• Considerable attention is focused on avoiding “slips” or relapses
• Individual may describe fear or anxiety regarding relapse and facing a high risk for relapse situation
• Less frequent but often intense temptations to use substances or return to substance use may be faced

Source: Connors, G. J., Donovan, D. M., & DiClemente, C.C. (2001). Substance abuse treatment and the stages of change: selecting and planning interventions (pp. 13-31). New York: Guilford Press.

Sample Assessment Tool

Confidential Drinking Questionnaire
(SOCRATES Pre-Assessment)

INSTRUCTIONS: This is confidential and will NOT be used to decide your judicial case. Before starting the assessment, fill in your student ID number on the scantron sheet and write Pre-Test at the top. Questions continued on the back.

1. How many times a week, on average, do you drink?
A) Less than 1
B) 1
C) 2
D) 3
E) 4 or more

2. When you do drink, how many drinks, on average, do you consume in one evening?
A) 0
B) 1-2
C) 3-5
D) 6-9
E) 10 or more

3. For the last week please fill in all the bubbles that apply:
A) I have blacked out from drinking
B) Drinking has affected my relationship w/others
C) Drinking has affected my academics
D) I drank more than originally intended
E) None of the above

4. For the last week please fill in all the bubbles that apply:
A) I have refused alcohol
B) I have limited my number of drinks
C) I stayed in while my friends drank
D) I have avoided high risk situations regarding alcohol
E) None of the above

Please read the following statements carefully. Each one describes a way that you might (or might not) feel about your drinking. For each statement, fill in one bubble from A to E, to indicate how much you agree or disagree with it right now.

 

	NO! Strongly Disagree	No Disagree	? Undecided or Unsure	Yes Agree	YES! Strongly Agree
5.  I really want to make changes in my drinking.	A	B	C	D	E
6.  Sometimes I wonder if I am an alcoholic.	A	B	C	D	E
7.  If I don’t change my drinking soon, my problems are going to get worse.	A	B	C	D	E
8.  I have already started making some changes in my drinking.	A	B	C	D	E
9.  I was drinking too much at one time, but I’ve managed to change my drinking.	A	B	C	D	E
10.  Sometimes I wonder if my drinking is hurting other people.	A	B	C	D	E
11.  I am a problem drinker.	A	B	C	D	E
12.  I’m not just thinking about changing my drinking, I’m already doing something about it.	A	B	C	D	E
13.  I have already changed my drinking, and I am looking for ways to keep from slipping back to my old pattern.	A	B	C	D	E
14.  I have serious problems with drinking.	A	B	C	D	E
15.  Sometimes I wonder if I am in control of my drinking.	A	B	C	D	E
16. My drinking is causing a lot of harm.	A	B	C	D	E
17.  I am actively doing things now to cut down or stop drinking.	A	B	C	D	E
18.  I want help to keep from going back to the drinking problems that I had before.	A	B	C	D	E
19.  I know that I have a drinking problem.	A	B	C	D	E
20.  There are times when I wonder if I drink too much.	A	B	C	D	E
21.  I am an alcoholic.	A	B	C	D	E
22.  I am working hard to change my drinking.	A	B	C	D	E
23.  I have made some changes in my drinking, and I want some help to keep from going back to the way I used to drink.	A	B	C	D	E

 

More About the SOCRATES

SOCRATES is an experimental instrument designed to assess readiness for change in alcohol abusers. The instrumentyields three factorially-derived scale scores: Recognition (Re), Ambivalence (Am), and Taking Steps (Ts). It is a public domain instrument and may be used without special permission.Answers are to be recorded directly on the questionnaire form. Scoring is accomplished by transferring to the SOCRATES Scoring Form the numbers circled by the respondent for each item. The sum of each column yields the three scale scores. Data entry screens and scoring routines are available.These instruments are provided for research uses only. Version 8 is a reduced 19-item scale based on factor analyses with prior versions. The shorter form was developed using the items that most strongly marked each factor. The 19-item scale scores are highly related to the longer (39 item) scale for Recognition (r = .96), Taking Steps (.94), and Ambivalence (.88).

 

Guidelines for Interpreting the SOCRATES

RECOGNITION

HIGH scorers directly acknowledge that they are having problems related to their drinking, tending to express a desire for change and to perceive that harm will continue if they do not change.

LOW scorers deny that alcohol is causing them serious problems, reject diagnostic labels such as “problem drinker” and “alcoholic,” and do not express a desire for change.

AMBIVALENCE

HIGH scorers say that they sometimes wonder if they are in control of their drinking, are drinking too much, are hurting other people, and/or are alcoholic. Thus a high score reflects ambivalence or uncertainty. A high score here reflects some openness to reflection, as might be particularly expected in the contemplation stage of change.

LOW scorers say that they do not wonder whether they drink too much, are in control, arehurting others, or are alcoholic. Note that a person may score low on ambialence eitherbecause they “know” their drinking is causing problems (high Recognition), or because they “know” that they do not have drinking problems (low Recognition). Thus a low Ambivalencescore should be interpreted in relation to the Recognition score.

TAKING STEPS

HIGH scorers report that they are already doing things to make a positive change in theirdrinking, and may have experienced some success in this regard. Change is underway, and they may want help to persist or to prevent backsliding. A high score on this scale has been found to be predictive of successful change.

LOW scorers report that they are not currently doing things to change their drinking, and havenot made such changes recently.

Results

(Courtesy of Center for Assessment and Research Studies):
Note: End of the year report will include larger sample size, Civic Learning as a sanction, and Back on Track sanctioned alcohol program)

SOCRATES Alcohol Use Survey
Results Report – December 2004
Pamela Kaliski, Jeanne Horst, and Sara Finney

Introduction

The following report describes responses from students who were sanctioned to participate in two alcohol abuse intervention programs offered through the Office of Judicial Affairs: By the Numbers and Calling the Shots. The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) was administered before and after participation in the programs.

Instrumentation

The SOCRATES is a 19-item instrument that was developed as a measure of motivation for change in alcohol use. There are three subscales, representing three stages of change: ambivalence, recognition, and taking steps. (Table 1 outlines definitions of the subscales). Students respond to items on a scale of 1 (NO! Strongly Disagree), 2 (No Disagree), 3 (? Undecided or Unsure), 4 (Yes Agree), or 5 (YES! Strongly Agree).

One item from the Recognition subscale (item 12 on the current scale, which was item 13 on the original scale) was inadvertently omitted from the pre-test. Consequently, rather than the original seven items on the subscale, six items from the Recognition subscale were analyzed for this report.

Table 1

SOCRATES Subscales Defined

Subscale	High Score	Low Score	Number of Items
Ambivalence1	Ambivalence; uncertainty about drinking habits	Certainty about drinking habits	4
Recognition	Acknowledgement of problem & desire for change	Denial of problem	62
Taking Steps	Concrete efforts to change behavior & maintain changes through prevention	No efforts to change	8

Note: 1Ambivalence should be interpreted in relation to scores on recognition. A person may score low on ambivalence either because they “know” their drinking is causing problems (high recognition), or because they “know” that they do not have drinking problems (low recognition). 2There were seven items on the original Recognition subscale; however, because one item was inadvertently omitted from the pre-test, the current report will include six items.

Samples
Responses to the SOCRATES were obtained prior to enrollment in the programs (pre-test), and after participation in the assigned program (post-test). There were 73 students who had completed a post-test but not a pre-test. Of these 73 students, 10 of them had only partial data on the post-test; therefore, there were 63 students who had complete data on the post-test, but no pre-test. Data from 8 participants were deleted from the pre-test data set, due to missing or improper identification numbers. Data from 7 participants were deleted from the post-test data set for the same reason. Listwise deletion was performed, which means that the data set included only responses from students with complete data on both the pre-test and the post-test (those with missing data were not included in the sample.) Figure 1 includes a Venn Diagram representing the sample sizes of those with pre-test data (n = 336), those with post-test data (n = 219), and those with both pre- and post-test data (n = 138). The analyses for the rest of this report will include only the 138 participants who had complete data on the pre- and post-tests. Table 2 shows the number of male and female students by year in school with complete data on both pre- and post-tests. A total of 74 (53.6%) females and 64 (46.4%) males had complete data on both pre- and post-test. Most of the sample consisted of first- and second-year students (95%).

Table 2

Year in School by Gender of Students with both Pre- and Post-Test Data

	1st Year	2nd Year	3rd Year	4th Year	Total
Males	57(41%)	15(11%)	1(.8%)	1(.8%)	74(53.6%)
Females	45(33%)	14(10%)	5(3.4%)	0	64(46.4%)
Total	102(74%)	29(21%)	6(4.2%)	1(.8%)	138(100%)

Programs in Judicial Affairs
“By the Numbers”, Calling the Shots”, and “Back on Track” are the three different alcohol intervention programs offered by Judicial Affairs. “Back on Track” is the highest level of judicial services, followed by “Calling the Shots”, followed by “By the Numbers”, the lowest level of judicial services. As illustrated in Table 3, the majority of participants in this sample were sanctioned to “By the Numbers”, with the remaining participants sanctioned to “Calling the Shots”; therefore, this report does not apply to students sanctioned to the highest level of judicial services (“Back on Track”). Figure 2 graphically illustrates the number of program participants with complete pre-post data.

Table 3

Number or Program Participants

	Frequency	Percent
By the Numbers	127	92.0
Calling the Shots	11	8.0
Total	138	100.0

Figure 2. Program Participants with Complete Pre-Post Data

Relationships Between the Subscales on the SOCRATES
The relationships between the three SOCRATES subscales were examined. Table 4 includes the correlations between the individual subscales, with values for the pre-test above the diagonal and values for the post-test below the diagonal. Correlations are examined in terms of their magnitude and their sign. Disregarding the sign, a high correlation suggests a stronger relationship and that the two variables share something in common with one another. Positive values indicate that as scores on one subscale increase, the scores on the other subscales tend to also increase. Likewise, as scores on one subscale decrease, the scores on the other subscale tend to decrease. The squared value of the correlation indicates the percent of shared variance between the two variables. It would be interesting to further discuss these findings together with you; this would assist in our ability to decide in appropriate analyses in the future.

The correlations between scores from the Recognition and Ambivalence subscales were similar and moderately high on both pre- and post-test. Squaring the correlation, scores from the Recognition and Ambivalence subscales shared 58% of the others’ variance. In other words, these two subscales are highly related, to the extent that if a student highly endorses an item on the one scale, it is likely that the student highly endorses an item on the other, and vice versa. Correlations were lower and moderate between responses to Recognition and Taking Steps subscales, and between Ambivalence and Taking Steps subscales.

Table 4

Intercorrelations among Subscales

	Ambivalence	Recognition	Taking Steps
Ambivalence	1.00	.767	.476
Recognition	.763	1.00	.622
Taking Steps	.492	.569	1.00

Note. The values above the diagonal represent correlations between the pre-test subscales. Values below the diagonal represent correlations between the post-test subscales.

Descriptive Statistics and Reliability Estimates for SOCRATES Scores

The means (i.e., averages), standard deviations and reliability of the scores from each of the individual subscales were estimated for both pre- and post-test data (See Table 5). The mean* represents the average response on the scale of the items, which ranges from 1 to 5. Because the three subscales are comprised of a different number of items, examining the means on an item level (mean*) enables more direct comparison of responses to the individual items. Note that the average (mean*) response to the Ambivalence subscale was similar to the average (mean*) response to the Recognition subscales on both pre- and post-test. Average (mean*) responses to Ambivalence and Recognition items were lower than the average (mean*) responses to the Taking Steps items on both pre- and post-test.

In other words, students responded similarly to items on the Ambivalence and Recognition subscales, but endorsed them less than the Taking Steps items. Students responded on the lower end of the 1 to 5 response scale. This may suggest that the content of the items, particularly on the Ambivalence and Recognition scales may not be applicable for this population. Figure 3 graphically portrays the averages (means*) on the scale of the item from pre- to post-test. The higher endorsement of the Taking Steps subscale in comparison to the Ambivalence and Recognition subscales may be due to a social desirability bias; in other words, these students may feel that they should respond in this manner because they are in the program.

Higher reliability estimates, specifically those greater than .70, suggest that items on a subscale are highly related to one another. Low values indicate that the responses to items on the same subscale are not consistent. Typically, scores from subscales with more items tend to have higher reliability estimates; the same patterns were demonstrated in this data. As illustrated in Table 5, the reliabilities of the subscales on both the pre-test and the post-test were all greater than .70; therefore, the responses to items on each of the subscales displayed adequate internal consistency.

Because an item was missing from the Recognition subscale, the reliability of the scores from the remaining 6 items on the subscale was a concern. However, reliability estimates for the Recognition subscale on the post-test only decreased from .84 (when analyzed with item 12 from the current scale) to .81 (when analyzed without item 12 from the current scale). This suggests that scores from the post-test Recognition subscale remained internally consistent, despite the loss of one item.

 Table 5

Descriptive Statistics and Reliability Estimates from both the Pre- and Post-test Scores

	Pre-test			Post-test
	Ambivalence	Recognition	Taking Steps	Ambivalence	Recognition	Taking Steps
Mean	6.54	9.84	21.98	6.41	9.37	19.44
Standard Deviation	2.71	3.06	7.11	2.82	3.41	7.92
Possible Range	4 - 20	6 - 30	8 - 40	4 - 20	6 - 30	8 - 40
Mean*	1.63	1.64	2.75	1.60	1.56	2.43
Standard Deviation*	.68	.51	.89	.70	.57	.99
Possible Range*	1 - 5	1 - 5	1 - 5	1 - 5	1 - 5	1 - 5
N	138	138	138	138	138	138
Reliability (Coefficient alpha)	.75	.76	.89	.79	.81	.93

Note. Mean*, standard deviation*, and possible range* are on the scale of the items (1 – 5). The Recognition Subscale does not include Item 12 on either scale.

Figure 3. Average Pre-Post Response to Subscale Items

Note. Because there are varying numbers of items on the three subscales, averages (Means*) are presented on the scale of the item. This enables comparison across subscales.

Frequency of Response Categories to Individual Items

Frequencies of responses to individual items, both pre- and post- are included in Table 6. Students tended to respond on the lower end of the scale on both Recognition and Ambivalence Subscales. Frequency of response was similar from pre- to post-test.

Table 6 Frequency of response to individual items (pre/post)
AMBIVALENCE SUBSCALE ITEMS	NO! Strongly Disagree	No, Disagree	?, Undecided or Unsure	Yes, Agree	YES! Strongly Agree
Sometimes I wonder if I am an alcoholic.	108/106	24/21	4/5	2/4	0/2
Sometimes I wonder if my drinking is hurting other people.	70/75	44/40	16/15