Direct Questioning

Perhaps the simplest way to assess readiness to change of a person who drinks is through direct questioning during the assessment interview. This should be done after risky alcohol consumption has been discussed, and the patient has received feedback on their level of drinking. Questions should avoid seeming judgmental or adversarial. Some questions that might prove useful are: 

• • • ‘How interested are you in changing your drinking now?’ 

    • ‘Do you feel that you ought to stop drinking’, or ‘Do you want to stop drinking now?’ 

    • ‘What would you be prepared to do to solve this drinking problem?’ 

    • ‘How confident are you that you can achieve this?’ 

The patient may be encouraged to explore the various treatment options from the perspective of motivation to participate. Alternatively, the patient may simply be asked: ‘How do you feel about your drinking at the moment?’ Responses may vary from: 

• • • Pre-contemplative responses such as, ‘I enjoy drinking’, ‘I’m not interested in stopping drinking’. 

    • Contemplative responses such as, ‘I’m thinking about stopping’, ‘I’m not sure if I’m ready at the moment’. 

    • Action-oriented responses such as, ‘I want to stop now’, ‘I may need some help’, or ‘The disadvantages of drinking outweigh the benefits for me’. 

Several questionnaires have been validated to assess the readiness to change of a person who drinks; they are the University of Rhode Island Change Assessment (URICA) scale, the Readiness to Change Questionnaire (RTCQ) and the 32-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). These are generally reserved for research use (see Appendix). 

It would be counterproductive to over-emphasise the assessment of motivation, as the expressed level of motivation does not predict outcome in every case. The stages of motivation are not mutually exclusive and may fluctuate quickly. There is little evidence of sequential movement through discrete stages. Many patients express highly selective motivation; for example, they may want to stop drinking, but not see a clinician. 

Finally, ambivalence is a key characteristic of the risky drinking population, characterised by simultaneously being motivated in apparently opposing directions. For example, a patient may say that he still enjoys drinking but acknowledges he has been advised to abstain. Hence, it is not surprising that there is evidence that greater expressed readiness to change is not always predictive of reduced alcohol consumption.