Measuring Readiness to Change with SOCRATES

Readiness to change is a crucial element influencing an alcoholic or drug user to seek out, follow and complete treatment. In order to change their substance abusing behaviour, a client must reach a state of readiness and willingness to change. For some alcoholics and drug users, a breaking point may occur in order to motivate a desire for change. However, motivation for changing problem behaviours is not synonymous with motivation for participating in treatment. Many clients enter treatment under pressure from family and friends. Although these clients enter treatment, they may not be ready to change and a relapse may occur. In order to determine the state of a person’s present motivation, a quick assessment can be done with the Stages of Change Readiness and Treatment Eagerness Scale SOCRARTES.

Stages of Change Readiness and Treatment Eagerness Scale

The Stages of Change Readiness and Treatment Eagerness Scale SOCRARTES was developed in 1996 by William R. Miller and J. Scott Tonigan. It is meant to measure a substance abusers current state of readiness for change. SOCRARTES is a 19 item self-report that breaks down readiness for change into 3 main scales: Recognition, Ambivalence, and Taking Steps. The items are scored on a 5-point system and then summed according to one of the 3 scales. The questionnaire takes approximately 3 minutes to complete and there is no training required to administer it.

SOCRARTES is used by clinicians to identify a client’s readiness or willingness to change. It indicates where the client is on the continuum between not prepared to change and already changing. Clients in the pre-contemplation stage are more likely to deny that they have a problem. Conversely, clients in the preparation and action stages are more likely to admit that they have a drinking problem. Determining where a client is on the scale provides valuable information for treatment planning. It also promotes a discussion to perceived barriers of change.

SOCRATES Questionnaires

There are two types of SOCRATES questionnaires. One is used to assess personal drinking and the other for personal drug use. Both are openly available to the public and may be self-administered. A copy of the SOCRATES Personal Drinking questionnaire is available online. In each questionnaire, there are 19 statements used to determine a client’s state of readiness for change. The following 5-point system is used to indicate how much they agree or disagree with each statement right now.

* 1 for NO! Strongly Disagree
* 2 for Disagree
* 3 for ? Undecided or unsure
* 4 for Yes Agree
* 5 for YES! Strongly Agree

SOCRATES Scoring Form

Once the questionnaire is completed, the scores are then transferred to the Socrates Profile Sheet. The questions are sorted and added up according to the three separate scales. Each scale contains a certain number of items to derive a raw score. They are as follows: Recognition (7 items), Ambivalence (4 items) and Taking Steps (8 items). The profile sheet is used to determine whether the client’s scores are low, average, or high relative to people already seeking treatment for substance abuse.

SOCRATES Profile Sheet

The following is a list of guidelines for interpreting a client’s score:

Recognition
* Recognition high scorers acknowledge that they are experiencing problems related to their drinking. They express a desire for change and see that they will continue to harm themselves if they do not change.
* Recognition low scorers deny that alcohol is causing them serious problems. They reject diagnostic labels such as problem drinker and alcoholic. They do not express a desire for change.

Ambivalence
* Ambivalence high scorers say that they sometimes wonder if they are in control of their drinking. They reflect on whether they are drinking too much and are hurting other people. They experience ambivalence or uncertainty and contemplate change.
* Ambivalence low scorers say that they do not wonder whether they drink too much. They tend not to think about how their behaviour might be hurting others, or whether they are an alcoholic. It’s important to note that the Ambivalence score should be interpreted in relation to the Recognition score.

Taking Steps
* Taking Steps high scorers report that they are already doing things to make a positive change in their drinking. It is evident that change is underway, and they may seek out help to persist and prevent relapse.
* Taking Steps low scorers report that they are currently not doing anything to change their drinking.

Study Results of SOCRATES

Overall, various studies have determined that SOCRATES is a useful instrument for assessing a client’s readiness for change. SOCRATES has demonstrated excellent test retesting and produced adequate internal consistency, thus making it a reliable and valid instrument. Researchers conclude that a client’s readiness to change is an important predictor of long-term treatment outcomes.

One study in particular notes that individuals who abuse multiple substances may vary in their readiness for change, in both alcohol and drugs. Therefore, it is important to administer each form of the SOCRATES when a client is abusing more than one type of substance. Often treatment programs focus on treating one substance, usually alcohol. By measuring a client’s readiness to change separately in alcohol and drug abuse, appropriate treatment planning and goals setting can be made to affect both areas.

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