Alcohol Decisional Balance Scales

Abstract

The Alcohol Decisional Balance Scale (ADBS) is a foundational psychometric instrument developed within the conceptual framework of the Transtheoretical Model (TTM) of health behavior change, formulated by James O. Prochaska and Carlo C. DiClemente. Adapted from Irving Janis and Leon Mann’s seminal conflict theory of decision-making, the ADBS systematically quantifies the cognitive appraisals, motivational drivers, and perceived trade-offs that individuals experience regarding their alcohol consumption. The standard instrument comprises 20 self-report items distributed across two core, theoretically derived orthogonal dimensions: the Pros of Drinking (evaluating perceived positive reinforcements, emotional coping mechanisms, and social facilitation) and the Cons of Drinking (capturing interpersonal conflict, functional impairment, social disapproval, and cognitive dissonance). A validated 10-item brief version, known as the DELTA Version, provides an abbreviated five-item per dimension assessment optimized for rapid clinical and longitudinal research protocols. Respondents rate the personal importance of each item in their decision-making process using a 5-point Likert scale ranging from 1 (“Not important at all”) to 5 (“Extremely important”). Psychometric evaluations across clinical addiction settings, psychiatric outpatient clinics, and college drinking populations demonstrate high internal consistency (Cronbach’s alpha coefficients routinely between 0.85 and 0.92 for both subscales), stable test-retest reliability, robust structural invariance, and marked predictive validity regarding stage-of-change transitions, treatment completion, and drinking reduction. By capturing the pivotal cognitive “crossover” where the perceived cons of drinking come to outweigh its pros, the ADBS serves as an indispensable diagnostic and prognostic tool in motivational interviewing, harm reduction, and evidence-based addiction therapeutics.

Keywords

Alcohol Decisional Balance Scale, ADBS, Transtheoretical Model, Stages of Change, Motivation to Change, Pros and Cons of Drinking, Decisional Balance, Addiction Psychometrics, Alcohol Use Disorder, Harm Reduction, Motivational Interviewing, Cognitive Appraisal

Authors

The conceptualization and psychometric operationalization of the Alcohol Decisional Balance Scale emerged from collaborative investigations conducted by prominent behavioral psychologists and clinical addiction researchers affiliated with the University of Rhode Island’s Cancer Prevention Research Center (CPRC) and the University of Maryland, Baltimore County (UMBC):

• Carlo C. DiClemente, Ph.D. — Emeritus Professor of Psychology at the University of Maryland, Baltimore County (UMBC); co-developer of the Transtheoretical Model and principal investigator on multiple National Institute on Alcohol Abuse and Alcoholism (NIAAA) projects examining processes of change in alcoholism.
• Wayne F. Velicer, Ph.D. (1944–2017) — Former Professor of Psychology and Co-Director of the Cancer Prevention Research Center at the University of Rhode Island; leading quantitative psychologist specializing in factor analysis, measurement invariance, and longitudinal modeling of behavioral change.
• James O. Prochaska, Ph.D. (1942–2023) — Former Professor of Clinical and Health Psychology and Director of the Cancer Prevention Research Center at the University of Rhode Island; pioneer of the Transtheoretical Model.
• Joseph P. Carbonari, Ed.D. — Professor of Psychology at the University of Houston; psychometrician and contributor to clinical trials evaluating stage-matched treatments for alcohol dependency.
• Mary M. Velasquez, Ph.D. — Centennial Commission Professor in the Steve Hicks School of Social Work and Director of the Health Behavior Research and Training Institute at the University of Texas at Austin; specialist in behavioral interventions and addiction counseling.

Purpose

The Alcohol Decisional Balance Scale was engineered to resolve a critical diagnostic and therapeutic challenge in substance use treatment: assessing an individual’s intrinsic motivational state and cognitive ambivalence without relying solely on consumption metrics or diagnostic symptom checklists. Traditional assessments of alcohol use disorder (such as volumetric tallies of standard drinks or inventories of physiological dependence) frequently fail to capture the underlying cognitive-affective deliberations that determine whether an individual is ready to modify their behavior, dismissive of intervention, or actively seeking change.

The explicit clinical and empirical objectives of the ADBS include:

• Quantifying Motivational Ambivalence: Ambivalence is a hallmark of substance misuse. By measuring the personal importance of both the subjective rewards (pros) and the adverse consequences (cons) of drinking simultaneously, the instrument captures the dynamic cognitive tension experienced by individuals throughout different phases of change.
• Identifying Stage of Change: In accordance with the Transtheoretical Model, the relative balance between Pros and Cons correlates systematically with an individual’s current stage of change (Precontemplation, Contemplation, Preparation, Action, or Maintenance). The ADBS allows clinicians to pinpoint whether a patient remains entrenched in Precontemplation (where pros substantially exceed cons) or has progressed into Contemplation or Preparation.
• Facilitating Stage-Matched Clinical Interventions: Applying interventions suited for individuals in the Action stage (e.g., behavioral action planning, stimulus control) to patients in Precontemplation frequently generates clinical resistance and premature dropout. The ADBS provides clinicians with actionable targets: for early-stage individuals, therapy focuses on raising awareness of the “Cons” rather than prematurely enforcing behavioral cessation.
• Guiding Motivational Interviewing (MI): Practitioners of motivational interviewing utilize ADBS profiles to explore discrepancy, elicit change talk, and process counter-change arguments, allowing patients to articulate how their alcohol use conflicts with personal values, vocational goals, and familial health.
• Tracking Longitudinal Treatment Trajectories: Administered repeatedly across the trajectory of outpatient or residential treatment, the scale tracks cognitive shifts. An upward movement in the perceived importance of Cons alongside a downward trend in the valuation of Pros serves as a robust proxy for therapeutic progress and a hedge against prospective relapse.

Psychological Construct

The psychological construct evaluated by the ADBS is decisional balance regarding alcohol consumption. Decisional balance represents an individual’s cognitive weighing of the positive and negative consequences associated with continuing or modifying a specific health-risk behavior. Rather than conceptualizing decision-making as a purely rational, economic calculation, the construct acknowledges that perceived benefits and costs are highly subjective, emotionally valenced, and shaped by experiential learning, social reinforcement, and coping mechanisms.

The Pros of Drinking Dimension

The Pros of Drinking subscale assesses the subjective value and utility an individual attributes to consuming alcohol. In substance use disorders, positive expectancies and functional reliance sustain behavioral persistence despite accumulating negative outcomes. Within the ADBS, the Pros dimension captures several distinct facets:

• Tension Reduction and Emotional Coping: Alcohol is appraised as an effective chemical coping mechanism to alleviate dysphoria, stress, anxiety, or existential boredom (e.g., Item 4: “Drinking helps me deal with problems”; Item 16: “My drinking helps give me energy and keeps me going”; Item 19: “Without alcohol, my life would be dull and boring”).
• Social Lubrication and Affiliation: Drinking is perceived as essential for navigating interpersonal gatherings, facilitating social bonding, and conforming to peer group norms (e.g., Item 7: “Drinking helps me to have fun and socialize”; Item 14: “Not drinking at a social gathering would make me feel too different”).
• Enhanced Self-Concept and Expression: The temporary reduction of behavioral inhibition is interpreted as an authentic elevation of personal charisma, confidence, and self-worth (e.g., Item 2: “I like myself better when I am drinking”; Item 9: “Drinking makes me more of a fun person”; Item 11: “Drinking helps me to loosen up and express myself”; Item 17: “I am more sure of myself when I am drinking”; Item 20: “People seem to like me better when I am drinking”).

The Cons of Drinking Dimension

The Cons of Drinking subscale assesses the perceived severity, personal relevance, and affective salience of the adverse repercussions stemming from alcohol consumption. Crucially, the ADBS does not merely measure the physical presence of adverse events, but the extent to which these consequences matter to the individual. The Cons dimension encompasses:

• Interpersonal Conflict and Stigmatization: Deterioration of relationships with significant others, family members, and peers (e.g., Item 1: “My drinking causes problems with others”; Item 6: “Some people try to avoid me when I drink”; Item 10: “Some people close to me are disappointed in me because of my drinking”).
• Role Functioning and Occupational Impairment: Disruption in the ability to fulfill core obligations at home, in education, or within the workplace (e.g., Item 8: “Drinking interferes with my functioning at home or/and at work”; Item 15: “I am losing the trust and respect of my coworkers and/or spouse because of my drinking [drug use]”).
• Ego-Dystonic Affect and Moral Dissonance: Cognitive distress arising from breaches in personal integrity, character perceptions, and dishonesty (e.g., Item 3: “Because I continue to drink some people think I lack the character to quit”; Item 5: “Having to lie to others about my drinking bothers me”; Item 18: “I am setting a bad example for others with my drinking”).
• Behavioral Dysregulation and Harm Risk: Awareness of diminished behavioral control, legal complications, and hazardous risks to personal safety or the physical well-being of others (e.g., Item 12: “I seem to get myself into trouble when drinking”; Item 13: “I could accidentally hurt someone because of my drinking”).

The Decisional Balance Crossover Construct

A central theoretical postulation of the construct is that behavior change does not occur simply when Cons become elevated, but specifically when the cognitive balance shifts such that the perceived Cons of the behavior surpass its perceived Pros. This dynamic is mathematically captured by calculating standardized difference scores (or T-score differentials), yielding a metric known as the Decisional Balance Delta (Cons T-score minus Pros T-score). A negative Delta characterizes early motivational phases, zero denotes peak ambivalence, and a positive Delta marks readiness for behavioral modification.

Theoretical Framework

The Alcohol Decisional Balance Scale is anchored in the synthesis of two major theoretical paradigms: Janis and Mann’s Conflict Model of Decision-Making (1977) and the Transtheoretical Model (TTM) of Health Behavior Change developed by James O. Prochaska and Carlo C. DiClemente (1983, 1992).

Janis and Mann’s Conflict Model

Irving Janis and Leon Mann formulated a comprehensive decision-making model based on psychological conflict. They conceptualized decision-making as a balance sheet comprising eight cognitive categories divided across two overarching domains:

1. Utilitarian gains and losses for self: Direct practical benefits or costs experienced by the decision-maker.
2. Utilitarian gains and losses for significant others: Practical consequences of the choice for family, friends, or colleagues.
3. Self-approval or self-disapproval: Moral, ethical, and self-esteem appraisals resulting from the decision.
4. Approval or disapproval from significant others: Perceived social praise, acceptance, rejection, or stigma.

When Wayne F. Velicer, Carlo C. DiClemente, and James O. Prochaska (1985) empirically tested Janis and Mann’s complex eight-category structure in health behaviors (initially smoking cessation), mathematical factor analyses repeatedly demonstrated that these eight cells coalesce into two primary, higher-order orthogonal dimensions: the Pros (combining utilitarian gains for self/others and self/other approval) and the Cons (combining utilitarian losses for self/others and self/other disapproval). This parsimonious two-factor formulation formed the operational foundation for the ADBS.

Integration with the Transtheoretical Model

The Transtheoretical Model posits that intentional behavioral change unfolds over time through a sequence of five discrete stages:

• Precontemplation: Individuals possess no intention to modify their drinking behavior in the foreseeable future (typically framed as the next six months). In this stage, cognitive evaluations are heavily skewed: the Pros of drinking are rated substantially higher than the Cons. The individual perceives alcohol as fulfilling vital adaptive functions while minimizing or rationalizing adverse consequences.
• Contemplation: Individuals acknowledge that their alcohol consumption is problematic and contemplate change within the next six months, yet remain deeply ambivalent. During Contemplation, the perceived Cons of drinking rise dramatically to approximately equal the Pros. This cognitive deadlock frequently results in prolonged behavioral paralysis.
• Preparation: Individuals intend to take concrete action within the immediate future (typically the next 30 days) and often begin making small behavioral alterations. Psychometrically, this stage is characterized by the decisive crossover point: the Cons of drinking systematically surpass the Pros.
• Action: Individuals have actively altered their overt behavior, achieving abstinence or adhering to strict reduction criteria for less than six months. In this stage, Cons remain elevated, while the valuation of Pros exhibits a precipitous decline.
• Maintenance: Individuals have sustained behavioral modification for more than six months and work actively to prevent relapse. Pros of drinking drop to low baseline levels, while Cons stabilize as salient cognitive reminders of why relapse must be avoided.

In a seminal cross-sectional investigation spanning 12 distinct health-risk behaviors, Prochaska et al. (1994) demonstrated remarkable mathematical regularity in decisional balance across behavioral domains: from Precontemplation to Action, the Cons of the problem behavior increased by approximately one full standard deviation (1.0 SD), while the Pros decreased by approximately one-half of a standard deviation (0.5 SD). The ADBS reliably captures these structural mathematical dynamics within populations misusing alcohol.

Validity

The psychometric validity of the Alcohol Decisional Balance Scale has been corroborated across an extensive body of empirical literature spanning clinical, university, and community cohorts.

Construct Validity

Construct validity is substantiated by structural equation modeling (SEM) and confirmatory factor analyses, which demonstrate that the two-factor model (Pros and Cons) consistently outperforms unidimensional, bipolar models or complex multi-factor alternatives. Studies examining structural invariance across diverse demographic groups (e.g., gender, race/ethnicity, and socioeconomic strata) demonstrate that the underlying constructs of Pros and Cons maintain measurement equivalence across populations (Ward et al., 2004).

Convergent Validity

The ADBS exhibits robust, theoretically congruent correlations with established indices of alcohol involvement, motivational readiness, and drinking-related consequences:

• Measures of Alcohol Involvement: The Cons subscale correlates positively and moderately-to-strongly with the Alcohol Use Disorders Identification Test (AUDIT) (typically r = 0.50 to 0.65) and the Drinker Inventory of Consequences (DrInC) (r = 0.60 to 0.72), confirming that individuals reporting elevated problem severity attribute high personal importance to negative drinking outcomes.
• Readiness and Motivation Scales: The Cons subscale and the Decisional Balance Delta score correlate positively with the Contemplation and Action subscales of the University of Rhode Island Change Assessment (URICA) and the Readiness to Change Questionnaire (RTCQ) (r = 0.45 to 0.60), whereas the Pros subscale correlates positively with URICA Precontemplation scores (r = 0.35 to 0.48) (Carey et al., 2001).
• Alcohol Expectancies: The Pros subscale demonstrates strong positive convergent correlations with the positive reinforcement and tension-reduction subscales of the Comprehensive Effects of Alcohol (CEOA) and the Alcohol Expectancy Questionnaire (AEQ) (r = 0.55 to 0.70).

Discriminant Validity

Discriminant validity is evidenced by weak or non-significant correlations between ADBS subscales and unrelated personality constructs, such as general cognitive intelligence, social desirability response biases (e.g., Marlowe-Crowne Social Desirability Scale, r < 0.15), and baseline demographic indicators when controlling for consumption volume.

Predictive and Criterion-Related Validity

The predictive utility of the ADBS has been established in longitudinal addiction trials. Baseline Decisional Balance Delta scores prospectively predict treatment engagement, retention, and drinking outcomes. In clinical trials such as Project MATCH and outpatient community programs (DiClemente & Hughes, 1990; DiClemente et al., 1992, 2007), individuals entering treatment with Cons significantly exceeding Pros were markedly more likely to complete therapy and maintain abstinence at 6- and 12-month follow-ups. Conversely, individuals who maintained elevated Pros scores despite undergoing behavioral treatment exhibited significantly elevated hazard ratios for relapse.

Reliability

The Alcohol Decisional Balance Scale demonstrates excellent internal consistency and temporal stability across a diverse spectrum of clinical and research populations.

Internal Consistency

Internal consistency metrics for both the full 20-item ADBS and the 10-item DELTA short-form routinely surpass classical psychometric benchmarks for clinical utility:

• Standard 20-Item Version: In outpatient clinical populations seeking treatment for alcohol dependence, the 10-item Pros of Drinking subscale consistently demonstrates a Cronbach’s alpha ranging between α = 0.86 and 0.91. The 10-item Cons of Drinking subscale demonstrates equivalent internal reliability, with alpha coefficients typically spanning α = 0.88 to 0.93 (DiClemente & Hughes, 1990; Carey et al., 2001).
• DELTA 10-Item Short-Form: Psychometric analyses conducted by Ward, Velicer, and Rossi (2004) confirmed that despite reducing each subscale to five items, internal consistency remains robust: α = 0.81 to 0.86 for the brief Pros subscale and α = 0.83 to 0.88 for the brief Cons subscale.
• College and At-Risk Populations: In non-treatment-seeking young adult and university cohorts, Collins, Carey, and Otto (2009) reported Cronbach’s alpha values of α = 0.85 for Pros and α = 0.87 for Cons, confirming that the scale functions reliably across non-clinical and sub-clinical samples.

Test-Retest Reliability

Evaluation of temporal stability across short test-retest intervals (one to two weeks) among stable individuals in the Precontemplation or Maintenance stages yields intra-class correlation coefficients (ICC) and Pearson correlation coefficients exceeding r = 0.82 for both dimensions. Over extended periods, changes in ADBS scores reliably track true stage transitions rather than measurement error, affirming the instrument’s sensitivity to genuine cognitive and motivational changes.

Factor Analysis

The structural composition of the ADBS has been rigorously scrutinized using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

Exploratory Factor Analysis (EFA)

Early psychometric development conducted by Velicer, DiClemente, and Prochaska utilized principal component analysis (PCA) and maximum likelihood factor extraction with both orthogonal (Varimax) and oblique (Promax) rotations. Across independent extraction procedures, a clear two-component solution consistently accounted for approximately 48% to 56% of the total item variance. The two factors unambiguously reflected Pros of Drinking and Cons of Drinking, with negligible cross-loadings (primary loadings > 0.50, cross-loadings < 0.25). The correlation between the two latent factors was consistently near zero or weakly negative (r = -0.05 to -0.20), validating the theoretical postulate that the perceived benefits and consequences of alcohol use function as distinct, semi-independent cognitive dimensions rather than an inseparable bipolar spectrum.

Confirmatory Factor Analysis (CFA) and Model Fit

Subsequent validation studies have tested competitive structural models via CFA:

• Model 1: Unidimensional Model. A single latent continuum with Pros loading positively and Cons loading negatively. This model exhibits poor fit across all datasets (χ²/df > 5.0, CFI < 0.75, RMSEA > 0.12).
• Model 2: Two Uncorrelated Orthogonal Factors. Pros and Cons modeled as entirely independent dimensions. This model provides acceptable-to-good fit indices across clinical samples.
• Model 3: Two Correlated Oblique Factors. Pros and Cons modeled as correlated latent constructs. This model routinely demonstrates the superior fit across both outpatient clinical cohorts and young adult populations. Typical goodness-of-fit indices include:
  • Comparative Fit Index (CFI) ≥ 0.94 – 0.97
  • Tucker-Lewis Index (TLI) ≥ 0.93 – 0.96
  • Root Mean Square Error of Approximation (RMSEA) ≤ 0.045 – 0.058 (90% CI: 0.038, 0.065)
  • Standardized Root Mean Square Residual (SRMR) ≤ 0.048

Factorial Invariance and Short-Form Optimization

Ward, Velicer, and Rossi (2004) conducted multi-group confirmatory factor analyses to assess factorial invariance across demographic strata. Tests of configural, metric, and scalar invariance demonstrated that factor loadings, item intercepts, and error variances remain invariant across gender and age cohorts. In the derivation of the 10-item DELTA short-form, researchers utilized item response theory (IRT) and structural modeling to retain the five items per factor that demonstrated the highest factor loadings, optimal item-total discrimination indices, and maximum sensitivity to stage-of-change transitions.

Instrument / Measurement Tool

• Instrument Name: Alcohol Decisional Balance Scales (ADBS)
• Alternative Titles: Decisional Balance Scale for Alcohol; Decisional Balance Inventory – Alcohol; DELTA Version (Reduced Drinking Short Form)
• Instrument Type: Self-administered psychometric questionnaire / standardized self-report rating scale
• Theoretical Basis: Transtheoretical Model (TTM) of Health Behavior Change; Janis & Mann’s Decision-Making Conflict Theory
• Target Population: Adolescents and adults (ages 16+) presenting with varying levels of alcohol consumption, from sub-clinical recreational drinkers to individuals meeting diagnostic criteria for severe Alcohol Use Disorder
• Item Count:
  • Full Standard Form: 20 items (10 Pros, 10 Cons)
  • DELTA Brief Version: 10 items (5 Pros, 5 Cons)
• Administration Format: Paper-and-pencil, computer-based assessment, or interactive web-based digital evaluation
• Estimated Completion Time: Full Version: 4 to 7 minutes; DELTA Brief Version: 2 to 3 minutes
• Response Scale: 5-point Likert-type rating scale evaluating the personal importance of each statement when making a decision about drinking:
  • 1 = Not important at all
  • 2 = Slightly important
  • 3 = Moderately important
  • 4 = Very important
  • 5 = Extremely important
• Subscale Item Breakdown (Standard 20-Item Version):
  • Pros of Drinking: Items 2, 4, 7, 9, 11, 14, 16, 17, 19, 20
  • Cons of Drinking: Items 1, 3, 5, 6, 8, 10, 12, 13, 15, 18
• Subscale Item Breakdown (DELTA 10-Item Version):
  • Pros of Drinking: Items 2, 3, 6, 9, 10
  • Cons of Drinking: Items 1, 4, 5, 7, 8
• Scoring and Computational Procedures:
  • Raw Subscale Scores: Calculated by summing the response values for the corresponding items on each subscale. On the 20-item version, raw scores for both Pros and Cons range from 10 to 50. On the DELTA version, raw scores range from 5 to 25. Alternatively, subscale means can be generated (ranging from 1.0 to 5.0).
  • Standardized T-Scores: In clinical practice and normative comparisons, raw scores are commonly converted into standardized T-scores (Mean = 50, Standard Deviation = 10) based on normative reference populations matched by stage of change.
  • Decisional Balance Difference (Delta) Score: Computed as Cons T-Score − Pros T-Score (or Cons Raw Mean − Pros Raw Mean). A negative score indicates that the individual attributes greater importance to the benefits of drinking (indicative of Precontemplation). A score near zero indicates intense ambivalence (Contemplation). A positive score demonstrates that the perceived negative consequences outweigh the benefits (Preparation, Action, or Maintenance).

Permissions & Fee and Test Year

The Alcohol Decisional Balance Scale was initially developed and validated between 1990 and 1994 under the auspices of federally funded research grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) awarded to Carlo C. DiClemente, Wayne F. Velicer, and James O. Prochaska.

Licensing and Accessibility:

• The ADBS resides in the public domain for clinical, academic, and non-commercial educational research purposes. Researchers and clinicians may utilize, reproduce, and administer the instrument without payment of royalties or licensing fees, provided proper bibliographic citation is accorded to the original authors.
• Institutional access, user manuals, and normative scoring algorithms are hosted by the HABITS Lab (Health and Addictive Behaviors: Investigating Transitions) at the University of Maryland, Baltimore County, directed by Dr. Carlo C. DiClemente.
• For commercial digital deployment, inclusion within proprietary electronic health record (EHR) software suites, or corporate commercial diagnostic platforms, interested entities should contact the respective authors or copyright holders via UMBC or the University of Rhode Island.

References

• Carey, K. B., Maisto, S. A., Carey, M. P., & Purnine, D. M. (2001). Measuring readiness to change substance misuse among psychiatric outpatients: Reliability and validity of self-report measures. Journal of Studies on Alcohol, 62(1), 79–88. https://doi.org/10.15288/jsa.2001.62.79
• Collins, S. E., Carey, K. B., & Otto, J. M. (2009). A new decisional balance measure of motivation to change among at-risk college drinkers. Psychology of Addictive Behaviors, 23(3), 464–471. https://doi.org/10.1037/a0015841
• DiClemente, C. C. (2007). Mechanisms, determinants and process of change in the modification of drinking behavior. Alcoholism: Clinical and Experimental Research, 31(Suppl 3), 13S–20S. https://doi.org/10.1111/j.1530-0277.2007.00490.x
• DiClemente, C. C., Carbonari, J. P., & Velasquez, M. M. (1992). Alcoholism treatment mismatching from a process of change perspective. In R. R. Watson (Ed.), Drug and Alcohol Abuse Reviews: Vol. 3, Alcohol Abuse Treatment (pp. 115–142). The Humana Press.
• DiClemente, C. C., & Hughes, S. O. (1990). Stages of change profiles in outpatient alcoholism treatment. Journal of Substance Abuse, 2(2), 217–235. https://doi.org/10.1016/s0899-3289(05)80057-4
• Janis, I. L., & Mann, L. (1977). Decision making: A psychological analysis of conflict, choice, and commitment. Free Press.
• Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395. https://doi.org/10.1037/0022-006X.51.3.390
• Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102–1114. https://doi.org/10.1037/0003-066X.47.9.1102
• Prochaska, J. O., Velicer, W. F., Rossi, J. S., Goldstein, M. G., Marcus, B. H., Rakowski, W., Fiore, C., Harlow, L. L., Redding, C. A., Rosenbloom, D., & Rossi, S. R. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13(1), 39–46. https://doi.org/10.1037/0278-6133.13.1.39
• Velicer, W. F., DiClemente, C. C., & Prochaska, J. O. (1985). Decisional balance measure for assessing and predicting smoking status. Journal of Personality and Social Psychology, 48(5), 1279–1289. https://doi.org/10.1037/0022-3514.48.5.1279
• Ward, R. M., Velicer, W. F., & Rossi, J. S. (2004). Factorial invariance and internal consistency for the decisional balance inventory – short form. Addictive Behaviors, 29(5), 953–958. https://doi.org/10.1016/j.addbeh.2004.02.046
• Werch, C. E. (1997). Expanding the stages of change: A program matched to the stages of alcohol acquisition. American Journal of Health Promotion, 12(1), 23–27. https://doi.org/10.4278/0890-1171-12.1.23

13. Items of the Scale (Questionnaire)