Self-Efficacy Scales- Drug Abstinence

1. Abstract

The Drug Abstinence Self-Efficacy Scale (DASES), also recognized within clinical addiction literature under the broader taxonomy of Self-Efficacy Scales- Drug Abstinence, is a standardized psychometric instrument designed to evaluate an individual’s perceived situational confidence in abstaining from illicit drug use when exposed to high-risk relapse triggers. Originating from the conceptual operationalization of self-efficacy theory articulated by Albert Bandura and systematized within the Transtheoretical Model of Behavior Change (TTM) by James O. Prochaska, Carlo C. DiClemente, and colleagues, the instrument exists primarily in a comprehensive 20-item inventory and an abbreviated 12-item short form. Both variants assess situational abstinence confidence across four correlated second-order domains: Negative Affect, Social/Positive situations, Physical and Other Concerns, and Cravings and Urges (withdrawal and impulse cues). Each item requires respondents to rate their confidence on a 5-point Likert scale ranging from 1 (Not at all confident) to 5 (Extremely confident).

Extensive psychometric investigations across diverse clinical cohorts—including outpatient substance use disorder programs, residential therapeutic communities, criminal justice cohorts (e.g., drug-involved probationers), and dual-diagnosis populations presenting with co-occurring severe mental illness—substantiate the tool’s structural stability, construct validity, and prognostic utility. Internal consistency estimates across subscales routinely achieve robust reliability coefficients, typically ranging between Cronbach’s α = .87 and .92. Confirmatory factor analyses consistently corroborate an oblique four-factor architecture that tracks dynamic treatment shifts across the stages of change. Clinically, baseline and serial administrations of the DASES inform individualized relapse prevention strategies, delineate vulnerability profiles, and furnish researchers with a sensitive, responsive outcome marker for behavioral and pharmacological substance use interventions.

2. Keywords

Drug Abstinence Self-Efficacy Scale, DASES, self-efficacy, substance use disorder, relapse prevention, Transtheoretical Model, behavioral addiction, psychometrics, craving, negative affect

3. Authors

The development and theoretical adaptation of situational abstinence self-efficacy instruments stem from foundational research conducted by Carlo C. DiClemente, Ph.D., Professor Emeritus of Psychology at the University of Maryland, Baltimore County (UMBC), in collaboration with key investigators of the Transtheoretical Model including James O. Prochaska, Ph.D., and Wayne F. Velicer, Ph.D., at the Cancer Prevention Research Center, University of Rhode Island.

Significant psychometric refinement, cross-population validation, and structural adaptation for drug-involved clinical and correctional populations were spearheaded by researchers at Texas Christian University’s Institute of Behavioral Research (TCU-IBR), notably Michael L. Hiller, Ph.D., Kevin M. Broome, Ph.D., Kevin Knight, Ph.D., and D. Dwayne Simpson, Ph.D. Subsequent extensions evaluating dual-diagnosis and severe mental illness cohorts were conducted by Carlo C. DiClemente alongside Melanie E. Bennett, Ph.D., Alan S. Bellack, Ph.D., and Matthew Nidecker, Ph.D., at the Department of Veterans Affairs Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC) and the University of Maryland School of Medicine.

4. Purpose

The primary clinical and psychometric objective of the Drug Abstinence Self-Efficacy Scale is the systematic assessment of an individual’s judgment regarding their capability to refrain from substance use across multidimensional, trigger-dense environmental and intrapersonal contexts. Within contemporary addiction medicine and clinical psychology, substance dependence is recognized as a chronic, relapsing disorder governed by complex neurobiological vulnerabilities, conditioned responses to internal and external cues, and cognitive-behavioral appraisals. Effective therapeutic interventions require valid, granular metrics capable of identifying which specific situational ecologies threaten an individual’s sobriety and evaluating whether an intervention successfully bolsters the cognitive resilience necessary to withstand those contexts.

From a diagnostic and treatment-planning vantage, the DASES does not merely produce an aggregate abstinence index; it generates an idiosyncratic risk profile. By identifying whether an individual exhibits high vulnerability (i.e., low self-efficacy) predominantly when managing dysregulated negative mood states, navigating social pressure and celebrations, contending with somatic distress, or resisting visceral neurochemical cravings, clinicians can design targeted relapse prevention roadmaps. For instance, an individual who scores exceptionally high on the Social/Positive domain but markedly low on Negative Affect requires cognitive-behavioral interventions focused on affective regulation, emotional distress tolerance, and distress coping mechanisms, rather than basic refusal assertiveness training.

In clinical trials and longitudinal outcome research, the DASES functions as an indispensable continuous marker. It captures dynamic cognitive transformations throughout pharmacotherapy, cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and motivational interviewing (MI). Because gains in abstinence self-efficacy prospectively forecast the maintenance of behavioral change and significantly reduce the likelihood of post-treatment substance recurrence, tracking DASES trajectory profiles allows clinicians to evaluate readiness for treatment discharge, step-downs in level of care, or the necessity of immediate supportive booster sessions.

5. Psychological Construct

The central construct quantified by the DASES is situational abstinence self-efficacy, defined as an individual’s subjective confidence in their behavioral capacity to avoid using illicit substances across challenging contexts. Grounded in social cognitive foundations, self-efficacy is explicitly differentiated from outcome expectancies; it does not measure what an individual believes will occur if they use drugs, nor does it measure generalized self-esteem or broad optimism. Instead, it constitutes a context-specific cognitive appraisal of capability. The instrument partitions this multidimensional construct into four empirical subscales:

Negative Affect

This subscale assesses the respondent’s confidence in refraining from illicit drug consumption when experiencing dysphoric, dysregulated, or distressing emotional states. Intrapersonal negative affect constitutes one of the most pervasive precipitants of drug relapse documented across the addiction literature. The scale probes internal conditions such as profound depression, acute worry, feelings of inward anger, deep frustration escalating toward interpersonal eruption, and generalized perceptions of catastrophic failure (e.g., sensing that everything is going wrong). Items mapping onto this factor examine the individual’s perceived ability to manage psychological discomfort without relying on chemical coping mechanisms, self-medication, or emotional avoidance through psychoactive substances.

Social/Positive

The Social/Positive domain appraises confidence within interpersonal contexts characterized by celebratory atmospheres, positive emotional arousal, social exposure to drugs, and explicit or implicit peer persuasion. Relapse risk in this domain is driven not by emotional distress, but by conditioned social cues, affiliation motivations, and relaxed behavioral vigilance. Specific situational cues encompass attending social gatherings, parties, or bars where others are actively consuming substances, encountering direct offers of drugs from acquaintances or former drug-using associates, experiencing an impulse to enhance relaxation during vacations, and navigating high-arousal celebratory events. Individuals scoring low on this domain struggle with interpersonal refusal assertiveness and boundary maintenance within peer networks.

Physical and Other Concerns

This factor evaluates situational self-efficacy in response to somatic distress, physiological depletion, and external interpersonal stressors that do not immediately present as acute negative affective episodes. It captures states of physical exhaustion, headaches, acute or chronic pain, physical injury, and cognitive-emotional distress elicited by worry or intense concern for significant others. Furthermore, this domain captures cognitive intrusion phenomena, such as encountering vivid dreams involving drug consumption. It reflects an individual’s perceived resilience when bodily stamina is compromised or when diffuse ambient stress taxes cognitive coping reserves.

Cravings and Urges

The Cravings and Urges dimension captures an individual’s efficacy expectations when confronted with potent neurobiological cravings, physiological withdrawal distress, and sudden unexpected impulses to consume substances. Unlike deliberate decisions, cravings frequently manifest as visceral, cue-elicited conditioning responses. This subscale measures confidence during acute withdrawal agony, states of intense somatic longing for the drug, and unanticipated cue exposure that catches the individual psychologically unprepared. Additionally, it probes cognitive temptations such as testing one’s willpower to determine if moderate control is feasible, or succumbing to exploratory urges to “see what happens” if use is initiated.

6. Theoretical Framework

The theoretical architecture of the DASES is anchored in the convergence of Albert Bandura’s Social Cognitive Theory and the Transtheoretical Model of Behavior Change formulated by Prochaska, DiClemente, and colleagues. Bandura posited that psychological functioning involves a continuous reciprocal interaction among behavioral, cognitive, and environmental influences. Within this framework, self-efficacy represents the primary cognitive mediator of behavioral execution, persistence, and expenditure of effort in the face of obstacles. When applied to addictive behaviors, an individual’s decision to abstain, along with their capacity to navigate high-risk relapse environments, depends fundamentally on their appraisal of personal efficacy.

Concurrently, the Transtheoretical Model positions self-efficacy as a core organizing construct alongside the Stages of Change (Precontemplation, Contemplation, Preparation, Action, and Maintenance), Decisional Balance (Pros and Cons), and the Processes of Change. In the TTM, self-efficacy is conceptualized as the inverse counterpart to situational temptation. While temptation quantifies the intensity of an urge to engage in a problematic behavior across specific situations, self-efficacy measures the perceived competence to abstain. Longitudinal research reveals a predictable, non-linear developmental trajectory: during the Precontemplation and Contemplation stages, drug temptation dramatically outstrips abstinence self-efficacy. As individuals transition through Preparation and into Action, self-efficacy rises concurrently with the systematic deployment of behavioral and cognitive coping processes. In the Maintenance stage, self-efficacy stabilizes at high levels across all situational categories, reflecting consolidated behavioral change.

Furthermore, the DASES interfaces with Alan Marlatt’s Cognitive-Behavioral Model of Relapse. Marlatt hypothesized that encountering a high-risk situation necessitates an immediate coping response. If an individual possesses high self-efficacy and deploys effective coping mechanisms, the probability of relapse diminishes markedly. Conversely, if situational self-efficacy is deficient, the individual experiences heightened anxiety, expects positive immediate consequences from drug consumption, and exhibits elevated vulnerability to an initial lapse. If a lapse occurs, a low sense of self-efficacy exacerbates the Abstinence Violation Effect (AVE), triggering intense guilt, internal attributions of failure, and ultimately a full-blown relapse. The DASES operationalizes this theoretical junction by directly measuring the cognitive appraisal that determines whether a high-risk situation will be negotiated successfully.

7. Validity

The psychometric integrity of the DASES has been established through rigorous investigations evaluating construct, convergent, discriminant, and predictive validity across diverse clinical cohorts.

Construct and Factorial Validity

Construct validity is substantiated by structural equation modeling and factor-analytic studies confirming that the four theoretical domains—Negative Affect, Social/Positive, Physical and Other Concerns, and Cravings/Urges—represent distinct yet interrelated dimensions of a broader second-order abstinence self-efficacy construct. Studies by Hiller et al. (2000) among drug-involved probationers demonstrated that the multidimensional model yielded superior fit indices compared to a unidimensional construct, confirming that self-efficacy in addiction cannot be accurately reduced to a single global score without loss of critical clinical variance.

Convergent and Concurrent Validity

Convergent validity is documented through robust associations with theoretically aligned instruments. DASES scores correlate positively with validated measures of treatment engagement, therapeutic alliance, internal locus of control, and active behavioral coping strategies as measured by the Coping Strategies Inventory. Conversely, DASES subscales exhibit strong inverse correlations with measures of drug craving intensity, such as the Penn Alcohol Craving Scale (PACS) adapted for illicit substances, and the Brief Substance Craving Scale. Furthermore, research by Nidecker, DiClemente, Bennett, and Bellack (2008) in patients with co-occurring severe mental illness and substance use disorders demonstrated that DASES scores converge predictably with the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) and the University of Rhode Island Change Assessment (URICA), with self-efficacy scores rising systematically as clients advance from Precontemplation to Action and Maintenance.

Discriminant Validity

Discriminant validity has been demonstrated by showing that the DASES measures constructs empirically distinct from general self-esteem (e.g., Rosenberg Self-Esteem Scale), generalized self-efficacy (e.g., Schwarzer’s Generalized Self-Efficacy Scale), and baseline intellectual quotient. While general self-efficacy captures a broad sense of personal agency, it accounts for negligible unique variance in specific drug-taking contexts, whereas the DASES demonstrates robust specificity in delineating drug-avoidance capability.

Predictive and Prognostic Validity

The predictive validity of the DASES represents its most clinically consequential metric. Prospective investigations consistently document that post-treatment or mid-treatment DASES scores significantly forecast drug abstinence status at 3-, 6-, and 12-month follow-ups. In longitudinal research on criminal justice populations undergoing residential substance abuse treatment (Hiller et al., 2000), probationers with higher end-of-treatment self-efficacy scores demonstrated significantly lower rates of positive urinalysis screens, fewer rearrests, and longer latencies to first substance lapse. Similarly, studies evaluating dual-diagnosis cohorts revealed that lower baseline self-efficacy on the Negative Affect and Cravings and Urges subscales independently predicted early treatment dropout and rapid post-discharge relapse.

8. Reliability

The internal consistency and temporal stability of the Drug Abstinence Self-Efficacy Scale have been confirmed across multiple peer-reviewed studies involving inpatient, outpatient, and correctional samples.

Internal Consistency

Internal consistency estimates for both the full 20-item instrument and its 12-item abbreviated variant consistently exceed conventional psychometric standards (α ≥ .80). In the landmark psychometric study conducted by Hiller, Broome, Knight, and Simpson (2000) assessing 755 drug-involved probationers participating in community-based treatment, the subscale Cronbach’s alpha coefficients were observed as follows:

• Negative Affect: α = .92
• Social/Positive: α = .92
• Physical and Other Concerns: α = .87
• Withdrawal/Urges (Cravings and Urges): α = .89
• Full Composite Scale: α = .95

Subsequent investigations by DiClemente, Nidecker, and Bellack (2008) and Nidecker et al. (2008) evaluating clinical cohorts presenting with co-occurring severe mental illnesses (such as schizophrenia, schizoaffective disorder, and bipolar disorder) alongside substance use disorders replicated these high internal consistency metrics, yielding subscale alpha values ranging from .84 to .91 for the 12-item variant. These figures confirm that item homogeneity is preserved even within complex psychiatric populations where cognitive disorganization or affective flattening could otherwise compromise measurement precision.

Test-Retest Stability and Measurement Error

Test-retest reliability has been examined across short-term, clinically stable intervals (e.g., 7 to 14 days) during pre-treatment intake phases before therapeutic interventions alter cognitive perceptions. Under these non-intervention conditions, intra-class correlation coefficients (ICCs) and Pearson test-retest coefficients routinely fall within the range of r = .81 to .88, denoting strong temporal stability. Importantly, when assessed across active treatment phases (e.g., from intake to 90-day post-admission), the DASES exhibits statistically significant, clinically meaningful score elevations, confirming that while the tool is reliable in stable baselines, it maintains sensitivity to therapeutic change over time.

9. Factor Analysis

The latent structural integrity of the Drug Abstinence Self-Efficacy Scale has been evaluated through exploratory (EFA) and confirmatory factor analyses (CFA).

Exploratory Factor Analysis (EFA)

Early exploratory factor extractions using principal axis factoring with oblique rotations (promax and direct quartimin) consistently yielded four distinct factors with eigenvalues exceeding Kaiser’s criterion of 1.0, collectively accounting for approximately 62% to 68% of the total variance across substance-using cohorts. The four-factor structure aligned with the theoretical categories established by Velicer, DiClemente, Rossi, and Prochaska (1990) in the development of situational relapse models for addictive behaviors:

• Factor 1 (Negative Affect): Items reflecting depression, worry, frustration, anger, and feelings that everything is going wrong loaded cleanly onto this factor, with primary pattern coefficients ranging between .68 and .86, and minimal cross-loadings (< .20).
• Factor 2 (Social/Positive): Items assessing exposure to drugs at bars/parties, encouragement from peers, social drug offers, and celebratory excitement exhibited primary loadings ranging from .65 to .84.
• Factor 3 (Physical and Other Concerns): Items capturing somatic pain, physical exhaustion, headaches, drug-related dreams, and worry about others loaded between .58 and .79.
• Factor 4 (Cravings and Urges): Items querying withdrawal agony, visceral cravings, sudden impulses, and testing willpower loaded between .62 and .83.

Confirmatory Factor Analysis (CFA)

Subsequent confirmatory investigations (e.g., Hiller et al., 2000; Nidecker et al., 2008) formally tested competing structural hypotheses: a one-factor unidimensional model, a four-factor orthogonal model, and a four-factor oblique (correlated) model. The four-factor oblique model exhibited superior fit indices across all samples.

In structural equation modeling using maximum likelihood estimation with robust standard errors (MLR), the four-factor oblique architecture achieved robust model fit criteria:

• Comparative Fit Index (CFI): .94 to .97
• Tucker-Lewis Index (TLI): .93 to .96
• Root Mean Square Error of Approximation (RMSEA): .045 to .058 (with 90% confidence intervals spanning .038 to .065)
• Standardized Root Mean Square Residual (SRMR): .039 to .048

Inter-factor correlations in these models ranged from r = .52 to .74, indicating that while the dimensions share common variance attributable to a overarching construct of abstinence self-efficacy, they represent empirically distinguishable cognitive vulnerabilities. Factorial invariance testing has further established structural and metric equivalence across genders, racial/ethnic minority groups, and criminal justice versus voluntary community treatment samples.

10. Instrument / Measurement Tool

The operational specifications, administration protocols, and scoring procedures for the Drug Abstinence Self-Efficacy Scale are detailed below:

• Instrument Designation: Drug Abstinence Self-Efficacy Scale (DASES) / Self-Efficacy Scales- Drug Abstinence.
• Primary Author: Carlo C. DiClemente, Ph.D., and collaborators within the Transtheoretical Model research network.
• Primary Purpose: Quantitative assessment of perceived situational confidence to abstain from illicit drug consumption across acute high-risk relapse environments.
• Administration Format: Standardized self-report paper-and-pencil inventory or computer-assisted personal interview (CAPI). Can also be administered verbally by a trained clinician for individuals with limited literacy.
• Target Population: Adolescents and adults (ages 14 and older) with a history of substance abuse, substance use disorder (SUD), or participating in relapse prevention programs.
• Inventory Variants:
  • Full Version: 20 items.
  • Brief Clinical / Research Version: 12 items.
• Completion Duration: Approximately 5 to 7 minutes for the 20-item scale; 2 to 3 minutes for the 12-item short form.
• Response Scale: 5-point Likert rating scale:
  • 1 = Not at all confident
  • 2 = Not very confident
  • 3 = Moderately confident
  • 4 = Very confident
  • 5 = Extremely confident
• Subscale Structural Allocation (20-Item Version):
  • Negative Affect (5 items): Items 3, 6, 14, 16, 18
  • Social/Positive (5 items): Items 4, 8, 15, 17, 20
  • Physical and Other Concerns (5 items): Items 2, 5, 9, 12, 13
  • Cravings and Urges (5 items): Items 1, 7, 10, 11, 19
• Subscale Structural Allocation (12-Item Version):
  • Negative Affect (3 items): Items 1, 3, 9
  • Social/Positive (3 items): Items 10, 11, 12
  • Physical and Other Concerns (3 items): Items 2, 7, 8
  • Cravings and Urges (3 items): Items 4, 5, 6
• Scoring and Computational Rules:
  • Subscale Scores: Calculated by deriving the mathematical mean of items within each subscale (ranging from 1.0 to 5.0) or computing the raw unweighted summation (ranging from 5 to 25 per subscale on the 20-item version; 3 to 15 per subscale on the 12-item version). Mean scoring is preferred clinically to allow direct comparison across subscales regardless of item counts.
  • Global Self-Efficacy Score: Calculated as the aggregate mean across all answered items (1.0 to 5.0) or the overall summation (ranging from 20 to 100 for the 20-item scale; 12 to 60 for the 12-item scale).
  • Missing Item Handling: If fewer than 20% of items are missing within a subscale, mean imputation based on the valid items of that subscale is permissible. If more than 20% are omitted, the subscale score should be treated as missing.
• Score Interpretation:
  • Mean Scores 1.00 – 2.49 (Low Efficacy): Denotes high vulnerability to relapse; indicates that the client perceives minimal internal agency in that situation. Requires intensive behavioral intervention.
  • Mean Scores 2.50 – 3.74 (Moderate Efficacy): Reflects emergent confidence, typical of clients navigating the Preparation and early Action stages. Vulnerabilities persist under severe, compounding stressors.
  • Mean Scores 3.75 – 5.00 (High Efficacy): Indicates strong perceived capability to maintain abstinence; typical of individuals in late Action and Maintenance stages of recovery.

11. Permissions & Fee and Test Year

The conceptual framework for drug abstinence self-efficacy measurement emerged from Carlo C. DiClemente’s seminal publication in 1986 (“Self-Efficacy and the addictive behaviors”), with situational models codified in 1990 by Velicer, DiClemente, Rossi, and Prochaska. The 20-item and 12-item Drug Abstinence Self-Efficacy Scales were further operationalized and standardized across clinical settings throughout the 1990s and formalized in empirical validation studies by Hiller et al. (2000) and Velasquez, Maurer, Crouch, and DiClemente (2001).

The scale was developed under federal and academic research grants aimed at standardizing addiction assessment protocols. As such, the DASES is considered an open-access psychometric instrument available free of charge for non-commercial academic research, public health investigations, and non-profit clinical applications. Researchers and healthcare practitioners are permitted to reproduce and administer the questionnaire without formal royalty fees, provided proper bibliographic attribution is accorded to Carlo C. DiClemente and the associated research teams in all publications and reports.

Instrument documentation, clinical scoring templates, and supplementary validation resources are hosted through academic repositories, including the Habits Lab at the University of Maryland, Baltimore County (UMBC) Department of Psychology (accessible via http://habitslab.umbc.edu/self-efficacy-scales/). For commercial applications, integration into proprietary digital platforms, or revenue-generating health-technology software, explicit licensing permission must be sought directly from the copyright holders and primary authors.

12. References

The following foundational peer-reviewed literature and empirical studies document the theoretical basis, psychometric properties, and clinical utility of the DASES:

• DiClemente, C. C. (1986). Self-efficacy and the addictive behaviors. Journal of Social and Clinical Psychology, 4(3), 302–315. https://doi.org/10.1521/jscp.1986.4.3.302
• DiClemente, C. C., Nidecker, M., & Bellack, A. S. (2008). Motivation and the stages of change among individuals with severe mental illness and substance abuse disorders. Journal of Substance Abuse Treatment, 34(1), 25–35. https://doi.org/10.1016/j.jsat.2006.12.034
• Hiller, M. L., Broome, K. M., Knight, K., & Simpson, D. D. (2000). Measuring self-efficacy among drug-involved probationers. Psychological Reports, 86(2), 529–538. https://doi.org/10.2466/pr0.2000.86.2.529
• Nidecker, M., DiClemente, C. C., Bennett, M. E., & Bellack, A. S. (2008). Application of the Transtheoretical Model of change: Psychometric properties of leading measures in patients with co-occurring drug abuse and severe mental illness. Addictive Behaviors, 33(8), 1021–1030. https://doi.org/10.1016/j.addbeh.2008.03.011
• 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
• Velasquez, M. M., Maurer, G., Crouch, C., & DiClemente, C. C. (2001). Group Treatment for Substance Abuse: A Stages-of-Change Therapy Manual. Guilford Publications.
• Velicer, W. F., DiClemente, C. C., Rossi, J. S., & Prochaska, J. O. (1990). Relapse situations and self-efficacy: An integrative model. Addictive Behaviors, 15(3), 271–283. https://doi.org/10.1016/0306-4603(90)90070-E
• Werch, C. E., & DiClemente, C. C. (1994). A multi-component stage model for matching drug prevention strategies and messages to youth stage of use. Health Education Research, 9(1), 37–46. https://doi.org/10.1093/her/9.1.37

13. Items of the Scale (Questionnaire)