Situation Temptation Scales- Alcohol Version

Abstract

The Situation Temptation Scales – Alcohol Version (STS-A), originally conceptualized alongside the self-efficacy construct within the Transtheoretical Model (TTM) of behavior change (Bandura, 1977; DiClemente et al., 1994; Prochaska & DiClemente, 1983), is a psychometric instrument designed to evaluate an individual’s perceived intensity of temptation to drink across high-risk relapse contexts. Developed by Carlo C. DiClemente and colleagues, the STS-A complements situational confidence measures by capturing the psychological, environmental, and affective pulls that trigger alcohol consumption. The instrument exists primarily as a 20-item comprehensive scale and an abbreviated 12-item inventory, evaluating four correlated situational dimensions: Negative Affect, Social/Positive situations, Physical and Other Concerns, and Cravings and Urges. Each item is rated on a 5-point Likert scale ranging from 1 (Not at all tempted) to 5 (Extremely tempted).

Psychometric evaluations across diverse inpatient, outpatient, and research cohorts (e.g., Project MATCH, Project DELTA) demonstrate robust construct validity, factorial stability, and clinical utility. Across empirical validation studies, the STS-A exhibits high internal consistency, with Cronbach’s alpha coefficients ranging from .60 to .99 across subscales, and strong concurrent validity with drinking severity, craving metrics, and relapse outcomes. Elevated temptation scores reliably discriminate between stages of change, tracking readiness, post-treatment lapse susceptibility, and longitudinal maintenance of sobriety. This article offers an exhaustive structural, theoretical, psychometric, and clinical profile of the STS-A.

Keywords

Situation Temptation Scales, STS-A, Transtheoretical Model, Alcohol Use Disorder, Relapse Prevention, High-Risk Situations, Craving, Self-Efficacy, DiClemente, Project MATCH

Authors

The primary architects and principal investigators responsible for developing, operationalizing, and validating the Situation Temptation Scales – Alcohol Version (and its sibling inventory, the Alcohol Abstinence Self-Efficacy Scale) include:

• Carlo C. DiClemente, Ph.D. — Professor Emeritus of Psychology at the University of Maryland, Baltimore County (UMBC). Dr. DiClemente is co-developer of the Transtheoretical Model of Behavior Change alongside James O. Prochaska, and an international authority on addiction psychology and health behavior change.
• Joseph P. Carbonari, Ed.D. — Professor of Psychology at the University of Houston, specializing in quantitative psychometrics, multivariate research methodology, and addiction measurement models.
• Richard P. G. Montgomery, Ph.D. — Research associate and clinical collaborator involved in the initial psychometric standardization and factorial validation of situational alcohol assessment tools.
• Mary M. Velasquez, Ph.D. — Centennial Professor in Leadership for Community, University of Texas at Austin, renowned for translational research on motivational interviewing, TTM applications in clinical substance abuse populations, and Project DELTA.

Primary institutional affiliation: Department of Psychology, University of Maryland, Baltimore County (UMBC), Habits Lab, 1000 Hilltop Circle, Baltimore, MD 21250.

Purpose

The primary clinical and empirical purpose of the Situation Temptation Scales – Alcohol Version (STS-A) is to quantify the subjective magnitude of temptation an individual experiences to consume alcohol when confronted with specific intrapersonal, interpersonal, physiological, and environmental antecedents. Within the overarching paradigm of substance use disorder (SUD) assessment, relapse is rarely a random phenomenon; rather, it is precipitated by distinct cues and contexts that challenge an individual’s regulatory capacity (Marlatt & Gordon, 1985). By systematically deconstructing these antecedents, the STS-A establishes an empirical map of situational vulnerability.

Clinically, the STS-A serves several vital diagnostic and therapeutic functions:

• Individualized Relapse Risk Profiling: The scale enables clinicians to pinpoint the exact environmental triggers (e.g., social gatherings) or affective states (e.g., interpersonal anger, depressive episodes) that pose the greatest threat to a client’s sobriety, facilitating targeted behavioral interventions.
• Treatment Planning and Coping Skills Training: By distinguishing between cue-induced physiological craving and negative-affect-driven drinking, therapy can be customized. For instance, high scores on Negative Affect prompt cognitive restructuring and distress tolerance interventions, whereas high Social/Positive scores necessitate assertiveness training and drink-refusal skills.
• Stage of Change Concordance: The STS-A allows researchers and practitioners to operationalize the Transtheoretical Model. Temptation systematically peaks in the Precontemplation and Contemplation stages and progressively diminishes across Action and Maintenance, serving as a dynamic index of recovery consolidation.
• Outcome Assessment in Clinical Trials: As demonstrated in landmark multi-site addiction studies such as Project MATCH, tracking fluctuations in situational temptation over time provides a continuous marker of pharmacotherapeutic and psychotherapeutic efficacy, predicting sustained abstinence versus prospective lapse.

Psychological Construct

The core psychological construct evaluated by the STS-A is situational temptation, defined within the TTM framework as an individual’s subjective urge, impulse, or desire to engage in a specific problem behavior when facing adverse or cue-dense circumstances (DiClemente et al., 1994; Velicer et al., 1990). Temptation functions as the inverse counterpart to situational self-efficacy: whereas self-efficacy reflects confidence in one’s ability to abstain, temptation reflects the psychological intensity of the motivational pull exerted by internal and external triggers.

The construct is multidimensional, comprised of four distinct yet interrelated domains:

1. Negative Affect

This subscale evaluates the degree to which distressing internal affective states trigger the desire to drink. Rooted in negative reinforcement models of addiction (Baker et al., 2004), alcohol is cognitively appraised as a chemical coping mechanism to attenuate psychological pain, anxiety, frustration, and depressive mood. Representative situations include feeling depressed, feeling anxious or worried, experiencing internal rage, or sensing that everything is going wrong. High scorers in this domain display affective vulnerability and emotional-relief drinking patterns.

2. Social/Positive Situations

This subscale captures the pull to consume alcohol during celebratory, recreational, and socially facilitative contexts. Governed by positive reinforcement mechanisms, drinking in these situations is motivated by social cohesion, euphoria, and environmental modeling. Items evaluate temptation when on vacation, during celebrations, when observing others drinking at a bar, or when encountering direct peer pressure. Elevated scores reflect social-hedonic conditioning and vulnerability to social facilitation cues.

3. Physical and Other Concerns

This domain captures the temptation to drink prompted by physiological somatic distress, physical fatigue, somatic pain, and cognitive preoccupations. Individuals who score high in this dimension may use alcohol as a crude analgesic, a hypnotic agent to manage exhaustion, or a self-medicating response to acute headaches and somatic tension. It also encompasses situations where concern for others or intrusive ruminations trigger the urge to drink.

4. Cravings and Urges

This dimension reflects acute, physiological, cue-conditioned cravings and visceral impulses, including the physiological agony of acute withdrawal. It also encapsulates paradoxical cognitive-behavioral vulnerabilities, such as experiencing an urge to test one’s personal willpower or taking “just one drink to see what happens.” This subscale evaluates biological neuroadaptation, classical cue reactivity, and cognitive rationalization.

Theoretical Framework

The theoretical bedrock of the Situation Temptation Scales is the Transtheoretical Model of Behavior Change (TTM) developed by James O. Prochaska and Carlo C. DiClemente (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992). The TTM conceptualizes intentional health behavior modification not as an all-or-nothing event, but as a dynamic, cyclical progression through five distinct Stages of Change:

1. Precontemplation: The individual has no intention to change behavior in the foreseeable future, characterized by high temptation and low self-efficacy.
2. Contemplation: The individual is aware of the problem and seriously considering cessation, but experiences acute ambivalence. Temptation remains high.
3. Preparation: The individual intends to take action in the immediate future and begins behavioral micro-steps.
4. Action: The individual has actively modified drinking behavior within the past six months, requiring effortful self-regulation as temptation begins to decline.
5. Maintenance: The individual works to prevent relapse and consolidate gains; sustained recovery is achieved when situational temptation drops to negligible levels.

Within the TTM, self-efficacy theory (Bandura, 1977) was adapted to capture situational confidence and temptation. DiClemente and colleagues posited that successful transition across the stages requires a critical shift: temptation must systematically decrease while self-efficacy increases. The STS-A operationalizes the temptation side of this balance.

Furthermore, the scale incorporates G. Alan Marlatt’s cognitive-behavioral relapse prevention taxonomy (Marlatt & Gordon, 1985). Marlatt posited that high-risk relapse situations divide into intrapersonal determinants (negative emotional states, physical discomfort) and interpersonal determinants (social pressure, interpersonal conflict). The four-factor structure of the STS-A directly reflects this clinical taxonomy, bridging macro-level stage progression with micro-level cognitive-behavioral risk factors.

Validity

The construct, criterion, and predictive validity of the STS-A have been evaluated extensively across outpatient clinics, residential addiction centers, and large-scale clinical trials such as Project MATCH and Project DELTA.

Construct and Factorial Validity

In the foundational validation study by DiClemente, Carbonari, and Montgomery (1994) involving individuals seeking outpatient alcoholism treatment (N = 227), confirmatory factor analyses supported a robust four-factor structure corresponding to Negative Affect, Social/Positive, Physical/Other Concerns, and Cravings/Urges. The factors demonstrated clear conceptual coherence and differentiated between internal emotional stress and external interpersonal cues.

Convergent and Discriminant Validity

The STS-A correlates negatively with situational confidence measures (e.g., the Confidence subscale of the Alcohol Abstinence Self-Efficacy Scale; r values typically between -.45 and -.75 across subscales). It correlates positively with validated craving inventories, such as the Penn Alcohol Craving Scale (PACS) and the Obsessive Compulsive Drinking Scale (OCDS). Discriminant validity has been confirmed by low to moderate correlations with general psychiatric distress inventories, demonstrating that the STS-A captures specific behavioral temptation rather than generalized neuroticism or global psychopathology.

Predictive and Criterion Validity

Longitudinal investigations during Project MATCH demonstrated that baseline and end-of-treatment STS-A scores independently predict post-treatment relapse latency, frequency of drinking days, and drinks per drinking day at 3-, 9-, and 15-month follow-ups. Clients exhibiting higher residual temptation in the Negative Affect and Cravings domains during the Action phase demonstrated significantly higher hazard ratios for rapid relapse compared to those whose temptation declined systematically (DiClemente et al., 1994; Project MATCH Research Group, 1997).

Reliability

The internal consistency and test-retest reliability of the STS-A have been replicated across multiple independent samples:

• Internal Consistency (DiClemente et al., 1994): In the initial psychometric validation of the 20-item scale, Cronbach’s alpha coefficients for the four subscales were:
  • Negative Affect: α = .99
  • Social/Positive: α = .86
  • Physical and Other Concerns: α = .60
  • Withdrawal/Urges (Cravings): α = .70
• Internal Consistency (Project DELTA): Cross-validation within the Project DELTA cohort yielded consistent internal reliability coefficients across the domains:
  • Negative Affect: α = .81
  • Social/Positive: α = .75
  • Physical and Other Concerns: α = .63
  • Withdrawal/Urges: α = .70
• Abbreviated Forms: The 12-item brief version maintains comparable internal consistency, with alphas typically ranging from .70 to .88 across the four consolidated subscales, minimizing respondent burden without compromising measurement fidelity.
• Temporal Stability: Test-retest reliability over a two-week interval among stable outpatients yielded intraclass correlation coefficients (ICCs) between .78 and .86, confirming measurement stability in non-interventional periods.

Factor Analysis

Psychometric evaluation using exploratory factor analysis (EFA) with oblimin rotation originally extracted four primary factors explaining approximately 60% to 68% of the total variance across items. Subsequent confirmatory factor analysis (CFA) supported the four-factor correlated model over unidimensional and orthogonal structures.

In standard CFA testing across clinical cohorts, the four-factor oblique model yielded strong goodness-of-fit metrics:

• Comparative Fit Index (CFI) ≥ .92
• Tucker-Lewis Index (TLI) ≥ .91
• Root Mean Square Error of Approximation (RMSEA) ≤ .065 (90% CI [.052, .078])
• Standardized Root Mean Square Residual (SRMR) ≤ .058

Item factor loadings consistently exceed .60 for primary indicator items. For instance, in the Negative Affect dimension, items such as “When I feel like blowing up because of frustration” and “When I am feeling angry inside” demonstrate standardized loadings ranging from .72 to .88. In the Social/Positive domain, items referencing bars and parties load between .68 and .85. Higher-order factor models evaluating a single overarching general factor of “Global Temptation” have also shown acceptable fit, justifying both subscale-specific interpretation and aggregate summary scoring.

Instrument / Measurement Tool

• Full Instrument Name: Situation Temptation Scales – Alcohol Version (STS-A)
• Alternative / Companion Name: Alcohol Abstinence Self-Efficacy Scale – Temptation Subscale (AASE-T)
• Primary Developer: Carlo C. DiClemente, Ph.D., and colleagues
• Format: Self-administered paper-and-pencil or computerized self-report questionnaire
• Item Count: 20 items in the standard full version; 12 items in the brief versions
• Response Scale: 5-point Likert scale:
  • 1 = Not at all tempted
  • 2 = Not very tempted
  • 3 = Moderately tempted
  • 4 = Very tempted
  • 5 = Extremely tempted
• Subscale Breakdown (20-Item Standard Form):
  • 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 Breakdown (12-Item Short Form):
  • 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
• Subscale Breakdown (12-Item DELTA Project Variant):
  • Negative Affect: Items 1, 3, 10
  • Social/Positive: Items 2, 5, 12
  • Physical and Fatigue: Items 7, 8, 9
  • Cravings and Urges: Items 4, 6, 11
• Scoring Procedures: Subscale scores are derived by calculating the mean or sum of the items assigned to each dimension. Total scale scores represent the arithmetic sum (ranging from 20 to 100 for the full form) or average item mean (ranging from 1.0 to 5.0). Higher scores denote greater intensity of situational relapse risk and temptation to drink.

Permissions & Fee and Test Year

The Situation Temptation Scales – Alcohol Version was established and psychometrically validated in 1994 by DiClemente, Carbonari, and Montgomery. As an instrument developed with public federal research grant funding and hosted by academic institutions, the scale is generally considered to be in the public domain for research and non-profit clinical applications.

The instrument and its clinical administration guidelines can be accessed via the University of Maryland, Baltimore County (UMBC) Habits Lab repository (http://habitslab.umbc.edu/situation-temptation-scales/). Commercial distribution, computerized proprietary inclusion, or corporate utilization requires formal permissions and potential licensing arrangements with the developers. Researchers and clinicians utilizing the scale should provide proper APA bibliographic attribution to the primary authors.

References

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• Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191
• DiClemente, C. C. (2007). Mechanisms, determinants and process of change in the modification of drinking behavior. Alcoholism: Clinical and Experimental Research, 31(s3), 13S–20S. https://doi.org/10.1111/j.1530-0277.2007.00490.x
• DiClemente, C. C., Carbonari, J. P., & Montgomery, R. P. G. (1994). The Alcohol Abstinence Self-Efficacy scale. Journal of Studies on Alcohol, 55(2), 141–148. https://doi.org/10.15288/jsa.1994.55.141
• 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. https://doi.org/10.1007/978-1-4612-0359-9_5
• 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
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• 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
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• Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol, 58(1), 7–29. https://doi.org/10.15288/jsa.1997.58.7
• 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

13. Items of the Scale (Questionnaire)