Situation Temptation Scales- Drug Version

1. Abstract

The Situation Temptation Scales- Drug Version (STS-D) is an empirically validated psychometric instrument engineered to evaluate an individual’s perceived temptation to consume illicit substances across high-risk environmental, affective, and interpersonal contexts. Grounded in the Transtheoretical Model (TTM) of behavior change pioneered by James O. Prochaska and Carlo C. DiClemente, the STS-D serves as a functional counterpart to situational self-efficacy inventories, conceptualizing temptation as an inverse or complementary determinant of an individual’s behavioral confidence in maintaining abstinence.

The instrument is administered primarily in a full 20-item version and an abbreviated 12-item short form. Both configurations map onto four core empirical dimensions: Negative Affect, Social/Positive situations, Physical and Other Concerns, and Cravings and Urges (alternatively operationalized in addiction literature as withdrawal/urges). Each stimulus item depicts a specific, context-dependent relapse trigger, and respondents rate their subjective intensity of temptation on a standardized 5-point Likert scale ranging from 1 (Not at all tempted) to 5 (Extremely tempted).

Extensive psychometric investigations among community cohorts, outpatient clinical populations, and criminal justice-involved substance users demonstrate robust structural validity, high internal consistency reliability, and substantial predictive utility. Cronbach’s alpha coefficients across dimensions systematically range from .72 to .90. Confirmatory factor analytic investigations have repeatedly substantiated the four-factor correlated model, which exhibits marked factorial invariance across diverse demographic and clinical subgroups. The STS-D is widely acknowledged as a foundational tool for operationalizing stage transitions, guiding cognitive-behavioral relapse prevention strategies, and predicting treatment retention and clinical relapse in both research and therapeutic environments.

2. Keywords

Situation Temptation Scales, STS-D, Transtheoretical Model, Substance Use Disorders, Craving, Relapse Prevention, Self-Efficacy, Behavioral Assessment, Psychometrics, Drug Dependence

3. Authors

The theoretical conceptualization and initial operationalization of the Situation Temptation Scales emerged from the foundational research of the Cancer Prevention Research Center at the University of Rhode Island, under the scientific leadership of:

• Wayne F. Velicer, Ph.D. — Former Professor of Psychology and Co-Director of the Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA. Dr. Velicer was a leading methodologist in psychometrics, structural equation modeling, and longitudinal behavior change analysis.
• Carlo C. DiClemente, Ph.D. — Professor Emeritus of Psychology, University of Maryland, Baltimore County (UMBC), Baltimore, MD, USA. Co-originator of the Transtheoretical Model and internationally recognized authority on addiction treatment, motivational interviewing, and health psychology.
• Joseph S. Rossi, Ph.D. — Professor of Psychology and Director of Research at the Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA. Expert in experimental design, statistical modeling, and quantitative behavioral metrics.
• James O. Prochaska, Ph.D. — Late Professor of Clinical and Health Psychology and founder of the Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA. Co-developer of the Transtheoretical Model.
• Matthew L. Hiller, Ph.D., Kevin M. Broome, Ph.D., Kevin Knight, Ph.D., and D. Dwayne Simpson, Ph.D. — Institute of Behavioral Research (IBR), Texas Christian University (TCU), Fort Worth, TX, USA. These investigators systematically evaluated and adapted the STS-D for correctional, criminal justice, and community-supervised substance-involved populations.

4. Purpose

The primary diagnostic and empirical purpose of the Situation Temptation Scales- Drug Version is to quantitatively capture the magnitude of relapse risk elicited by idiosyncratic internal and external situational triggers. Substance use disorders (SUDs) are characterized by compulsive seeking and consumption of chemical agents despite severe adverse consequences. Within cognitive-behavioral frameworks and relapse prevention paradigms, the path to resumption of drug use is rarely random; rather, it unfolds when an individual encounters specific “high-risk situations” that challenge self-regulatory resources.

From a theoretical perspective, the STS-D was designed to measure one of the central intervening outcome constructs of the Transtheoretical Model. Whereas the construct of self-efficacy (historically rooted in Albert Bandura’s social cognitive theory) captures an individual’s confidence in their operational capacity to avoid substance use in challenging moments, temptation assesses the subjective affective and motivational pull exerted by those exact situations. Rather than treating temptation and confidence as absolute mathematical inverses, contemporary psychometric theory recognizes that measuring temptation directly captures the intrusive, cue-reactive urge states that destabilize cognitive resolve.

In clinical practice, the STS-D operates as an indispensable diagnostic and treatment-planning instrument:

• Individualized Relapse Profiles: By evaluating subscale scores across emotional, social, physiological, and craving dimensions, clinicians can develop highly targeted treatment blueprints. For instance, an individual with elevated Negative Affect scores but nominal Social/Positive scores requires immediate emotion-regulation training, whereas high social scores necessitate assertiveness and drug-refusal assertiveness modeling.
• Stage Progression Monitoring: In longitudinal interventions, decreases in situation-specific temptation provide quantitative evidence of an individual’s transition across the stages of change—from Precontemplation and Contemplation toward Action and Maintenance.
• Outcome Evaluation: Clinical trials use the STS-D as an intermediate endpoint to gauge the efficacy of pharmacotherapies and cognitive-behavioral interventions aimed at extinguishing drug cue reactivity.
• Criminal Justice Screening: Widely deployed across probation, parole, and diversion systems (e.g., drug courts), the tool assists corrections professionals in identifying high-risk offenders who require intensive community supervision or residential rehabilitation pathways.

5. Psychological Construct

The Situation Temptation Scales- Drug Version operationalizes the multidimensional construct of situational temptation. This psychological phenomenon represents the intersection between associative conditioning, cognitive appraisal, and neurobiological reward circuitry. Temptation is defined as the experienced urge or motivational press toward drug consumption when confronted with specific antecedent stimuli. In the STS-D, this construct is decomposed into four discrete, highly reliable psychological dimensions:

Negative Affect

The Negative Affect dimension captures the drive to engage in chemical coping when faced with dysphoric internal emotional states. This subscale measures negative reinforcement mechanisms, wherein substance use functions as an experiential avoidance strategy to chemically attenuate intrapsychic distress. Items assess vulnerability in states of depression, worry, generalized internal frustration, and profound anger. In individuals exhibiting high Negative Affect temptation, classical conditioning has forged powerful neural associations between emotional pain and the homeostatic relief provided by drug intoxication. For instance, when an individual experiences acute professional failure or relational discord, the resultant emotional agony functions as a proximal trigger for immediate, compulsive self-medication.

Social/Positive Situations

The Social/Positive dimension reflects temptation triggered by positive reinforcement paradigms, festive environments, and peer facilitation. In these contexts, substance consumption is not sought for emotional relief, but rather to amplify hedonic pleasure, enhance interpersonal camaraderie, or participate in normative social rituals. Items measure temptation while on vacation, during celebratory gatherings, or when directly offered substances by acquaintances or former drug-using associates. This dimension captures vulnerability linked to social modeling, perceived peer norms, and the associative pairing of relaxation or recreational settings with substance accessibility.

Physical and Other Concerns

The Physical and Other Concerns dimension assesses situational vulnerability rooted in somatic distress, physiological depletion, and somatic cognitive interruptions. Items in this domain evaluate the urge to use drugs when experiencing acute headaches, profound physical exhaustion, musculoskeletal pain or physical trauma, somatic worry regarding significant others, or intrusive drug-related dreams. This construct demonstrates the bidirectional relationship between physical homeostasis and psychological vulnerability; when physiological reserves are depleted by illness, fatigue, or somatic stress, the cognitive executive capacity required to resist drug impulses is substantially undermined.

Cravings and Urges

The Cravings and Urges dimension measures vulnerability to neurobiological withdrawal states, acute interoceptive craving spikes, and spontaneous, unprompted drug impulses. Furthermore, this dimension captures paradoxical cognitive phenomena, such as the deliberate desire to “test one’s willpower” or the curiosity to “see what happens” if an individual uses substances after a period of abstinence. Items evaluate intense bodily cravings, the severe agony of physiological withdrawal, and unexpected intrusive impulses that catch the individual off guard. This subscale directly reflects the neuroadaptive and incentive-sensitization processes central to severe chemical dependence, capturing the autonomic urge states that occur independently of external social cues or overt affective crises.

6. Theoretical Framework

The architectural foundation of the STS-D is anchored in the Transtheoretical Model of Behavior Change, formulated by James O. Prochaska and Carlo C. DiClemente. Developed to provide a comprehensive, integrative paradigm for understanding intentional human behavioral transformation, the TTM integrates core principles from across divergent psychotherapy systems into an overarching temporal and cognitive framework.

The Core Dimensions of the Transtheoretical Model

The TTM posits that health behavior modification is not a discrete, all-or-nothing event, but rather a dynamic process occurring across five distinct Stages of Change:

1. Precontemplation: The individual does not intend to change behavioral patterns in the foreseeable future (typically defined as within the next six months) and often remains in denial regarding the adverse impacts of substance use.
2. Contemplation: The individual acknowledges the existence of a problem and seriously considers modifying their behavior within the next six months, but remains trapped in profound ambivalence.
3. Preparation: The individual intends to take concrete corrective action within the immediate future (usually the next month) and initiates minor preliminary behavioral steps.
4. Action: The individual overtly alters their behavior and social environment, actively maintaining continuous abstinence for up to six months.
5. Maintenance: The individual consolidates behavioral gains, working continuously to prevent relapse for periods extending beyond six months.

Within this stage progression, two major psychological constructs serve as intermediate markers of structural change: Decisional Balance (the comparative appraisal of the perceived pros and cons of changing) and Self-Efficacy / Temptation.

Integration with Self-Efficacy and Relapse Prevention Theory

The theoretical synthesis developed by Velicer, DiClemente, Rossi, and Prochaska (1990) positioned situational temptation in direct dialogue with Bandura’s self-efficacy construct and G. Alan Marlatt’s Relapse Prevention model. Marlatt posited that high-risk situations (such as interpersonal conflict, social pressure, and negative emotional states) threaten an individual’s sense of self-control. If an effective coping response is not enacted, the individual experiences decreased self-efficacy and an increase in positive outcome expectancies for substance use, which sharply elevates the probability of an initial “lapse” and subsequent full-blown relapse via the Abstinence Violation Effect (AVE).

Velicer and colleagues established that temptation and self-efficacy vary inversely across the stages of change. In the Precontemplation stage, temptation to use drugs across high-risk contexts is exceptionally high, while self-efficacy is virtually nonexistent. As individuals progress through Action and establish robust Maintenance, situational temptation steadily decays across all environmental and affective domains, while situational self-efficacy increases. Consequently, measuring situational temptation provides clinicians and researchers with an objective gauge of an individual’s movement along the behavioral change continuum.

7. Validity

The validity of the Situation Temptation Scales- Drug Version has been confirmed across diverse empirical settings, encompassing outpatient clinical trials, residential treatment programs, and large-scale probationer studies.

Construct Validity

Construct validity is evidenced by the scale’s predictable systematic variation across the TTM stages of change. Cross-sectional and longitudinal structural equation models demonstrated that mean total scores and individual subscale scores on the STS-D decrease monotonically as individuals move from Precontemplation toward Maintenance (Velicer et al., 1990; Hiller et al., 2000). Individuals in the Precontemplation phase consistently yield standardized temptation scores well over one standard deviation above the normative mean, whereas individuals in the Maintenance phase score more than one standard deviation below the mean, confirming the scale’s alignment with its underlying theoretical framework.

Convergent and Discriminant Validity

Convergent validity has been established by examining correlations between the STS-D and collateral measures of addiction severity, psychological distress, and substance-related problems:

• The Negative Affect subscale demonstrates strong positive correlations ($r = .55$ to $.68$, $p < .001$) with validated inventories of psychological distress, including the Beck Depression Inventory (BDI-II) and the Brief Symptom Inventory (BSI).
• The Cravings and Urges subscale correlates strongly ($r = .62$ to $.74$) with visual analog craving scales, the Penn Alcohol Craving Scale (PACS) adapted for illicit substances, and biochemical markers of active withdrawal.
• The Social/Positive subscale correlates positively with instruments assessing peer drug network density and socialization with substance-using peers.

Discriminant validity is supported by the STS-D’s capacity to differentiate between situational temptation and general trait neuroticism or generalized negative affectivity. While sharing common affective variance, structural equation modeling shows that situational temptation accounts for unique, incremental variance in substance-related outcomes above and beyond trait-level personality constructs.

Predictive Validity

The STS-D has consistently proven to be an exceptional predictor of real-world clinical and behavioral outcomes. In an influential empirical study conducted by Hiller, Broome, Knight, and Simpson (2000) investigating a sample of $N = 1,147$ drug-involved probationers, higher scores on the STS-D administered during intake into community correctional programming significantly predicted subsequent urinalysis-confirmed drug use and disciplinary discharge during supervision. Probationers who scored in the upper quartile of the Negative Affect and Cravings and Urges dimensions demonstrated a two- to three-fold higher hazard ratio for rapid relapse compared to their low-scoring peers, underscoring the scale’s utility for risk stratification.

8. Reliability

The internal consistency, temporal stability, and measurement error margins of the STS-D have been rigorously documented across numerous psychometric investigations.

Internal Consistency Reliability

In the landmark validation study conducted by Hiller et al. (2000) involving a diverse cohort of substance-involved criminal justice clients, the internal consistency coefficients (Cronbach’s alpha) across both the 20-item instrument and its subscales met or exceeded standard thresholds for clinical and research applications:

• Negative Affect Subscale: $\alpha = .90$, demonstrating excellent internal reliability and item homogeneity across diverse dysphoric emotional states.
• Social/Positive Subscale: $\alpha = .87$, indicating robust internal consistency across interpersonal, celebratory, and peer-prompted items.
• Withdrawal/Urges (Cravings and Urges) Subscale: $\alpha = .83$, reflecting strong cohesion among physiological cravings, withdrawal distress, and impulsive urges.
• Physical and Other Concerns Subscale: $\alpha = .72$, showing acceptable internal consistency for a multidimensional physiological and somatic distress scale.
• Total Scale: The composite 20-item scale consistently yields a total Cronbach’s alpha of $\alpha ge .92$.

Analysis of the 12-item abbreviated version shows comparable reliability profiles, with alphas typically ranging between $.78$ and $.86$ across subscales, confirming that structural brevity can be attained without substantial loss of internal consistency.

Test-Retest Reliability

In stable clinical samples tested over a 1- to 2-week interval during which active treatment had not yet commenced, the STS-D demonstrated strong temporal stability. Pearson correlation coefficients for test-retest reliability across subscales range between $r = .79$ and $r = .88$. Over extended temporal frames (e.g., three to six months), scores exhibit sensitivity to treatment-induced change, demonstrating appropriate longitudinal variance rather than static trait permanence.

9. Factor Analysis

The structural dimensionality of the Situation Temptation Scales has been repeatedly investigated using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

Exploratory Factor Analysis

In the original instrument derivation studies conducted by Velicer, DiClemente, and colleagues (1990), principal component and common factor analyses with varimax and oblique rotations were conducted across broad pools of situational items. A clear four-factor orthogonal and correlated solution consistently emerged, with scree tests, Kaiser’s criterion (eigenvalues $> 1.0$), and parallel analyses converging on a four-dimensional latent space accounting for over $60%$ of the total variance. Factor loadings for designated items systematically exceeded $.50$, with negligible cross-loadings onto alternative dimensions.

Confirmatory Factor Analysis and Model Fit

Confirmatory factor analytic investigations by Hiller et al. (2000) rigorously tested competing structural models, comparing a unidimensional single-factor model against hierarchical and correlated four-factor models. The four-factor correlated model demonstrated superior goodness-of-fit across standard psychometric metrics:

• Comparative Fit Index (CFI): Values regularly exceed $.92$, indicating adequate to good model approximation.
• Tucker-Lewis Index (TLI): Coefficients systematically surpass $.90$.
• Root Mean Square Error of Approximation (RMSEA): Estimates typically range between $.048$ and $.062$ ($90% \text{ CI } [.042, .068]$), meeting the criteria for acceptable to close model fit.
• Standardized Root Mean Square Residual (SRMR): Observed values are consistently below $.05$.

Standardized factor loadings ($lambda$) across individual items range from $.54$ to $.86$. In the Negative Affect factor, items such as “When I sense everything is going wrong for me” and “When I feel like blowing up because of frustration” yield standardized loadings exceeding $.75$. Similarly, in the Social/Positive factor, “When I see others using drugs at a bar or a party” and “When people I used to use drugs with encourage me to use drugs” present loadings above $.80$.

Measurement Invariance

Multiple-group CFA has confirmed full configural and metric invariance across biological sex, racial and ethnic categories (including White, African American, and Hispanic cohorts), and primary drug classes (e.g., stimulants vs. opioids). Scalar invariance has been supported across major clinical demographics, confirming that variations in observed scores reflect true differences in latent situational temptation rather than psychometric measurement bias.

10. Instrument / Measurement Tool

• Full Instrument Name: Situation Temptation Scales- Drug Version
• Standard Acronym: STS-D
• Instrument Nature: Quantitative psychometric self-report rating scale
• Construct Assessed: Situational temptation to consume illicit drugs across specific high-risk contexts
• Number of Items: 20 items (Full-Scale Version); 12 items (Short-Form Version)
• Available Formats: Pen-and-paper survey, computerized self-administered assessment, and structured clinical interview
• Response Scale: 5-point Likert-type scale:
  • 1 = Not at all tempted
  • 2 = Not very tempted
  • 3 = Moderately tempted
  • 4 = Very tempted
  • 5 = Extremely tempted
• Factor/Subscale Configuration (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
• Factor/Subscale Configuration (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 Methodology:
  • Subscale raw scores are derived by calculating either the mathematical sum or the arithmetic mean of items assigned to each respective dimension.
  • Mean subscale scores retain the original 1.0 to 5.0 metric, facilitating direct clinical interpretation.
  • A total global temptation score is computed by averaging all items (range: 1.0 – 5.0).
  • No items are reverse-coded; higher scores universally denote higher intensity of situational temptation and elevated relapse risk.

11. Permissions & Fee and Test Year

Initial Development Year: 1990 (theoretical integration and smoking scale archetype); systematically adapted and validated for illicit drug populations during the 1990s and published prominently in 2000 (Hiller et al., 2000).

Licensing and Availability: The Situation Temptation Scales- Drug Version resides in the public domain for non-profit academic, therapeutic, and clinical research purposes. In accordance with open-science assessment initiatives in addiction research, the instrument may be administered without royalty fees or licensing charges. Academic investigators and clinical providers may access the authentic instrument and documentation through university research portals, including the Health and Addictive Behaviors: Investigating Transitions and Solutions (HABITS) Lab directed by Dr. Carlo C. DiClemente at the University of Maryland, Baltimore County, as well as institutional archives of the Texas Christian University Institute of Behavioral Research (TCU IBR).

Commercial Use: Any commercial deployment, electronic incorporation into fee-for-service enterprise software platforms, or third-party digital publication requires prior authorization from the copyright holders and developing academic bodies.

12. References

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., Prochaska, J. O., & Gibertini, M. (1985). Self-efficacy and the stages of self-change of smoking. Cognitive Therapy and Research, 9(2), 181–200. https://doi.org/10.1007/BF01204849

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

Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford 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

Simpson, D. D., & Joe, G. W. (1993). Motivation as a predictor of early dropout from drug abuse treatment. Psychotherapy: Theory, Research, Practice, Training, 30(2), 357–368. https://doi.org/10.1037/0033-3204.30.2.357

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)