University of Rhode Island Change Assessment Scale (URICA) – Drug Version

Abstract

The University of Rhode Island Change Assessment Scale – Drug Version (URICA-DV) is a prominent, psychometrically validated self-report instrument designed to operationalize and assess the stages of change outlined in the Transtheoretical Model (TTM) of behavior change within illicit drug-using and substance-dependent populations. Originating from the seminal work of James O. Prochaska and Carlo C. DiClemente, the URICA was modified to specifically capture intentional behavior change processes surrounding problem drug use. The full-length instrument comprises 32 items, with widely implemented reduced variants including 28-item, 24-item, and 12-item versions. Across all iterations, items are scored on a 5-point Likert response scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree).

The scale measures four distinct, theoretically anchored dimensions: Precontemplation (lack of problem awareness and resistance to change), Contemplation (ambivalence, awareness of the problem, and evaluation of change), Action (active behavioral modification and commitment to cessation), and Maintenance (sustained behavioral consolidation and relapse prevention). Rather than assigning respondents to a single discrete stage, the URICA-DV captures continuous subscale scores that yield empirically derived motivational profiles or a composite Readiness to Change score (calculated as Contemplation + Action + Maintenance − Precontemplation). Extensive psychometric research confirms robust internal consistency across subscales (Cronbach’s α typically ranging from .69 to .85 across adult clinical samples, with lower values occasionally observed in the Maintenance subscale of briefer forms), well-established convergent validity with treatment attendance and drug abstinence outcomes, and a reliable four-factor structure demonstrated via exploratory and confirmatory factor analyses. The URICA-DV serves as an indispensable tool in clinical assessment, motivational interviewing, tailored treatment planning, and addiction research worldwide.

Keywords

University of Rhode Island Change Assessment, URICA, Transtheoretical Model, Stages of Change, Substance Abuse Assessment, Motivation to Change, Readiness to Change, Drug Addiction, Psychometrics, Factor Analysis, Relapse Prevention, Treatment Engagement

Authors

The theoretical framework and original instantiation of the University of Rhode Island Change Assessment Scale were developed by:

• Carlo C. DiClemente, Ph.D. – Department of Psychology, University of Maryland, Baltimore County (UMBC), Baltimore, Maryland, USA.
• James O. Prochaska, Ph.D. – Cancer Prevention Research Center, Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA.
• Wayne F. Velicer, Ph.D. – Cancer Prevention Research Center, Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA.
• Joseph L. Fava, Ph.D. – Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island, USA.

Specific adaptations and psychometric validation of the URICA for drug-using and illicit substance-dependent cohorts were spearheaded by collaborative investigative teams, including Joseph P. Carbonari, Ed.D. (University of Houston), Allen Zweben, Ph.D. (Columbia University School of Social Work), Mark A. Belding, Ph.D., Harvey A. Siegal, Ph.D. (Wright State University School of Medicine), and Michael V. Pantalon, Ph.D. (Yale University School of Medicine).

Purpose

The primary purpose of the University of Rhode Island Change Assessment Scale – Drug Version (URICA-DV) is to quantitatively evaluate an individual’s motivational readiness to address, modify, or cease illicit drug use. Rooted in clinical health psychology and addiction medicine, the scale addresses a profound challenge in substance use disorder (SUD) treatment: client heterogeneity regarding readiness, motivation, and psychological resistance. Historically, addiction treatment models assumed that all presenting patients were uniformly prepared for immediate behavioral action. However, high rates of premature dropout, non-compliance, and relapse demonstrated that mismatching therapeutic interventions with a patient’s true psychological stage of change undermines clinical efficacy.

In clinical practice, the URICA-DV provides clinicians with an objective, empirically validated profile of a client’s current stage status. By distinguishing whether an individual is actively denying problem severity (Precontemplation), ambivalently considering change (Contemplation), actively acquiring new coping strategies (Action), or consolidating gains to avoid regression (Maintenance), therapists can tailor interventions accordingly. For instance, individuals scoring high in Precontemplation require non-confrontational, motivational enhancement techniques (such as motivational interviewing) to raise awareness of substance-related negative consequences. Conversely, clients with elevated Action scores benefit most from cognitive-behavioral skills training, stimulus control, and structured coping mechanisms.

In clinical trials and observational research, the URICA-DV operates as a primary or secondary outcome measure, an explanatory covariate, and a prognostic indicator. It allows researchers to evaluate whether novel pharmacotherapies or behavioral interventions alter internal motivation, to test hypotheses concerning stage transitions over time, and to investigate the mechanisms of change underlying sustained recovery from substances such as cocaine, opioids, cannabis, amphetamines, and polysubstance misuse.

Psychological Construct

The psychological construct assessed by the URICA-DV is Readiness to Change, operationalized not as a static personality trait or a simple binary switch (motivated versus unmotivated), but as a dynamic, multidimensional process characterized by progressive cognitive, affective, and behavioral tasks. The construct comprises four primary dimensions:

1. Precontemplation

Precontemplation reflects an absence of perceived need for behavioral change. Individuals at this stage typically minimize or deny the negative consequences associated with their illicit drug use. They externalize responsibility, attributing external difficulties (such as legal problems, family conflict, or financial instability) to societal oppression, unfair interpersonal relationships, or bad luck rather than personal drug consumption. Sample thoughts include the belief that changing is a waste of time because the problem does not lie within themselves. Within the URICA-DV, items tapping this subscale capture active resistance to psychological exploration, hostility toward therapeutic intervention, and defensive minimization (e.g., “As far as I’m concerned, I don’t have any problems that need changing”).

2. Contemplation

Contemplation is characterized by marked ambivalence and internal conflict. The individual acknowledges that their drug consumption creates significant adverse consequences and contemplates cessation, but remains simultaneously attached to the positive reinforcing aspects of substance use. Clients in this stage weigh the perceived benefits versus costs of change (the decisional balance). They often experience chronic procrastination or “chronic contemplation,” remaining open to information, feedback, and external advice while lacking firm commitment to immediate cessation. URICA-DV items measuring contemplation capture desire for self-understanding, recognition of personal struggle, and receptivity to guidance (e.g., “I’ve been thinking that I might want to change something about myself”).

3. Action

The Action dimension captures visible, overt behavioral modification and vigorous personal investment in altering drug-using behaviors, environments, and routines. Individuals scoring high in Action have initiated concrete steps to achieve and maintain abstinence, manage cravings, or alter high-risk lifestyle patterns. This subscale reflects substantial effort, commitment, and personal agency. It taps the subjective realization that cognitive intention must be translated into active behavioral execution (e.g., “I am really working hard to change” and “Anyone can talk about changing; I’m actually doing something about it”).

4. Maintenance

Maintenance focuses on the sustained consolidation of gains achieved during the Action stage, lifestyle stabilization, and active vigilance against relapse. Once drug use has ceased or markedly decreased, the primary clinical challenge shifts to preventing recurrence under conditions of acute stress, negative affect, social pressure, or cue exposure. The Maintenance subscale of the URICA-DV assesses ongoing struggle, fear of slipping back, recognition of past vulnerabilities, and the proactive search for assistance or reinforcement to preserve long-term recovery (e.g., “It worries me that I might slip back on a problem I have already changed, so I am looking for help”).

Continuous Readiness Profile and Composite Scoring

Unlike categorical algorithm staging tools that sort clients into mutually exclusive stages based on arbitrary timeframes (such as intending to quit within 30 days), the URICA-DV treats these stages as continuous, co-occurring psychological processes. A client may simultaneously display elevated Contemplation and Action scores while showing low Precontemplation. Alternatively, a client mandated to treatment may exhibit high Precontemplation alongside moderate Contemplation. Researchers and clinicians also calculate a composite Readiness Score by summing the means of the Contemplation, Action, and Maintenance subscales and subtracting the mean of the Precontemplation subscale: $$\text{Readiness} = (M_{\text{Contemplation}} + M_{\text{Action}} + M_{\text{Maintenance}}) – M_{\text{Precontemplation}}$$.

Theoretical Framework

The foundational underpinning of the URICA-DV is the Transtheoretical Model of Health Behavior Change (TTM), formulated in the late 1970s and 1980s by James O. Prochaska and Carlo C. DiClemente. The model emerged from a comparative comparative synthesis of major psychotherapy and behavior change theories—hence the descriptor transtheoretical—integrating psychoanalytic, humanistic, experiential, cognitive, and behavioral paradigms into a comprehensive explanatory framework.

The TTM posits that intentional human behavior change unfolds through an orderly sequence of stages rather than occurring as a single, instantaneous event. The core organizing dimensions of the TTM encompass:

• Stages of Change: The temporal, motivational, and cognitive-behavioral dimension reflecting when change occurs (Precontemplation, Contemplation, Preparation, Action, Maintenance, and Termination). In the URICA, Preparation items are theoretically absorbed into the transition between Contemplation and Action.
• Processes of Change: The covert and overt cognitive, affective, and behavioral activities that individuals implement to progress through the stages. These include experiential processes (e.g., consciousness raising, emotional arousal, environmental reevaluation) which are prominent during early stages, and behavioral processes (e.g., stimulus control, counterconditioning, contingency management) which dominate later stages.
• Decisional Balance: Derived from Janis and Mann’s decision-making model, evaluating the cognitive appraisal of the “Pros” versus “Cons” of changing problem behavior.
• Self-Efficacy: Originating from Albert Bandura‘s social cognitive theory, capturing an individual’s situation-specific confidence in resisting drug use across high-risk contexts without relapsing.

A central tenet of the TTM is that the progression through stages is spiral rather than strictly linear. In chronic relapsing conditions such as drug dependency, individuals routinely cycle through stages multiple times, learning from previous relapses, refining coping responses, and progressing toward stable, sustained maintenance. The URICA-DV captures this fluid, dynamic movement by providing continuous indices across the critical stages of this transtheoretical continuum.

Validity

The validity of the URICA and its drug-specific adaptation (URICA-DV) has been extensively substantiated across diverse outpatient, inpatient, residential, methadone maintenance, and forensic substance abuse treatment populations.

Construct Validity

Construct validity is evidenced by the scale’s predictable relationships with external indicators of substance involvement and cognitive appraisals. Studies demonstrate that clients presenting with high Precontemplation scores systematically report lower perceived severity of drug-related negative consequences, endorse fewer “Cons” of drug use, and exhibit higher defensiveness. Conversely, clients with elevated Contemplation and Action scores report greater perceived distress, higher substance-related functional impairment, and greater perceived necessity of professional treatment.

Convergent and Concurrent Validity

Belding et al. (1996) investigated the convergent validity of the URICA in a clinical cohort of methadone maintenance patients, comparing URICA subscales with other motivational instruments, such as the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Their findings confirmed moderate-to-strong correlations between corresponding dimensions (e.g., URICA Action correlating positively with SOCRATES Taking Steps, and URICA Precontemplation correlating inversely with Recognition). In a study evaluating crack cocaine users, Siegal et al. (2001) demonstrated that baseline URICA scores showed meaningful concurrent relationships with treatment referral adherence, self-reported health problems, and psychosocial stressors.

Predictive Validity

The predictive validity of the URICA-DV has been repeatedly established concerning treatment entry, retention, and post-discharge drug abstinence. Pantalon, Nich, Frankforter, and Carroll (2002) evaluated the URICA among dually diagnosed, treatment-seeking individuals presenting with concurrent alcohol and cocaine use disorders. They found that baseline readiness profiles significantly predicted session attendance, active participation in therapy, and negative urine toxicology screens during the initial 12 weeks of treatment. Clients characterized by “uninvolved” or high-Precontemplation profiles experienced markedly higher dropout rates. Similarly, DiClemente, Schlundt, and Gemmell (2004) synthesized evidence demonstrating that higher composite Readiness Scores consistently predict favorable retention in outpatient addiction clinics.

Discriminant Validity

Discriminant validity is supported by the distinct factor structure showing weak or negative correlations between theoretically distant stages. Specifically, the Precontemplation subscale consistently correlates negatively with Action (typically $r = -.20$ to $-.50$) and Contemplation. Furthermore, research demonstrates that the URICA-DV does not merely mirror general psychological distress or depressive symptomatology, retaining incremental predictive validity after controlling for Beck Depression Inventory (BDI) scores and severity of physical drug dependence.

Reliability

The reliability of the URICA-DV has been comprehensively documented across multiple clinical drug-using samples, assessing both internal consistency (Cronbach’s alpha) and temporal stability (test-retest reliability).

Internal Consistency

Across validation studies utilizing the full 32-item instrument and its validated subsets, the URICA-DV has demonstrated satisfactory-to-excellent internal consistency. Table 1 summarizes representative Cronbach’s alpha coefficients reported across major psychometric investigations:

As evident from the empirical data, the 32-item drug version yields consistently high alpha coefficients across all four subscales (.76 to .88). Briefer forms (such as the 12-item brief scale) exhibit attenuated reliability, particularly for the Maintenance subscale (α = .35 in Rothfleisch, 1998), suggesting that the multidimensional aspects of maintenance require more extensive item representation to maintain acceptable internal consistency in clinical drug settings.

Test-Retest Stability

Because the URICA assesses dynamic, state-like stages of change that are expected to fluctuate in response to therapy or clinical events, test-retest coefficients must be interpreted with caution. Short-term test-retest reliability across 1- to 2-week intervals prior to active intervention indicates moderate-to-high temporal stability (intraclass correlation coefficients ranging between .68 and .84), confirming that subscale scores represent stable motivational states rather than transient momentary moods.

Factor Analysis

The factorial structure of the URICA-DV has been rigorously tested using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

Exploratory Factor Analysis (EFA)

In initial scale development investigations by McConnaughy, Prochaska, and Velicer (1983) and subsequent drug-specific adaptations by Carbonari, DiClemente, and Zweben (1994), principal component analyses (PCA) and principal axis factoring with orthogonal (Varimax) and oblique (Promax) rotations were conducted. Across analyses, a four-factor solution consistently emerged, explaining approximately 50% to 58% of the total variance.

• Factor 1 (Precontemplation): Characterized by high positive loadings (ranging from .45 to .78) for items reflecting denial of problems (e.g., Item 1, 5, 11, 23).
• Factor 2 (Contemplation): Strong loadings (.50 to .75) for items addressing self-evaluation, awareness, and seeking advice (e.g., Item 2, 8, 12, 15).
• Factor 3 (Action): Substantial loadings (.52 to .81) on items capturing active behavioral striving, modifying routines, and overcoming obstacles (e.g., Item 3, 7, 10, 14, 25, 30).
• Factor 4 (Maintenance): Significant loadings (.44 to .72) on items regarding relapse concerns, sustaining improvements, and resisting regression (e.g., Item 6, 16, 18, 22, 27).

Confirmatory Factor Analysis (CFA)

Subsequent CFA investigations across drug-dependent cohorts have compared competing theoretical models: a unidimensional model, an orthogonal four-factor model, an oblique (correlated) four-factor model, and a second-order factor model where a overarching Readiness latent construct accounts for the shared variance among the lower-order factors. The correlated four-factor model has consistently demonstrated superior fit to the data, satisfying standard structural equation modeling fit criteria:

• Comparative Fit Index (CFI): Typically > .90 to .94 in well-specified models.
• Tucker-Lewis Index (TLI): Typically > .90.
• Root Mean Square Error of Approximation (RMSEA): Values ranging from .045 to .065, indicating acceptable to good model fit.
• Standardized Root Mean Square Residual (SRMR): Typically ≤ .06.

CFA studies have also confirmed that certain items in the 32-item version show moderate cross-loadings or higher residual covariances (e.g., Item 4 in Contemplation, Item 20 in Action, Item 9 in Maintenance, and Item 31 in Precontemplation). These findings led researchers to omit these problematic items in refined 28-item and 24-item shortened models, resulting in elevated parameter estimates and cleaner factor purity without sacrificing theoretical coverage.

Instrument / Measurement Tool

The University of Rhode Island Change Assessment Scale – Drug Version is formatted as a standardized self-report questionnaire. Its operational characteristics are detailed below:

• Instrument Type: Standardized self-administered psychological assessment instrument (also adaptable for structured clinical interview administration).
• Target Population: Adolescents and adults (ages 16 and older) with suspected, self-reported, or clinically diagnosed illicit drug use or substance use disorders.
• Item Count:
  • Full Standard Form: 32 items.
  • Shortened Forms: 28-item version, 24-item version, and 12-item screening version.
• Administration Time: Approximately 8 to 12 minutes for the 32-item version; 3 to 5 minutes for the shortened versions.
• Response Format: 5-point Likert scale:
  • 1 = Strongly Disagree
  • 2 = Disagree
  • 3 = Undecided
  • 4 = Agree
  • 5 = Strongly Agree
• Subscale Item Composition (Standard 32-Item Version):
  • Precontemplation (8 items): 1, 5, 11, 13, 23, 26, 29, 31 (Item 31 is omitted in some 28-item variants).
  • Contemplation (8 items): 2, 4, 8, 12, 15, 19, 21, 24 (Item 4 is omitted in some 28-item variants).
  • Action (8 items): 3, 7, 10, 14, 17, 20, 25, 30 (Item 20 is omitted in some 28-item variants).
  • Maintenance (8 items): 6, 9, 16, 18, 22, 27, 28, 32 (Item 9 is omitted in some 28-item variants).
• Subscale Item Composition (24-Item Version):
  • Precontemplation (6 items): 1, 5, 7, 16, 19, 22
  • Contemplation (6 items): 3, 6, 9, 13, 14, 17
  • Action (6 items): 2, 4, 8, 11, 18, 23
  • Maintenance (6 items): 10, 12, 15, 20, 21, 24
• Scoring and Computational Rules:
  • Subscale Mean Scores: Sum the endorsed item scores within each subscale and divide by the number of items in that subscale (yielding a mean score between 1.0 and 5.0 for each dimension).
  • Readiness Score: Derived by summing the mean scores of Contemplation, Action, and Maintenance, and subtracting the mean score of Precontemplation: $$\text{Readiness Score} = M_{\text{Contemplation}} + M_{\text{Action}} + M_{\text{Maintenance}} – M_{\text{Precontemplation}}$$.
  • Cluster Profile Scoring: Clinicians plot standardized $T$-scores across all four subscales to classify respondents into empirical motivational profiles, such as Precontemplative, Ambivalent, Participation/Action, or Relapse Risk.

Permissions & Fee and Test Year

The URICA was originally formulated in the early 1980s (McConnaughy et al., 1983), with the substance- and drug-specific versions refined throughout the 1990s (Carbonari, DiClemente, & Zweben, 1994; Belding et al., 1996; Siegal et al., 2001). The instrument is widely treated as a public-domain scientific measure for research and clinical non-profit applications.

No royalty or commercial user fee is required for academic, clinical non-commercial, or educational utilization of the scale. However, authors request appropriate scholarly citation and adherence to standard psychometric administration guidelines. The scale and related documentation are maintained through academic repositories, including the University of Maryland, Baltimore County (UMBC) HABITS Laboratory (http://habitslab.umbc.edu/urica/) under the stewardship of Dr. Carlo C. DiClemente. Commercial software developers or proprietary treatment conglomerates seeking to integrate the scale into fee-for-service electronic medical record platforms are advised to seek permission directly from the copyright holders.

References

• Belding, M. A., Iguchi, M. Y., & Lamb, R. J. (1996). Stages of change in methadone maintenance: Assessing the convergent validity of two measures. Psychology of Addictive Behaviors, 10(3), 157–166. https://doi.org/10.1037/0893-164X.10.3.157
• Carbonari, J. P., DiClemente, C. C., & Zweben, A. (1994, November). A readiness to change measure. Paper presented at the 28th Annual Meeting of the Association for Behavioral and Cognitive Therapies (ABCT), San Diego, CA.
• Carney, M. M., & Kivlahan, D. R. (1995). Motivational subtypes among veterans seeking substance abuse treatment: Profiles based on stages of change. Psychology of Addictive Behaviors, 9(2), 135–142. https://doi.org/10.1037/0893-164X.9.2.135
• DiClemente, C. C. (2005). Conceptual models and applied research: The ongoing contribution of the Transtheoretical Model. Journal of Addictions Nursing, 16(1–2), 5–12. https://doi.org/10.1080/10884600590916400
• DiClemente, C. C., Schlundt, D., & Gemmell, L. (2004). Readiness and stages of change in addiction treatment. The American Journal on Addictions, 13(2), 103–119. https://doi.org/10.1080/10550490490435969
• Levesque, D. A., Gelles, R. J., & Velicer, W. F. (2000). Development and validation of a stages of change measure for men in batterer treatment. Cognitive Therapy and Research, 24(2), 175–199. https://doi.org/10.1023/A:1005404506240
• McConnaughy, E. A., Prochaska, J. O., & Velicer, W. F. (1983). Stages of change in psychotherapy: Measurement and testing of a model. Psychotherapy: Theory, Research & Practice, 20(3), 368–375. https://doi.org/10.1037/h0090198
• Pantalon, M. V., Nich, C., Frankforter, T., & Carroll, K. M. (2002). The URICA as a measure of motivation to change among treatment-seeking individuals with concurrent alcohol and cocaine problems. Psychology of Addictive Behaviors, 16(4), 299–307. https://doi.org/10.1037/0893-164X.16.4.299
• 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
• Rothfleisch, J. (1998). Comparison of two measures of stages of change among drug abusers. Dissertation Abstracts International: Section B: The Sciences and Engineering, 59(6-B), 3073.
• Siegal, H. A., Li, L., Rapp, R. C., & Saha, P. (2001). Measuring readiness for change among crack cocaine users: A descriptive analysis. Substance Use & Misuse, 36(6–7), 687–700. https://doi.org/10.1081/JA-100104085

Items of the Scale