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

Abstract

The University of Rhode Island Change Assessment Scale (URICA) – Alcohol Version is a premier self-report psychometric instrument designed to evaluate an individual's readiness to change, motivational stance, and movement across the stages of change in relation to problem drinking. Grounded in the Transtheoretical Model (TTM) of intentional behavior change conceptualized by James O. Prochaska and Carlo C. DiClemente, the instrument assesses client motivation along a continuous conceptual continuum rather than assigning individuals to rigid, mutually exclusive categories. The standard alcohol-adapted iteration of the URICA encompasses 28 items distributed evenly across four distinct theoretical subscales: Precontemplation (7 items), Contemplation (7 items), Action (7 items), and Maintenance (7 items). Respondents rate each statement on a 5-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Abbreviated variants, including a 24-item adaptation and the 12-item Project DELTA reduced drinking version, are also utilized in outpatient and clinical research environments.

Extensive psychometric evaluations have demonstrated that the URICA exhibits robust structural validity and sound internal consistency across diverse clinical populations, including outpatient alcoholism treatment cohorts, aftercare programs, and dual-diagnosis psychiatric samples. Coefficient alpha values across the four subscales consistently range from satisfactory to high: Precontemplation ($\alpha = .66$ to $.75$), Contemplation ($\alpha = .73$ to $.81$), Action ($\alpha = .74$ to $.83$), and Maintenance ($\alpha = .74$ to $.86$). Factor analytic studies confirm a correlated four-factor oblique structure that mirrors the hypothesized cyclical nature of behavioral resolution. Clinicians and researchers derive both distinct subscale profiles and a standardized composite Readiness to Change score, which correlates strongly with therapeutic alliance, treatment retention, medication adherence, and long-term alcohol abstinence. This comprehensive review delineates the psychometric architecture, theoretical framework, scoring paradigms, empirical validity, and clinical utility of the URICA Alcohol Version.

Keywords

University of Rhode Island Change Assessment, URICA, Transtheoretical Model, Stages of Change, Alcohol Use Disorder, Readiness to Change, Motivational Assessment, Precontemplation, Contemplation, Psychometrics

Authors

The conceptualization and initial operationalization of the University of Rhode Island Change Assessment Scale were spearheaded by James O. Prochaska, Ph.D., and Carlo C. DiClemente, Ph.D., during their foundational work on the Transtheoretical Model at the University of Rhode Island. The specific adaptation, refinement, and validation of the URICA for alcohol-abusing and substance-dependent populations was led by Carlo C. DiClemente, Ph.D. (Department of Psychology, University of Maryland, Baltimore County – UMBC), in collaboration with key methodological and clinical researchers, including:

• Carlo C. DiClemente, Ph.D. — Professor Emeritus, Department of Psychology, University of Maryland, Baltimore County (UMBC); Co-developer of the Transtheoretical Model.
• Susan O. Hughes, Ph.D. — Research Associate in behavioral medicine and addiction treatment protocols.
• Joseph P. Carbonari, Ed.D. — Department of Psychology, University of Houston; Principal investigator on longitudinal psychometric modeling and stage profiling.
• Allen Zweben, Ph.D. — School of Social Work, Columbia University; Investigator on Project MATCH and alcohol behavioral interventions.

Administrative and psychometric resources for the URICA and its behavioral variations are maintained through the UMBC Habits Lab under the direction of Dr. DiClemente.

Purpose

The primary clinical and empirical purpose of the URICA Alcohol Version is to provide a continuous, multi-dimensional assessment of a client's motivational readiness to address problem drinking. Historically, clinical addiction medicine viewed motivation through a binary lens: an individual was categorized either as "motivated" or "in denial." Such dichotomous paradigms frequently resulted in therapeutic confrontation, premature discharge, or inappropriate treatment placement. The URICA operationalizes motivation not as an immutable character trait, but as a dynamic, fluctuating internal state characterized by specific cognitive, affective, and behavioral processes.

In clinical practice, the URICA provides healthcare practitioners with an empirical basis for treatment matching. According to stage-paradigm theory, therapeutic interventions must align with the patient's prevailing stage of change to prevent resistance and disengagement. Applying action-oriented behavioral techniques (e.g., behavioral contracting, stimulus control) to an individual in Precontemplation frequently generates resistance and precipitates therapeutic rupture. Conversely, employing consciousness-raising or motivational interviewing strategies with a client already engaged in active behavioral modification may stall clinical momentum. Assessing an individual's stage profile at intake allows clinicians to tailor psychotherapy, psychiatric consultations, and psychoeducational programs to the exact motivational coordinates of the patient.

In clinical trials and health services research, the URICA serves as a vital prognostic indicator and mediator of treatment outcomes. Landmark investigations, such as Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), incorporated stage-of-change metrics to assess therapeutic response, compliance, and relapse trajectories. The instrument's capacity to yield both four distinct subscale scores and a continuous readiness index enables researchers to track micro-level motivational shifts occurring over the course of pharmacotherapy (e.g., naltrexone, acamprosate) or psychosocial interventions (e.g., Cognitive Behavioral Therapy, Motivational Enhancement Therapy, Twelve-Step Facilitation).

Psychological Construct

The URICA measures four core dimensions corresponding to the major stages of intentional behavioral resolution described in the Transtheoretical Model. Rather than forcing an individual into an artificial categorical typology, the scale measures the degree to which an individual simultaneously endorses the phenomenological markers of each developmental stage:

1. Precontemplation (PC)

The Precontemplation dimension captures an individual's lack of problem awareness, active denial, externalization of responsibility, and resistance to change. Individuals scoring high on this subscale do not perceive their alcohol consumption as problematic, despite objective adverse consequences impacting physical health, social relationships, or vocational stability. Defensive mechanisms characteristic of this construct include projection, minimization, and rationalization. Item exemplars include statements such as "As far as I’m concerned, I don’t have any problems that need changing" and "I’m not the problem one. It doesn’t make much sense for me to consider changing." In clinical contexts, elevated PC scores without compensatory contemplation scores reflect severe resistance, high attrition risk, and external coercion to attend treatment.

2. Contemplation (C)

The Contemplation dimension gauges the acknowledgment of problem drinking accompanied by profound ambivalence. Individuals with high Contemplation scores recognize that their alcohol use produces detrimental consequences and express a desire for personal growth, yet they remain suspended between the perceived costs of change and the immediate reinforcement derived from substance use. This construct involves cognitive evaluation, information seeking, and openness to therapeutic guidance. Exemplar items include "I’ve been thinking that I might want to change something about myself" and "I have a problem and I really think I should work on it." While contemplators are receptive to psychological education, they have not yet committed substantial behavioral energy toward cessation.

3. Action (A)

The Action dimension reflects deliberate behavioral and environmental modifications aimed at reducing or eliminating alcohol consumption. This construct encompasses active participation in therapeutic modalities, implementation of coping mechanisms to manage cravings, restructuring social networks, and visible changes in lifestyle routines. Individuals endorsing Action items exhibit high investment of time and energy into resolving their addiction. Statements representing this dimension include "I am really working hard to change" and "Anyone can talk about changing; I’m actually doing something about it." Elevated Action scores denote acute behavioral investment, which must be sustained to prevent regression.

4. Maintenance (M)

The Maintenance dimension evaluates the cognitive and behavioral strategies utilized to consolidate behavioral gains, prevent relapse, and integrate new non-drinking identities into long-term functioning. Rather than static cessation, Maintenance involves vigilance against triggers, managing protracted withdrawal symptoms, navigating high-risk environments, and coping with the emotional distress of potential recurrences. Items assessing this construct include "It worries me that I might slip back on a problem I have already changed, so I am looking for help" and "I’m struggling to prevent myself from having a relapse of my problem." Elevated scores on this scale indicate awareness of vulnerability and ongoing commitment to stabilizing recovery.

Theoretical Framework

The theoretical bedrock of the URICA is the Transtheoretical Model (TTM), formulated by James O. Prochaska and Carlo C. DiClemente (1983; Prochaska, DiClemente, & Norcross, 1992). The TTM emerged from an integrative comparative analysis of dominant psychotherapy systems—including psychoanalytic, humanistic, behavioral, and cognitive paradigms—synthesizing how individuals effect intentional modification of addictive behaviors with or without formal professional intervention.

The architecture of the TTM rests upon three core conceptual axes:

1. The Stages of Change: The temporal and motivational progression through which an individual moves, conceptualized not as a linear sequence, but as an upward spiral. Relapse and recycling through previous stages are recognized as standard components of the chronic addiction lifecycle rather than definitive clinical failures.
2. The Processes of Change: Ten covert and overt activities utilized by individuals to progress across stages. These encompass experiential processes (e.g., consciousness raising, dramatic relief, environmental reevaluation) predominant during Precontemplation and Contemplation, and behavioral processes (e.g., stimulus control, counterconditioning, reinforcement management) essential for the Action and Maintenance phases.
3. Intermediate Outcome Markers: Comprising Decisional Balance (the cognitive appraisal of the pros and cons of drinking versus cessation, derived from Janis and Mann's conflict model) and Self-Efficacy (Bandura's construct evaluating situational confidence to resist drinking when confronted with high-risk precipitants).

Within this framework, the URICA operationalizes the first axis—the Stages of Change. The instrument is unique because it measures the current experiential manifestations of these stages concurrently. Rather than forcing clients into a single arbitrary stage via mutually exclusive algorithms, the URICA generates a dimensional motivational profile that reflects the complex, multi-layered ambivalence typical of substance dependence.

Validity

The psychometric validity of the URICA has been established through extensive empirical evaluations across clinical, forensic, and community settings.

Construct and Structural Validity

Structural validity has been affirmed via confirmatory factor analyses in diverse addiction cohorts. Carbonari and DiClemente (2000), analyzing data from Project MATCH ($N = 1,726$), confirmed that the four theoretical stages constitute distinct yet correlated latent variables. The intercorrelations among the subscales systematically adhere to a simplex-like pattern: adjacent stages (e.g., Contemplation and Action) display stronger positive correlations than non-adjacent stages (e.g., Precontemplation and Action), providing profound theoretical corroboration for the developmental stage continuum.

Convergent and Discriminant Validity

Convergent validity is corroborated through moderate to high correlations with alternative motivational metrics and behavioral markers. The URICA Contemplation and Action subscales correlate positively ($r = .50$ to $.72$) with the Stages of Change and Treatment Eagerness Scale (SOCRATES) Recognition and Taking Steps dimensions, as well as the Readiness to Change Questionnaire (RCQ). Discriminant validity is demonstrated by weak or non-significant correlations with general intellectual capacity, social desirability indices, and demographic variables. Furthermore, the Precontemplation subscale exhibits significant negative associations with client-reported distress, symptom severity indices, and initial readiness markers ($r = -.35$ to $-.58$), successfully differentiating resistant individuals from treatment-ready peers.

Predictive and Ecological Validity

Extensive prospective trials demonstrate the URICA's capacity to predict treatment retention, therapeutic alliance, and drinking outcomes. DiClemente and Hughes (1990) demonstrated that baseline stage profiles accurately differentiated outpatient alcoholism clients who successfully completed treatment from those who dropped out against medical advice. Carbonari and DiClemente (2000) demonstrated that individuals entering treatment with high Action and Maintenance profiles maintained significantly higher rates of continuous alcohol abstinence at 1-year and 3-year follow-ups compared to those displaying Precontemplation-dominant profiles. In dual-diagnosis contexts, Pantalon, Nich, Frankforter, and Carroll (2002) confirmed that the URICA reliably predicts retention and decreases in substance consumption among individuals with concurrent alcohol and cocaine dependence.

Reliability

The internal consistency and temporal stability of the URICA Alcohol Version have been rigorously evaluated across both inpatient, outpatient, and trauma-care environments.

Internal Consistency (Cronbach's Alpha)

Reliability estimates consistently exceed standard psychometric criteria ($lpha ge .70$) across independent validation studies:

• DiClemente and Hughes (1990): Outpatient alcoholism treatment sample ($N = 224$):
  • Precontemplation: $\alpha = .69$
  • Contemplation: $\alpha = .75$
  • Action: $\alpha = .82$
  • Maintenance: $\alpha = .80$
• Carbonari, DiClemente, and Zweben (1994): Project MATCH validation cohorts:
  • Outpatient Arm: Precontemplation ($\alpha = .75$), Contemplation ($\alpha = .81$), Action ($\alpha = .83$), Maintenance ($\alpha = .86$)
  • Aftercare Arm: Precontemplation ($\alpha = .74$), Contemplation ($\alpha = .79$), Action ($\alpha = .82$), Maintenance ($\alpha = .74$)
• Carney and Kivlahan (1995): Substance abuse treatment-seeking veteran cohorts demonstrated subscale alpha ranges between $.80$ and $.84$ across all four dimensions.
• Project DELTA: Reduced-drinking intervention trial demonstrated strong reliability: Precontemplation ($lpha = .66$), Contemplation ($lpha = .73$), Action ($lpha = .74$), and Maintenance ($lpha = .81$).

Test-Retest Stability

Because the URICA evaluates a dynamic psychological construct expected to change in response to clinical intervention, short-term test-retest reliability is evaluated over brief intervals (1 to 2 weeks) prior to active therapy. Intraclass correlation coefficients (ICCs) over a 7- to 14-day baseline span from $.78$ to $.86$, indicating robust measurement stability in the absence of treatment-induced shifts.

Factor Analysis

The factor structure of the URICA has been subjected to rigorous exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) since its inception.

Exploratory Factor Analyses

Early psychometric investigations conducted by Prochaska, DiClemente, and colleagues applied principal component and principal axis factoring with oblique (Promax and Oblimin) rotations, allowing latent factors to correlate. These analyses consistently yielded four primary eigenvalues exceeding 1.0, accounting for 45% to 58% of the total variance. Factor loadings for individual items onto their designated target latent stages consistently exceed $.45$, with minimal cross-loadings onto non-target dimensions ($< .25$).

Confirmatory Factor Analyses & Model Fit

Structural equation modeling has formally evaluated several competing topological models:

1. A single-factor general motivation model;
2. A two-factor model (Unmotivated vs. Motivated);
3. A four-factor orthogonal (uncorrelated) model;
4. A four-factor oblique (correlated) model.

CFA investigations (Carbonari & DiClemente, 2000; Levesque, Gelles, & Velicer, 2000) definitively confirm that the four-factor oblique model provides the superior fit to empirical data. Goodness-of-fit indices across diverse alcohol samples demonstrate acceptable to excellent parameters:

• Comparative Fit Index (CFI): $.90 – .94$
• Tucker-Lewis Index (TLI): $.89 – .93$
• Root Mean Square Error of Approximation (RMSEA): $.045 – .062$
• Standardized Root Mean Square Residual (SRMR): $.051 – .065$

The oblique model fit mirrors the theoretical simplex structure: Contemplation correlates positively with Action ($r pprox .40$ to $.60$), while Precontemplation demonstrates inverse relationships with both Contemplation ($r pprox -.20$ to $-.35$) and Action ($r pprox -.40$ to $-.55$).

Instrument / Measurement Tool

The URICA Alcohol Version is a self-administered psychometric assessment tool. Below are the operational testing parameters:

• Test Type: Standardized self-report rating scale / multidimensional inventory.
• Administration Format: Paper-and-pencil, computerized self-report, or clinical digital portal.
• Target Population: Adults and adolescents ($16+$ years) presenting with at-risk drinking, alcohol misuse, or diagnosed Alcohol Use Disorder (AUD).
• Completion Time: 8 to 12 minutes for the 28-item instrument; 3 to 5 minutes for the 12-item DELTA version.
• Item Count: Standard version: 28 items; Clinical variant: 24 items; Brief variant (DELTA): 12 items.
• Response Scale: 5-point Likert scale:
  • 1 = Strongly Disagree
  • 2 = Disagree
  • 3 = Undecided
  • 4 = Agree
  • 5 = Strongly Agree
• Subscale Item Breakdown (28-Item Version):
  • Precontemplation: Items 1, 4, 9, 11, 20, 23, 26
  • Contemplation: Items 2, 7, 10, 13, 17, 18, 21
  • Action: Items 3, 6, 8, 12, 22, 27
  • Maintenance: Items 5, 14, 16, 19, 24, 25, 28
• Subscale Item Breakdown (24-Item Version):
  • Precontemplation: Items 1, 5, 7, 16, 19, 22
  • Contemplation: Items 3, 6, 9, 13, 14, 17
  • Action: Items 2, 4, 8, 11, 18, 23
  • Maintenance: Items 10, 12, 15, 20, 21, 24
• Subscale Item Breakdown (12-Item Project DELTA Version):
  • Precontemplation: Items 1, 5, 6
  • Contemplation: Items 2, 8, 10
  • Action: Items 3, 9, 11
  • Maintenance: Items 4, 7, 12
• Scoring Methodology:
  • Subscale Means: Sum the endorsed item values for each respective subscale and divide by the total number of items comprising that subscale (7 items each in the 28-item version). Subscale scores range from 1.0 to 5.0.
  • Readiness to Change Score: A continuous composite index derived by summing the mean scores of the three positive stage scales and subtracting the mean of the Precontemplation scale:
    $$\text{Readiness Score} = \text{Contemplation Mean} + \text{Action Mean} + \text{Maintenance Mean} – \text{Precontemplation Mean}$$
  • Profile Interpretation: Rather than categorizing an individual based solely on their highest single score, clinicians evaluate the complete profile across the four dimensions. Common empirical cluster profiles include: Precontemplative (high PC, low C, A, M), Ambivalent (high PC and high C), Contemplative (high C, moderate PC, low A), Action (high C and A, low PC), and Maintenance (high M, high A, very low PC).

Permissions & Fee and Test Year

The standard development of the URICA was published in 1990 through the empirical work of Carlo C. DiClemente and Susan O. Hughes. The instrument is considered an open-access, non-commercial psychological assessment available for clinical, academic, and health research purposes without licensing fees.

Researchers and clinicians are permitted to utilize, administer, and reproduce the URICA provided that appropriate scholarly attribution is maintained and the scale is not commercialized. The measurement tool and supporting psychometric scoring guidelines are accessible via the University of Maryland, Baltimore County (UMBC) Habits Lab repository hosted at http://habitslab.umbc.edu/urica/. Institutional and pharmaceutical trials intending to integrate the instrument into commercial proprietary diagnostic platforms are encouraged to contact the authors directly for administrative clearance.

References

• Carbonari, J. P., & DiClemente, C. C. (2000). Using theoretical model profiles to differentiate levels of alcohol abstinence success. Journal of Consulting and Clinical Psychology, 68(5), 810–817. https://doi.org/10.1037/0022-006X.68.5.810
• 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/10.1080/10884600590919106
• 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
• DiClemente, C. C., Schlundt, D., & Gemmell, L. (2004). Readiness and stages of change in addiction treatment. American Journal on Addictions, 13(2), 103–119. https://doi.org/10.1080/10550490490435969
• Grencavage, L. M. (2001). Demand-withdraw couple interaction, disease-model beliefs, and readiness to change problem drinking. Dissertation Abstracts International: Section B: The Sciences and Engineering, 61(8-B), 4406.
• 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:1005404509494
• 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
• Soderstrom, C. A., DiClemente, C. C., Dischinger, P. C., Hebel, J. R., McDuff, D. R., Auman, K. M., & Kufera, J. A. (2007). A controlled trial of brief intervention versus brief advice for at-risk drinking trauma center patients. Journal of Trauma-Injury Infection & Critical Care, 62(5), 1102–1112. https://doi.org/10.1097/TA.0b013e318047b74f

Items of the Scale