The present study examined the factor structure and psychometric properties of the adult-based Drug-Taking Confidence Questionnaire (Sklar et al., 1997
) in a clinical sample of adolescent substance abusers. A 5-factor, 37-item version was optimal. The factors identified for adolescents were Negative Situations, Social/Drug, Pleasant Emotions, Testing Personal Control, and Physical/Intimacy. This 5-factor model was a better fit for youth compared to the original 8-factor model (Sklar et al, 1997
) and a 1-factor model. Present findings provide initial evidence for the validity of the revised DTCQ for SUD adolescents.
The differences in factor structure between the adult and adolescent forms of the DTCQ are consistent with previous literature suggesting that the structure of cognitions associated with alcohol and drug involvement changes as adolescents gain more experience with substance use (e.g., Christiansen et al., 1985
; Deas, Riggs, Langenbucher, Goldman, & Brown, 2000
; Dunn & Goldman, 1998
). The reduced number of factors in the revised DTCQ presented here suggests that situational self-efficacy is less differentiated among adolescents than in previous samples of adults. For example, the Social/Drugs factor, comprised of items from the adult Social Pressure, Urges and Temptations, and Pleasant Times with Others subscales, suggests that adolescents may perceive situations in which they have a desire to use, in which peers and drugs or alcohol are present and in which substances are offered to them as related, and they construct self-efficacy for future use around such experiences. Similarly, the Physical/Intimacy factor may represent that adolescents perceive physical relapse precipitants (i.e., wanting to stay awake, wanting to lose weight), in the same context as those linked to their intimate interactions with others and that their confidence in these physical situations is related to their confidence to resist using in social situations (being with intimate friends, having a good time) rather than other negative physical states that may arise more often in adulthood (e.g., feeling nauseous, having a headache, having trouble sleeping). These results are consistent with studies showing that the immediate risks for teens are social situations paired with strong positive affect, rather than negative situations such as physical problems or conflict (e.g., Brown, Stetson et al., 1989
; Brown, Vik et al., 1989
The 5-factor structure found in this study differs from previous findings in an adolescent sample using the Situational Confidence Questionnaire (Annis & Graham, 1988
), a questionnaire measuring situational self-efficacy to cope in drinking-related situations. Kirisci and colleagues (Kirisci & Moss, 1997
; Kirisci, Moss & Tarter, 1996
) confirmed an 8-factor structure corresponding to Marlatt's high-risk situations in a sample of adolescents. Several factors may account for differences between these findings and those reported here. First, prior studies used confirmatory factor analysis and item response theory to assess the adequacy of an 8-factor model in an adolescent sample. Since exploratory analyses were not conducted in either study with the SCQ, it is not clear whether a 5-factor model would have been a better fit than an 8-factor model in a community sample. Of note, in the present study, an 8-factor model did come close to meeting the model fit criteria; however this solution was not as good a fit as the five-factor model which emerged based on our exploratory factor analysis. Second, the SCQ measures coping self-efficacy to resist drinking rather than drug use, and adolescents may have had more varied experiences with drinking, corresponding to a more detailed set of coping self-efficacy constructs than for drug use.
Validation analyses were consistent with our predictions and provide support for the utility of the shortened and revised DTCQ scales. As hypothesized for construct validity, high confidence for coping in negative situations (Scale 1) was associated with urges to use (negative), the importance of not using (positive), and likelihood of resisting use (positive) in a situation related to interpersonal and intrapersonal conflict. Coping self-efficacy in the other four situations represented in the revised DTCQ (Scales 2-5) was significantly associated with appraisal variables in a social situation. These results suggest that the revised DTCQ does measure situation specific aspects of self-efficacy.
Motivation to abstain from alcohol and drugs following treatment was associated with youth self-efficacy. Relationships were slightly stronger between self-efficacy and motivation to abstain from drugs, rather than alcohol, which is consistent with research suggesting that motivation for abstinence varies across types of substances (Brown, Tapert, Tate, & Abrantes, 2000
). These findings highlight the importance of considering motivation when evaluating cognitive constructs associated with youth relapse (Brown & Ramo, 2006
). Youth entering treatment programs commonly have little motivation to abstain even though they may be motivated to resolve substance-related problems (Brown, 1999
). Since motivation will dictate the extent to which youth make effortful coping responses in relapse risk situations, which in turn influences beliefs about ability to cope, it is expected that coping self-efficacy will be associated with motivation in a developmentally-specific cognitive-behavioral model of relapse (Brown & Ramo, 2006
Coping self-efficacy appears to be relatively independent of ethnicity and family relationship functioning. The exception to this discriminant validity was the significant relationship between family expressiveness, and self-efficacy to resist the urge to use substances in negative situations. This finding suggests that adolescents who have a higher level of interpersonal communication within their families may have greater protection against relapse in negative interpersonal or intrapersonal states. This hypothesis, however, requires further validation.
Concurrent validity was examined in relation to substance use at intake and substances of choice. Modest but significant relationships were found between self-efficacy and quantity/frequency of use (use episodes), DSM-IV
dependence symptoms and the number of substances used. Correlations found in this study were comparable to those reported for the DTCQ in an adult sample (Sklar et al., 1997
). Relationships were strongest between self-efficacy and alcohol/drug withdrawal symptoms across all DTCQ scales, especially in the subsample of adolescents whose substance of choice was alcohol. This relationship suggests that intervention efforts for increasing self-efficacy may be most needed among adolescents who present with the greatest physical addiction symptoms.
Finally, it is useful to note that self-efficacy in two of the five situation clusters and total self-efficacy was predictive of substance use outcome 6 months after treatment. High self-efficacy was found to protect against a return to substance use and experiencing substance use-related problems after treatment. This is consistent with the adult literature demonstrating that lower coping self-efficacy predicts relapse after treatment for alcohol and drug abuse (e.g., Goldbeck, Myatt, & Aitchison, 1997
; Solomon & Annis, 1990
). Prospective findings such as these highlight the clinical utility of self-efficacy in understanding and preventing relapse in adolescents (Brown & Ramo, 2006
; Marlatt, Baer, & Quigley, 1995
). There were three situation clusters that were not predictive of relapse status after treatment (negative situations, testing personal control, and physical/intimacy). This is consistent with Burleson and Kaminer's (2005)
finding that situational self-efficacy was not predictive of substance use outcome in a treatment sample of adolescents. These scales may represent types of high-risk situations which youth have not encountered as often as social/drug-related situations or positive emotion situations, and thus they tend to rate their confidence at a consistently high level. It is also possible that other cognitive and behavioral constructs included in the Youth Relapse Model (such as coping skills, motivation) interact with self-efficacy to predict substance use outcome. These hypotheses need to be examined more fully in future research.
This investigation utilized a sample of youth with SUDs and comorbid DSM-IV
Axis I psychopathology. As such, the generalizability of these findings to other youth samples is unknown. Given the high rate of comorbidity of SUDs and Axis I psychiatric disorders among clinical samples of youth (Grella, Hser, Joshi, & Rounds-Bryant, 2001
), we expect that this scoring system for the DTCQ is likely to extend to the broader population of adolescents in treatment for SUDs. Understanding the patterns of responses on the DTCQ in clinical samples of youth is critical for treatment planning; however, it will also be useful to examine whether these response patterns differ across community and clinical samples of youth and future work should address this.
Self-efficacy was not evaluated across gender, nor psychiatric symptoms in this study, and these issues should be examined in future investigations of the adolescent revised DTCQ. Considering that the factors predicting treatment outcomes differ for adult men and women (Grella & Joshi, 1999
), and Axis I psychiatric disorders affect outcome from treatment (Grella et al. 2001
; Tomlinson, Brown, & Abrantes, 2004
), the role of self-efficacy in these relationships should be clarified in further research with this revised DTCQ for adolescents.
The present study provides initial evidence for the utility of a 37-item form of the DTCQ as a measure of coping self-efficacy for alcohol and drug dependent adolescents. There are several differences between the scales in the revised form (5-factors) and the original form (8-factors), which appear to reflect that the self-efficacy construct is associated with the relapse experiences adolescents have most often. This form can be used in both clinical and research settings that wish to include self-efficacy into broader cognitively-based models of substance use in adolescents. It may also help clinicians understand risk perceptions of youth and target areas of strengths and weaknesses for teens in treatment for alcohol and drug abuse.