Carlo Diclemente

University of Maryland, Baltimore County | UMBC · Department of Psychology

Substance misuse is a major ongoing public health issue. SBIRT is a helpful tool for assessing and identifying at-risk substance use. Evaluation of SBIRT trainings demonstrate post- training changes, however, baseline differences in SBIRT knowledge, attitudes, and behaviors by different health professionals are relatively understudied. Baseline kno...

Among individuals seeking to change health-related behaviors, relapse is a common experience. Whether it occurs very soon after initiating a change attempt or after several years of sustained changed behavior, it can be discouraging for patients and clinicians alike. Although there is a tendency in healthcare to try to ignore failure, we posit that...

Providers across disciplines need knowledge, attitudes, confidence and resources to communicate and collaborate effectively when working with families with infants affected by substance use. This pre-post study assessed the acceptability, perceived utility, and preliminary outcomes of a hybrid online and in-person interprofessional training program...

Designing interventions for technology requires paying attention to timing of messages and to tailoring of content of message to address smoker concerns and barriers. Using a consumer-focused design can assist in creating messaging that is acceptable and effective.

This paper informs practice in community‐based home visiting workforce development by describing the development and evaluation of a university‐based training certificate program for home visitors and supervisors. The Interactive Systems Framework for Dissemination and Implementation (ISF; Wandersman et al., 2008) guides our conceptualization and p...

Individuals with mental health and substance use disorders smoke at rates two to four times higher than the general population and account for over half of smoking-related deaths. Building capacity of behavioral health providers to provide smoking cessation treatment may decrease smoking prevalence in these groups. The present study evaluated a sta...

Motivation is a well-established predictor of recovery for addictive behaviors. Treatments aimed at changing substance use and gambling frequently employ motivational enhancing strategies, based in the principles of Motivational Interviewing (MI). Evidence for these approaches across addictive behaviors does not always paint a clear picture. The pu...

A grand challenge for social work is addressing widespread public health problems of alcohol misuse. MSW students (n = 83) received Screening, Brief Intervention, and Referral to Treatment (SBIRT) training through didactic sessions, role plays, and pre–post videotaped standardized patient (SP) interactions. SBIRT knowledge, self-reported practice b...

Stress, extrinsic motivation, smoking in the surrounding environment and lack of support in the postpartum period make cessation or suspension of smoking during pregnancy and maintenance of abstinence postpartum extremely difficult. More comprehensive and multi-dimensional interventions are needed to help pregnant women shift from predominantly ext...

Objective: Relapse is a crucial event that occurs for many individuals during recovery from alcohol use disorder. This article examines the impact of temptation to drink and self-efficacy to abstain on two distinct aspects of relapse. Causal chain analyses from Project MATCH, a multisite alcoholism treatment trial, provided initial support for the...

Recovery from substance abuse and mental health disorders represents a journey through which individuals move beyond treatment of provider-identified problems toward a path of achieving wellness and productive lives. Overcoming obstacles and barriers encountered along the recovery process, individuals reveal their own strengths and resilience neces...

This commentary on David Marks’ article on the Homeostatic Theory of Obesity and his Circle of Discontent mechanism for maintaining problematic eating behavior and obesity offers a perspective on the promise and potential of this theory. At the same time, we challenge the author to incorporate more of a process perspective into the theory. This wou...

Objective: We evaluated a well-specified peer mentor program that enhanced a professionally led smoking cessation group for persons with serious mental illnesses. Method: Participants were 8 peer mentors, persons with serious mental illnesses who had successfully quit smoking, and 30 program participants, persons with serious mental illnesses en...

Operating a motor vehicle under the influence of alcohol (OUI) is an international problem. In the United States, one intervention strategy is to require offenders to attend group-delivered interventions. We compared three year rearrest rates among 12,267 individuals in Maine receiving either a motivation-enhancing (ME) program, Prime For Life(®),...

Study objective: To examine a computer-assisted, counselor-guided motivational intervention (CAMI) aimed at reducing the risk of unprotected sexual intercourse. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a 9-month, longitudinal randomized controlled trial with a multisite recruitment strategy including cl...

This study examined self-reported staging for the goal of eating a low-fat diet and several specific dietary consumption behaviors to understand better readiness for dieting. Self-assessed motivation, food frequency measures, and psychosocial variables were obtained from 2057 low-income women enrolled in the Maryland Food for Life Program. Results...

This study evaluated whether alcohol abstinence self-efficacy at the end of alcohol treatment was moderated by utilization of behavioral processes of change (coping activities used during a behavior change attempt). It was hypothesized that self-efficacy would be differentially important in predicting posttreatment drinking outcomes depending on th...

Pediatricians underestimate the prevalence of substance misuse among children and adolescents and often fail to screen for and intervene in practice. The American Academy of Pediatrics recommends training in Screening, Brief Intervention, and Referral to Treatment (SBIRT), but training outcomes and skill acquisition are rarely assessed. We compared...

Screening, brief intervention, and referral to treatment (SBIRT) has become an empirically supported and widely implemented approach in primary and specialty care for addressing substance misuse. Accordingly, training of providers in SBIRT has increased exponentially in recent years. However, the quality and fidelity of training programs and subseq...

Abstract The purpose of this study was to identify differential improvement in alcohol use among injured patients following brief intervention. Latent class analysis was conducted to identify patient profiles based on alcohol-related risk from two clinical trials (Texas: N = 737; Maryland: N = 250) conducted in Level-1 trauma centers. Drinking was...

Objective: Patients entering treatment for alcohol problems do not have uniform treatment goals, and a pretreatment drinking goal has a significant impact on treatment outcome. The objective of this study was to understand better how an array of individual characteristics, including factors that affect treatment, are related to treatment goals bef...

Background and Purpose At-risk drinking is the primary predictor for injury in the US. Brief intervention has been developed to help reduce drinking and prevent alcohol-related injury risk behaviors. It is not clear, however, from the literature which patients experience the greatest improvements in drinking following brief intervention and hospit...

Screening and brief intervention for reducing alcohol consumption has been demonstrated to be effective in various medical settings. The NIAAA has recommended that physicians screen all patients for at-risk and problem drinking. Often, screening is based on the concept of a "standard drink." We administered a survey to residents (N = 270) in order...

The UMBC Psychology Department's Center for Community Collaboration (CCC) provides training and support for capacity building to promote substance abuse and mental health treatment as well as adherence improvement in community agencies funded through the Ryan White Act serving persons living with HIV/AIDS. This article describes an approach to diss...

When disasters and other broad-scale public health emergencies occur in the United States, they often reveal flaws in the pre-event preparedness of those individuals and agencies charged with responsibility for emergency response and recovery activities. A significant contributor to this problem is the unwillingness of some public health workers to...

Recovery from alcohol dependence or abuse is often described in dynamic, process-oriented terms. Once both researchers and clinicians moved away from static labels like dipsomania or alcoholic personality and moved toward a focus on drinking behavior, they began to envision a course of the illness or dependence that included not only a progression...

Background: Psychological factors such as motivation to change and self-efficacy influence drinking outcomes in alcohol-dependent individuals who are enrolled in pharmacobehavioral studies. Previous results from our research clinic indicated that initial stage of change of heavy drinkers enrolled in a pharmacobehavioral trial was significantly ass...

The purpose of the study was to better understand the experiences of persons with serious mental illnesses who have quit smoking. Former smokers with serious mental illnesses who had been abstinent for at least 4 months participated in an individually-administered structured interview about their motivation to quit smoking and the strategies that t...

Smoking among individuals with serious mental illness (SMI) creates significant health problems. This study explored stage of change transitions over time among smokers with serious mental illness (SMI) and how dose of a brief intervention and other psychosocial variables were related to stage transitions. Participants were a subsample of 110 patie...

Severe drinking can cause serious morbidity and death. Because the serotonin transporter (5-HTT) is an important regulator of neuronal 5-HT function, allelic differences at that gene may modulate the severity of alcohol consumption and predict therapeutic response to the 5-HT(3) receptor antagonist, ondansetron. The authors randomized 283 alcoholic...

This study evaluated the efficacy of a brief integrative multiple behavior intervention and assessed risk factors as mediators of behavioral outcomes among older adolescents. A randomized controlled trial was conducted with participants randomly assigned to either a brief intervention or standard care control with 3-month follow-up. A total of 479...

The authors investigated whether impulsivity and depression affect the success of interventions to reduce alcohol use. Unadjusted and adjusted regression models were constructed to analyze the effect of impulsivity and depression on 12-month outcomes of participants of a trauma center based randomized trial of brief personalized motivational interv...

To determine associations between religiosity and female adolescents' sexual and contraceptive behaviors. We conducted a secondary analysis on data from a randomized controlled trial comparing interventions designed to prevent pregnancy and sexually transmitted diseases (STDs). Multivariable modeling assessed the association between a religiosity i...

Relapse represents a return to a problematic pattern of engagement in an addictive behavior after successful modification. However, relapse is part of the learning process of “successive approximations” that characterizes most successful behavior change. This chapter describes the relapse process, relapse prevention, and how to encourage successful...

The objective of this study was to evaluate a 12-session home/community-based health promotion/obesity prevention program (Challenge!) on changes in BMI status, body composition, physical activity, and diet. A total of 235 black adolescents (aged 11-16 years; 38% overweight/obese) were recruited from low-income urban communities. Baseline measures...

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief interven...

Smoking cessation is best represented as a journey and not a single event. This article chronicles the path of change for the population of smokers in Maryland. This study compared the population of ever-smokers in Maryland over three time points (2000, 2002, and 2006) examining how the population of ever-smokers shifted over time. Analysis of proc...

The development and use of validated processes of change (POC) measures have received little attention in the literature despite their importance in the Transtheoretical Model. Using survey data (N = 2909), we examined the construct validity of a 22-item mammography POC scale by testing for factorial validity and factorial invariance across stage o...

A motivação vem sendo cada vez mais estudada no tratamento de adolescentes usuários de drogas. O objetivo deste trabalho foi avaliar o estágio motivacional para mudança em adolescentes infratores usuários de substâncias ilícitas que cometeram ato infracional e analisar a relação entre o estágio motivacional e a adesão ao tratamento. O estudo foi pr...

This study examined whether 3-month outcomes of a brief image-based multiple behavior intervention on health habits and health-related quality of life of college students were sustained at 12-month follow-up without further intervention. A randomized control trial was conducted with 303 undergraduates attending a public university in southeastern U...

We tested whether implementing the "5 A's" (Ask, Advise, Assess, Assist, Arrange) at six mental health centers reduces smoking among persons with serious mental illness. One hundred and fifty six patients were evaluated just before initiating the 5 A's and after six and 12 months. A delayed control condition evaluated 148 patients six months before...

To examine whether young adult cigarette smokers who were in the precontemplation and contemplation stages of change for smoking cessation would differ in their evaluations of vignettes depicting 2 types of physician advice. Fifty-seven young adult cigarette smokers who were undergraduate students (49.1% female, mean age = 20.4 years) attending an...

Our conceptual models determine how problems are approached and people treated. The Transtheoretical Model of Intentional Behavior Change proposes several important dimensions of the change process that include stages or tasks of change, specific processes of change that interact with the stages, and a context of change that broadens the perspectiv...

Understanding the role of personal motivation in addiction treatment changed with the advent of the Transtheoretical Model of intentional behavior change, a better understanding of relapse, and a shift in focus from denial to readiness. Motivation is a complex concept that covers many diverse aspects of the process of intentional behavior change. T...

Cigarette smoking during pregnancy is associated with poor maternal and child health outcomes. Effective interventions to increase smoking cessation rates are needed particularly for pregnant women unable to quit in their first trimester. Real-time ultrasound feedback focused on potential effects of smoking on the fetus may be an effective treatmen...

Initial motivation and readiness to change (RTC) are complex constructs and have been important but inconsistent predictors of treatment attendance and drinking outcomes in studies of alcoholism treatment. Motivation can be described in multiple ways as simply the accumulation of consequences that push change, a shift in intentions, or engagement i...

The present study examined psychiatric functioning, substance use and consequences, and motivation to change in people with schizophrenia and affective disorders and current or remitted cocaine dependence. Data were collected as part of a naturalistic, longitudinal study examining substance use, motivation to change, and the process of change in pe...

This study examined whether brief intervention strategies founded on the Behavior-Image Model and addressing positive images of college and career success could be potentially efficacious in impacting multiple health habits of high-risk adolescents transitioning into adulthood. Participants were stratified by grade level and drug use and individual...

To examine whether dietary attitudes and demographics differ based on smoking status among low-income women participating in a dietary intervention. Smoking status, stages of change for eating a healthier diet, and dietary intake were examined among 2066 women participating in the Maryland Women, Infants, and Children (WIC) Food for Life Program. R...

Epidemiologic data indicate most adolescents and adults experience multiple, simultaneous risk behaviors. The purpose of this study is to examine the efficacy of a brief image-based multiple-behavior intervention (MBI) for college students. A total of 303 college students were randomly assigned to: (1) a brief MBI or (2) a standard care control, wi...

People with severe mental illness (SMI) have high rates of substance use disorders. The Transtheoretical Model (TTM) is a framework for understanding behavior change. There are five leading measures associated with the TTM - University of Rhode Island Change Assessment, Processes of Change Scale, Decisional Balance Scale, Abstinence Self-Efficacy S...

This study tested the efficacy of brief image-based print mediated parent/caregiver and adolescent messages integrating physical activity with alcohol use avoidance. A total of 684 high school students were randomly assigned to either the parent postcard or adolescent flyer arm, with baseline and four-month post-intervention data collections. A sig...

Few health promotion trials have evaluated strategies to increase regular mammography screening. We conducted a randomized controlled trial of two theory-based interventions in a population-based, nationally representative sample of women veterans. Study candidates 52 years and older were randomly sampled from the National Registry of Women Veteran...

A complicating factor affecting the treatment of individuals with coexisting substance use problems and serious mental illness is their motivation for change and how these interacting, chronic conditions affect the entire process of intentional behavior change. This selective review explores conceptual and assessment issues related to readiness to...

This study examined the effects of brief image-based interventions, including a multiple behavior health contract, a one-on-one tailored consultation, and a combined consultation plus contract intervention, for impacting multiple health behaviors of students in a university health clinic. A total of 155 college students attending a major southern u...

This article explores the conceptual foundations of the search for mechanisms of change in psychotherapy and behavior change approaches. We examine historical and recent attempts to identify mechanisms and discuss results of research studies that examine the modification of drinking and other behaviors. Finally, we describe potential mechanisms of...

Background: Decreases in drinking behavior prior to treatment onset often occur in pharmacotherapy trials for alcohol dependence. We propose that these decreases are associated with both trait and state factors operating before initiation of treatment to influence participants' expectation or perception of future treatment outcome. While trait fac...

ObjectivesTwo studies were conducted to evaluate the reliability and predictive validity of measures of intrinsic and extrinsic motivation for exercise, and to examine differences in motivation as a function of stage of motivational readiness for exercise.DesignA cross-sectional design was employed in study one, and a longitudinal design was used i...

Purpose: To assess girls' reproductive educational choices, satisfaction with choice, and relationship between demographics, module choice, and satisfaction.Methods: We recruited 286 girls, aged 13 to 21 years, from a hospital-based adolescent clinic, from advertisements, and by word of mouth. At enrollment, participants completed a 60-minute compu...

Continuing our look at theories of addiction, we present one of the most powerful and influential writers. Carlo DiClemente presents here a concise summary of his model of behavioural change, the Transtheoretical Model of Intentional Behaviour Change.

Numerous reports document that preinjury alcohol use is associated with all modes of injury requiring treatment in a trauma center, with 25% to 50% or more of patients testing positive for alcohol at the time of admission. There is evidence that in trauma patients unaddressed alcohol use problems result in recurrent injury requiring readmission to...

Individuals with schizophrenia and severe mental illness smoke cigarettes at rates that well exceed the general population. Little is known about the correlates and sequelae of increased smoking severity on persons with severe mental illness. A total of 304 smokers from six community mental health centers were assessed for smoking history, psychiat...

The purpose of the current investigation was to develop and validate the Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ), a self-report measure of self-efficacy to recover from an eating disorder. Participants were 116 female patients with anorexia nervosa, bulimia nervosa, or a subthreshold eating disorder treated at an eating disorde...

Treatment and follow-up session attendance data from Project MATCH, a multisite clinical trial investigating patient-treatment matching, were analyzed to study compliance. High rates of compliance to both therapy and research protocols were achieved, enhancing treatment integrity and data quality. Strong baseline predictors of compliance did not em...

The overall purpose of this study was to explore the alcohol consumption patterns of adolescents by beverage type. A total of 705 primarily 9th grade students were recruited to participate in this study in the spring of 2002. Alcoholic beverage use differed significantly across gender and ethnicity on a number of beverage-specific drinking measures...

Validation of psychosocial measures for use in mammography screening research has been given inadequate attention in the literature. The authors report on the validation of 5 measures examining 4 attitudinal constructs (i.e., pros, cons, outcome expectations, and cancer worries) and 1 social influence construct (i.e., subjective norms) in a 22-item...

The primary purpose of this study was to test the efficacy of a brief, multi-health behavior intervention integrating physical activity and alcohol use prevention messages for high school-aged adolescents. A total of 604 participants, 335 9th and 269 11th grade students from a suburban high school in northeast Florida participated in this study. A...

The objective of this study was to develop and test a brief, experimental alcohol preventive intervention matched to the use of specific alcohol beverages among adolescents. A total of 232 high school students who drank within the last year participated in this study. Participants were randomly assigned to either the experimental intervention or a...

Many perspectives have been used to understand how people become addicted and how they change (Glantz & Pickens' 1992; Orford' 1985; Rotgers' Keller & Morgenstern' 1996). A review of these explanatory models reveals that becoming addicted usually involves multiple determinants representing very different domains of human functioning. Some influence...

It is the purpose of this chapter to set the rediscovery of religious and spiritual aspects of individuals that has emerged in behavioral research over the past 25 years in the context of the panoramic sweep of centuries of Judeo-Christian thought about the human person and to show the relevance of that thought for the emergence and development of...

The purpose of this study was to compare the effects of a single drug, i.e., alcohol, against a multiple drug preventive intervention. A controlled trial was conducted with 448 8th grade students (mean age = 13 years old) from an inner-city middle school (n = 216) and a rural junior high school (n = 232) in 2000-2001. Students were randomized withi...

Pregnant women who are dependent on nicotine and illicit substances are at especially high risk for health complications and psychosocial problems. Motivational enhancement therapy (MET) for reducing smoking during pregnancy was compared with standard-care practitioner advice in a 2-group randomized design. Participants were 63 pregnant opioid-depe...

This handbook is designed to be a toolbox of quickly accessible clinical resources for the psychologist working in primary care settings. The Handbook will help codify the newly established role of the primary care psychologist by providing clinicians with background knowledge of the primary care system, orienting frameworks for practice, overviews...

This article represents the proceedings of a symposium, "Development of Novel Pharmacotherapies for the Treatment of Alcohol Dependence: Focus on Antiepileptics," presented at the 2003 annual meeting of the Research Society on Alcoholism in Fort Lauderdale, FL. The organizers and cochairs were Bankole A. Johnson and Robert M. Swift. The presentatio...