This is interesting, has some limitations, in my view. First, the subjects were offered treatment. I suspect that those with higher Taking Action scores accepted the offer of treatment. If so, were their improvements an artifact of readiness to change or participation in treatment? Second, the study appears to lump people meeting criteria for DSM Abuse and DSM Dependence. Are these outcomes a product of people with more severe problems doing more poorly? This would be likely. Dependence is harder to treat than Abuse, and Abuse is probably likely to improve following a medical crisis. Third, I’m always interested in seeing these kinds of studies in a treatment population. Treatment studies allow us to find out of readiness is a predictor of treatment outcomes. Many studies have found that this isn’t the case.
The findings do highlight the importance of hope (self-efficacy) in promoting change. While problem awareness wasn’t predictive, one wonders if it offers an essential intermediary step that creates a foundation for other factors more directly predictive of change. Again, a treatment study would be interesting to see if these factors are predictive as pre-treatment factors and to see how treatment influences them and then how predictive they are at discharge.