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The 19-item version of the Socrates tool does not determine the client’s specific “stage of change” but provides scores on three scales – Recognition, Ambivalence and Taking steps – which measure the client’s general level of motivation:

  1. Recognition: This scale provides information about the client’s level of awareness or consciousness of and acknowledgement of the link between substance use and current problems.
  2. Ambivalence: This scale provides information about whether the client is certain or uncertain that he or she has or doesn’t have a problem. The scores are neither good nor bad; they simply indicate the amount of energy the client is spending in thinking about the change process or in debating the pros and cons of change.
  3. Taking steps: This scale considers evidence that a client is starting to take steps, or has already taken some steps, to change behaviour.

Scoring and Interpretation
When the client has finished with the tool, the counsellor transfers the answers the client has circled to the scoring sheet for both 8A and 8D and then totals the columns to get one number for each of the three scales. There is a range of scores within which the client’s total must fall. For example, recognition scores will fall between 7 and 35. These are called “raw scores.” The raw scores for each scale can then be placed on the profile sheet that has the comparison decile scores from Project match. In this way, you will be able to rank your client’s raw score to the decile scores of participants who were seeking treatment. You will circle the corresponding decile score that relates to the raw score. For example, on the recognition scale, a raw score of 29 is equal to a decile score of “30 or Low.” This means that your client’s score relates to what was evaluated as a low level of recognition for participants in Project match. It is understood that clients entering treatment will have a variety of levels of awareness of the links between problems and substance use.

Treatment readiness may be affected by outside factors such as work stress, responsibilities of caring for others, fear of change and previous failed treatment attempts. Chapter 10 discusses the Treatment Entry Questionnaire (teq), which also measures the internal or external reasons that the client is seeking treatment. The Socrates scores and teq scales go together very nicely.

What is ambivalence?
Do not be afraid of ambivalence! Ambivalence does not mean that the client is not ready to change, nor does it mean that the client will not change. Ambivalence is concrete evidence of the ongoing struggle between the pros and cons of change. Ambivalence ebbs and flows throughout treatment and can resurface in the face of setbacks or as the client moves from one stage to another and gets closer to change. The ambivalence that we can measure gives us hope clinically, because it means that the client is aware of the benefits of change as well as the costs. Many clients enter treatment and then withdraw prematurely because they see for the first time the costs of change! Resolving ambivalence must be completed prior to beginning treatment or the treatment can end up being postponed, delayed or even abandoned if the client becomes frightened or disheartened. Many researchers and clinicians discuss the decisional balance involved in behaviour change. The “decisional balance” exercise is a clinical tool that can be used to illustrate, in a tangible way, the hopes and fears that co-exist within any person contemplating such change. In this exercise, the counsellor and client together develop a list of the costs and benefits of change as well as the pros and cons of the status quo, using a table or grid like the one below.

What do the scores mean?
The scores will give the counsellor information about whether the client scored low, average or high relative to people already seeking treatment for alcohol and drug problems. The researchers give the following general interpretation guidelines for the Socrates—8 (A or D) scores. Recognition High scorers directly acknowledge that they are having problems related to their drug use. They tend to express a desire for change and perceive that harm will come if they do not change. Low scorers deny that alcohol or other drugs are causing them any serious problems, reject diagnostic labels such as “alcoholic,” “problem drinker” or “addict,” and do not express a desire for change. Ambivalence There are questions in the Socrates that ask the client if they “wonder” about whether they are: • a problem drinker or drug user • an alcoholic or drug addict These questions are designed to measure ambivalence, as clients who are still wondering will be ambivalent at this time. Clients who do not “wonder” already know that they “are” or definitely “are not” problem drinkers or addicts. High scorers say they sometimes “wonder” if they are in control of their use or are using too much, are hurting other people or are alcoholic or drug addicted. High scores reflect uncertainty. High scores may also indicate some openness to reflection, as is expected in the contemplation stage.

Taking steps
High scorers report they are already doing things to make a positive change in their drinking and may have experienced some success in this regard. High scores are predictive of successful change. Low scorers report that they are not currently doing things to change their drinking and have not made recent changes. It is important to point out to low-scoring clients that they have already taken the first step by attending the session or participating in the administration of some assessment tools. The counselor must offer affirmation and encouragement in an effort to move these clients toward the next stage of change.

Clinical tips
Some counsellors worry that the Socrates does not place the client in a stage of change exactly. Remember that the scores on the three scales, as well as each score in relation to the other scales, will give you an individualized profile of each client. The Treatment Entry Questionnaire will give you information about the internal and external motivators for seeking help. Scores on ambivalence must always be interpreted in relation to recognition scores. Keep in mind that low ambivalence can be positively affiliated with both:

  • low recognition levels and
  • high recognition levels.