CMR OVERVIEW
George De Leon, Ph.D. and Gerald Melnick, Ph.D.
Center for Therapeutic Community Research at NDRI
Overview: The CMR is an 18-item self-administered instrument designed to measure
motivation and readiness for treatment and to predict retention in treatment among
abusers of illicit drugs. The instrument is based on recovery theory (De Leon, 1995,
1997, 2000) which stresses the impact of both external and internal motivation on the
readiness for treatment. Items were developed on the basis of interviews with drug
abusers who asked to identify the influences that contributed to their entering and
remaining in treatment. Many of their self-reported expressions are used verbatim in the
items to create a sense of familiarity and perceived relevance. The CMR can be used as
an intake device, clinical treatment planning tool, and research instrument.
The instrument consists of four factor derived scales, Circumstances 1 (external
influences to enter or remain in treatment), Circumstances 2 (external influences to
leave treatment), Motivation (internal recognition of the need to change), and Readiness
for treatment. Confirmatory factor analysis in samples drawn from outpatient,
methadone maintenance, and short- and long-term residential treatment have
demonstrated the generality of the factors among the four treatment modalities.
Test Administration and Scoring: The CMR is a self-administered instrument
consisting of 18 Likert type items. The respondent uses a 5-point scale to rate each
statement from strongly disagree to strongly agree. Items may also be scored as Not
Applicable.
Reading level and Perceived Relevance: The items were drawn from interviews with
recovering drug abusers and capture the tone and vernacular of the respondents.
Statements were selected that were easy to read and would be perceived as familiar
and relevant to abusers of drugs.
Credentials and Training: There are no special credentials necessary for the
administration of the CMR. The major functions of test administrator is to answer any
questions concerning the purpose of the testing, explain the instructions and check the
completed instrument to determine that there is no missing data and that items marked
Not Applicable were understood by the respondent. In the event that respondents are
non literate, the instrument can be read to the respondent.
Completion Time: Most clients complete the CMR in less than 10 minutes.
Scoring Procedures for the CMR: Circumstances 1 consists of questions 1-3,
Circumstances 2 consists of questions 4-6, Motivation consists of questions 7-11, and
Readiness consists of questions 12-18. Scoring involves reversing the score values for
questions 4, 5, 6 and 12—scores of 5=1, 4=2, 3=3, 2=4 and 1=5. The individual score
values of each scale are then summed to derive the scale values. The scale values are
then summed to derive the Total Score. Not Applicable responses are recoded to the
client's mean score for the scale in which the response falls. This recoding is limited to
one item on each of the C scales, one item on the M scale and two items on the R
scale. Examination of the CMR data base of some 11,000 cases indicates that nearly all
clients will fall within this criteria.
CMR and Retention: Identification of client risk for early drop-out is based on a dividing
respondents into four score categories consisting of Low scorers (1 Standard Deviation
or more below the mean), Moderately Low scorers (between the mean and - 1 Standard
Deviation), Moderately High scorers (between the mean and + 1 Standard Deviation)
and High scorers (1 Standard Deviation or more above the mean). These score
categories are calculated for each of the scales and for the Total Score.
Scoring Time: Approximately 5 minutes to sum the scores and compare scores to
reference scores for the agency.
Reliability: Cronbach's alpha for the Total score is in the .70s and .80s across 30
separate studies involving a wide variety of client populations and treatment settings.
Individual scale score reliability varies with C1 evidencing low reliability in outpatient
samples. Reliability for C2 is mainly in the .50s and reliability for M and R are in .60 to
.80 range.
Validity: Validity for the CMR is measured by two criteria, the ability of the instrument to
differentiate between groups and the prediction of retention.
Differentiation Between Groups: The 18-item CMR was derived from the longer 42-item
CMRS. The correlation of .92 between the instruments indicates that they are virtually
equivalent. Prior studies with the CMRS have found that the instrument differentiates
between a street sample, entrants into a detoxification program and respondents of a
waiting list to enter a residential therapeutic community (Lipton, Morales & Goldsmith,
1991). Another study found that the instrument differentiated between drug abusing
homeless women who refused treatment and those entering a treatment program
(Erikson, et al 1995).
Prediction of Retention: The major retention studies have involved long-term residential
treatment (De Leon, et al. 1994). In three cohorts of 300, 330 and 795 adult admissions
there was a linear relationship between score category and 30-day retention with
retention on each of the scales and the Total Score. Furthermore, 30-day retention for
the High scorers on Total Score exceeded Low scorers by as much as 87 to 42 percent,
or better than 2 to 1. At one year, retention among high scorers exceeded Low scorers
by as much as 47 to 16 percent, or approximately 3 to 1. Additional studies with
adolescents show that the CMRS predicts retention in treatment across age groups
(Melnick, et al. 1997). These findings have subsequently been replicated with the CMR
(Melnick, 1999). Studies of prison-based TCs have found that the CMR predicts entry
into aftercare (De Leon, et al. 2000).
Normative Data: A secondary analysis of 30 studies involving over 11,000 clients
(Melnick, 1999) provides comparative data for a wide variety of treatment populations
and modalities including women's programs, MICA programs, prison based TCs,
methadone maintenance programs, drug free outpatient, detox, and adolescent TCs.
Gender, Race/Ethnicity, Age, and Primary Drug Considerations: Reliability for the
CMR is similar across gender, race/ethnic, age and primary drug groups. Additional
analyses and published papers have demonstrated the validity of the original CMR
scales across gender, race/ethnic, age and primary drug, including cocaine/crack
cocaine, opiates and marijuana.
Inquiries: Write to either George De Leon, Ph.D., or Gerald Melnick, Ph.D., at the
Center for Therapeutic Community Research at National Development and Research
Institutes, 71 West 23rd Street, 8th Floor, New York, NY 10010, or call (212) 845-4400.
References:
De Leon, G. (1995). Therapeutic communities for addictions: A theoretical framework.
The International Journal of the Addictions, 30(12), 1603-1645.
De Leon, G. (1997). Community As Method: Therapeutic Communities for Special
Populations and Special Settings. Westport, CT: Greenwood Publishing Group,
Inc., pp. 3-18.
De Leon, G. (2000). The Therapeutic Community: Theory, Model and Method. New
York, NY: Springer Publishing Co.
De Leon, G., Melnick, G., Thomas, G., Kressel, D., & Wexler, H. K. (2000). Motivation
for treatment in a prison-based therapeutic community. American Journal of Drug
and Alcohol Abuse, 26(1), 33-46.
De Leon, G. Melnick, G., Kressel, D., & Jainchill, N. (1994). Circumstance, motivation,
readiness, and suitability (The CMRS Scales): Predicting retention in therapeutic
community treatment. American Journal of Drug and Alcohol Abuse, 20(4), 495-515.
Erickson, J.R., Stevens, S., McKnight, P., & Figueredo, A. J. (1995). Willingness for
treatment as a predictor of retention and outcomes. Journal of Addictive Diseases,
14, 135-150.
Lipton, D.S., Morales, E., & Goldsmith, D. S. (1991). Pathways into Treatment: A study
of the drug treatment entry process. Final Project Report. Rockville, MD: National
Institute on Drug Abuse.
Melnick, G. (1999). Assessing Treatment Readiness in Special Populations: Final
Report of Project Activities, NIDA Grant Number 2 R01 DA07377-03. Rockville, MD:
National Institute on Drug Abuse.
Melnick, G., De Leon, G., Hawke, J., Jainchill, N., & Kressel, D. (1997) Motivation and
readiness for therapeutic community treatment among adolescents and adult
substance abusers. American Journal of Drug and Alcohol Abuse, 23(4), 485-507.