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. Author manuscript; available in PMC: 2025 Jan 23.
Published in final edited form as: Addict Res Theory. 2023 Nov 30;32(6):392–399. doi: 10.1080/16066359.2023.2282543

Initial Psychometric Testing of the Harm Reduction Self-Efficacy Scale (HRSES)

Frank J Schwebel 1, Dylan K Richards 1, Matthew R Pearson 1, Katie Witkiewitz 1
PMCID: PMC11756813  NIHMSID: NIHMS1956487  PMID: 39850944

Abstract

Abstinence self-efficacy, belief in one’s ability to abstain, has been identified as a predictor of substance use behavior change. Yet, many people who use substances do not want to abstain. Self-efficacy for achieving a range of goals (i.e., abstinence or harm reduction) would be more widely applicable and might also predict substance use behavior change. The current study reports on the development of the Harm Reduction Self-Efficacy Scale (HRSES), adapted from the Situational Confidence Questionnaire and other measures of behavioral regulation, to assess one’s self-efficacy to limit their substance use consistent with their own substance use goals. Participants were recruited from online support groups for individuals with varied personal goals for substance use. The current primary analyses included 226 individuals who completed the HRSES. Using exploratory factor analysis, we found support for a 4-factor solution reflecting self-efficacy in different situations that might promote substance use: negative emotions and situations, positive social situations, low self-regulation, and pleasant emotions. Each subscale was generally negatively correlated with substance use and positively correlated with quality of life, indicating greater self-efficacy was associated with less substance use and greater quality of life. Additional work is needed to test the psychometric properties of the HRSES, particularly confirmation of the factor structure in larger and more racially and ethnically diverse samples. The HRSES has promising psychometric properties and high clinical utility with wider applicability to a range of substance use goals.

Keywords: harm reduction, self-efficacy, moderation, abstinence, substance use

Self-efficacy is defined as an individual’s belief in their ability to implement and maintain a specific behavior (Bandura, 1977). In the context of substance use, self-efficacy has been defined as an individual’s belief that they can abstain or reduce their substance use, resist using substances when faced with external pressure to use, and maintain substance use behavior change over time (Hall et al., 2014; Kadden & Litt, 2011; Moos, 2007; Witkiewitz et al., 2022). Self-efficacy is a key component in the cognitive-behavioral model of addictive behavior, which proposes that individuals with higher abstinence self-efficacy will be more likely to maintain abstinence during high-risk situations for substance use (Marlatt & Gordon, 1980). A review of substance use self-efficacy found support for increased self-efficacy predicting improved substance use outcomes (e.g., lower quantity and frequency of use; Kadden & Litt, 2011). Other reviews have found that treatment appears to increase self-efficacy to abstain from substance use, although it is unclear what treatment components are responsible for this (Moos, 2007; Witkiewitz et al., 2022). It is also hypothesized that self-efficacy may be a mechanism of behavior change for substance use, but there is mixed support for this directional hypothesis in longitudinal research (Witkiewitz et al., 2022) and experimental studies (Shadel et al., 2017).

There are many measures of self-efficacy that are regularly used in alcohol and substance use research including the Situational Confidence Questionnaire (SCQ; Annis, 1987), the Alcohol Abstinence Self-Efficacy Scale (AASE; DiClemente et al., 1994), and the Drink Refusal Self-Efficacy Questionnaire (DRSEQ; Young et al., 1991). These measures are all largely based on the relapse taxonomy developed by Marlatt and Gordon (1980). The SCQ is a 100-item measure with 8 subscales (intrapersonal negative emotional states, intrapersonal positive emotional states, intrapersonal negative physical states, intrapersonal urges/temptations, testing personal control, interpersonal conflict, interpersonal social pressure, and interpersonal positive emotional states). The SCQ is one of the most commonly used measures of self-efficacy in alcohol and substance use research and there are short-form versions including a 39- (Annis & Graham, 1988) and 8-item version (Breslin et al., 2000). Self-efficacy, as measured by the SCQ, appears to have predictive and differential classification utility. SCQ scores are related to post-treatment decrease in alcohol consumption and negative alcohol-related problems (Moos & Moos, 2006) and can be used to classify people who are in long-term recovery (greater than one year) versus short-term recovery (less than one year) (Miller et al., 1989). Most existing measures of self-efficacy largely aim to assess abstinence self-efficacy or self-efficacy to not exceed heavy drinking cutoffs as highlighted by the measure titles (e.g., Alcohol Abstinence Self-Efficacy Scale) and/or measure prompt (SCQ: “Indicate on the scale provided how confident you are that you would be able to resist the urge to drink heavily in that situation”).

However, not everyone experiencing substance-related problems has a goal of abstinence or no heavy drinking (Collins et al., 2015). Another measure of self-efficacy, the Self-Efficacy for Drinking Control Scale (Sitharthan & Kavanagh, 1991)1, was developed to measure drinking control self-efficacy. Unfortunately, there is limited psychometric information about the scale beyond reporting a Cronbach’s alpha of 0.82 in one relatively small sample (N=60). Sitharthan and colleagues (2003) also developed the Controlled Drinking Self-Efficacy Scale. The scale has high levels of test-retest reliability and internal consistency. However, the measure focuses solely on alcohol self-efficacy, and there is limited additional psychometric work of the measure leaving a gap in the literature for assessing self-efficacy for a broader set of substance use goals.

Although the SCQ items were developed based on Marlatt’s relapse-risk taxonomy (Kadden & Litt, 2011), the model has since been revised (Witkiewitz & Marlatt, 2004)), and the revision of the model is nearly two decades old and needs to be updated. There also are new theories and areas of research that appear relevant to measuring substance use harm reduction. Self-regulation theory (Baumeister & Vohs, 2007) and self-determination theory (Ryan & Deci, 2000) have been applied to addiction science and specifically to goal-related behavior (e.g., Hustad et al., 2009; Richards et al., 2021). Though first introduced before the development of the SCQ, the abstinence violation effect was not incorporated in the SCQ and is theoretically related to substance use limits (Collins & Lapp 1991; Collins & Witkiewitz, 2013). Similarly, protective behavioral strategies are harm reduction behavioral approaches that can be used to reduce substance-related harms (Martens et al., 2004). Finally, given neurobiologically-informed models of addiction, particularly the Alcohol and Addiction Research Domain Criteria (Litten et al., 2015), it was hypothesized that failure to judge one’s ability to resist urges to use substances (reflecting impaired executive function and incentive salience) and difficulties in affective regulation (reflecting negative emotionality) might impact substance use harm reduction.

Current Study

Given the more frequent use of and more psychometric work done with the Situational Confidence Questionnaire, the goal of the current study was to adapt the 39-item version of the SCQ for people with a harm reduction substance use goal. Also, as noted above, the SCQ prompts individuals to assess their confidence for not engaging in heavy drinking and is not abstinence oriented, which made it easier to adapt. We aimed to develop a measure that could be used regardless of an individual’s self-defined goals, such that it could be flexible to abstinence goals or harm reduction goals (i.e., limiting the number of days using a substance or the quantity of a substance consumed; (Schwebel & Orban, 2023)). We created 15 additional items assessing other potential constructs related to substance use harm reduction. The newly adapted Harm Reduction Self-Efficacy Scale was administered to members of an online support group for people with abstinence or harm reduction goals, as well as some individuals with goals of unlimited substance use. We conducted exploratory factor analyses and tests of convergent validity as an initial examination of the psychometric properties of this measure.

Method

Participants

The current study is a secondary analysis of data originally reported by Schwebel and Orban (2023). Participants were recruited to complete an online survey between March and August 2021 using online advertising through Harm reduction, Abstinence, and Moderation Support (HAMS; www.hams.cc). Although based in the United States, HAMS is a web-based support group available online globally for individuals who are interested in support for a harm reduction, abstinence, or moderation goal for their alcohol and/or other drug use. HAMS began as a private message board in 2007 and has expanded to include a chat room, email group, Facebook groups, and live meetings. Of the 387 individuals who clicked the survey link, 23 did not complete any questions, 11 surveys were duplicate (i.e., duplicate IP address, first completed survey was retained), 10 were excluded for not being a HAMS member or for not being a HAMS member for their own substance use problem, leaving a sample of 343 participants (Schwebel & Orban, 2023). Analyses for the current study were restricted to 226 individuals who completed the HRSES. Most participants were female (76.5%) and non-Hispanic white (94.7%) (see Table 1 for complete sociodemographics). In terms of substance use, people most used alcohol (92.5%) and cannabis (4.0%) as primary substances. Cannabis (27.4%) was the most used secondary substance although most people reported not using a secondary substance (39.5%). Most participants had a harm reduction goal (64.2%), followed by a partial or total abstinence goal (29.6%), and a “no limits” goal (i.e., unrestricted substance use; 6.2%). Participants were offered the opportunity to receive a $10 electronic gift card for completing the survey. Median completion time was 24.7 minutes. This study was approved by the University of New Mexico Institutional Review Board and all participants provided informed consent.

Table 1.

Sociodemographics and substance use (history) of the analytic sample.

M (SD)
Age 41.28 (11.93)
Sex Assigned at Birth %
Male 23.0%
Female 76.5%
Other 0.4%
Gender %
Cisgender Man 21.9%
Cisgender Woman 67.4%
Transgender Man 2.2%
Transgender Woman 0.0%
Another Gender Identity 8.5%
Race %
American Indian or Alaska Native 3.5%
Asian 1.3%
Black or African American 1.3%
Native Hawaiian or Other Pacific Islander 0.0%
White 94.7%
Other 4.0%
Ethnicity %
Not Hispanic 94.7%
Mexican or Mexican-American 2.7%
Cuban 0.0%
Puerto Rican 0.9%
Hispanic-Other 2.2%
Past Month Substance Use M (SD)
Alcohol – Intoxication frequency (M (SD)) 11.09 (9.57)
Alcohol – Binge frequency (M (SD)) 7.60 (8.32)
Alcohol – Peak consumption (M (SD)) 11.30 (5.78)
Cannabis – Typical intoxication (M (SD)) 46.15 (21.58)
Cannabis – Peak intoxication (M (SD)) 63.43 (26.14)
Cannabis – Peak frequency (M (SD)) 41.23 (31.78)
Primary Substance of Choice %
Primary substance – Alcohol 92.5%
Primary substance – Cannabis 4.0%
Primary substance – Heroin 1.3%
Primary substance – Prescription opioids 0.9%
Primary substance – Methamphetamine 0.9%
Primary substance – Other 0.4%
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Measures

Harm reduction self-efficacy.

The HRSES items were derived by modifying instructions and items from the 39-item version of the Situational Confidence Questionnaire (SCQ-39; Annis & Graham, 1988). The instructions were modified from being abstinence-focused to being harm reduction-based (“Indicate on the scale provided how confident you are that you would be able to resist drinking beyond your limit or resist the urge to use your primary drug beyond your limit in each situation. I would be able to resist the urge to drink more than I intended or to use my primary drug more than I intended…”). Each item was measured using a 0–100 slider with the same value labels as the SCQ (0%=not at all confident, 20% confident, 40% confident, 60% confident, 80% confident, 100%=very confident). One item was removed for being narrowly focused on alcohol use (“If I were in a restaurant, and the people with me ordered drinks”). The research team created 15 additional items to assess additional constructs related to harm reduction self-efficacy including self-regulation theory (Baumeister & Vohs, 2007; 3 ‘failure to set standards’ items, 3 ‘failure to monitor items’), self-determination theory (Ryan & Deci, 2000; 3 ‘external regulation’ items), the abstinence violation effect (2 items), individual-level harm reduction behaviors (i.e., protective behavioral strategies, 2 items), 1 item reflecting the failure to judge one’s abilities to resist urges to use, and 1 item reflecting difficulty regulating an affective reaction. Thus, 53 items were subjected to further analysis.

Negative substance use-related consequences.

We used the 50-item Inventory of Drug Use Consequences (InDUC; Tonigan & Miller, 2002) to assess the lifetime number of negative substance use-related consequences experienced by participants. Participants responded whether they had ever experienced a wide-range of negative substance use-related consequences (“The quality of my work has suffered because of my drinking or drug use”). The 5 control items were removed, and the remaining 45 items were summed to create a total score representing the total number of lifetime negative consequences experienced at least once. The internal consistence reliability of the InDUC in the current sample was α=0.92.

Quality of life.

We used the 26-item World Health Organization Quality-of-Life Scale-BREF (WHOQOL-BREF; WHOQOL Group, 1998) to assess participants’ perceived quality of life during the past 2 weeks in physical health (“Do you have enough energy for everyday life?”), psychological (“To what extent do you consider your life to be meaningful?”), social (“How satisfied are you with your personal relationships?”), and environmental (“To what extent do you have the opportunity for leisure activities?”) domains of functioning. Items were responded to with varying 5-point scales (1=very poor; very dissatisfied; not at all to 5=very good; very satisfied; an extreme amount) depending on the question. Items in each subscale were averaged. The internal consistence reliability of the WHOQOL-BREF domains in the current sample ranged from α=0.71 to α=0.85.

Substance use goal.

We used a single item to assess participants’ substance use goal. Goals were classified as either a total abstinence goal (“Currently abstaining from all drugs/alcohol”), partial abstinence goal (“Currently abstaining from one or more substances but not all”), harm reduction goal (“I am working toward or am successfully setting limits/moderating my drug/alcohol use”), or no limits goal (“I am using drugs/alcohol without limits or restrictions”). We combined the total and partial abstinence goals to increase sample size in the subgroups given the similarity of the goals.

Substance use history.

All participants were asked to report the primary and secondary (if applicable) substance they use(d). Participants who reported any goal other than a total abstinence goal were asked to report on the quantity and frequency of their past 30-day substance use using a modified version of the Daily Drinking Questionnaire (DDQ; Collins et al., 1985). Frequency of alcohol and cannabis use, peak consumption, and frequency of heavy use as well as number of drinks/grams consumed each day for a typical week were assessed using a single item. A standard drink/grams of cannabis chart was provided to aid in responding to the alcohol/cannabis use items. See Table 1 for descriptive statistics.

Analytic Plan

We conducted a series of exploratory factor analyses (EFA) in Mplus 8.5 (Muthén & Muthén, 1998–2017) using maximum likelihood estimation with robust standard errors (MLR) and oblique geomin rotation. Prior simulation work has found the maximum likelihood to produce less biased standard errors than alternative estimators (e.g., weighted least squares with robust means and variances), particularly with smaller sample sizes (Li, 2016). We conducted an accompanying parallel analysis (Horn, 1965) which computes mean eigenvalues based on (50) randomly generated data sets. The number of factors retained is based on the factor for which the sample eigenvalue no longer exceeds its respective random eigenvalue. For example, if the second sample eigenvalue exceeds the second random eigenvalue, but the third sample eigenvalue does not exceed the third random eigenvalue, then the first two factors are retained. We went through an iterative process of removing items based on low factor loadings (loadings <.45) or high cross-loadings on additional factors (cross-loadings >.30) and then reconducted the EFA with those items removed. Internal consistency estimates for each subscale of the HRSES were calculated using Cronbach’s α. We examined both bivariate correlations and unique relationships (i.e., multiple regression) between HRSES subscales, substance use indicators, negative substance-related consequences, and quality of life. Finally, we compared HRSES subscales across individuals with abstinence, harm reduction, and ‘no limits’ goals using analysis of variance (ANOVA) with Tukey post-hoc comparisons.

Results

Exploratory Factor Analyses (EFA)

Using the full 53-item set, we conducted an initial EFA. Based on the parallel analyses, a 4-factor solution was selected. We removed 9 items based on low factor loadings and reran an EFA with the remaining 44 items. A 4-factor solution remained optimal; we removed 4 additional items with substantial cross-loadings and 1 additional item that had a low factor loading in the re-analysis, and reran an EFA with the remaining 39 items. Two additional items had low factor loadings on a primary factor and moderate cross-loadings on another factor, so we removed these items (See Supplemental Materials for further information). Thus, our final EFA model retained 37 items, which all items having greater than .45 loading on one of four factors and no cross-loadings greater than .30 (see Table 2).

Table 2.

Factor loadings and descriptive statistics from exploratory factor analysis

Factor Loadings
F1 λ F2 λ F3 λ F4 λ M SD
1. If I felt that I had let myself down .59* .18* .06 −.07 62.04 29.42
2. If there were fights at home or with family/friends .59* .10 .18* −.18* 61.08 32.76
3. If I had trouble sleeping .58* −.02 −.08 .02 68.41 32.33
4. If I had an argument with a friend .70* .01 −.05 .03 65.68 31.91
5. If other people didn’t seem to like me .77* −.07 −.02 −.01 68.47 31.59
6. If I felt confident and relaxed .13 −.04 .04 .63* 78.65 27.88
7. If I were out with friends and they stopped by the bar for a drink/a place to use .08 .81* .02 −.02 55.48 33.66
8. If I were enjoying myself at a party and wanted to feel even better .07 .71* .13* .01 54.67 34.24
11. If I were afraid that things weren’t going to work out .67* −.00 .21* −.04 61.31 31.28
12. If other people interfered with my plans .57* .05 .00 .19* 71.05 29.21
14. If there were problems with people at work or school .85* .01 −.09 −.06 65.70 30.56
15. If I felt uneasy in the presence of someone .60* .14 −.08 .08 63.12 32.13
16. If everything were going well .02 .06 .02 .85* 76.88 28.03
17. If I were at a party and other people were drinking/using .07 .91* −.05 −.04 53.37 33.91
18. If I wanted to celebrate with a friend .03 .85* −.00 .02 53.79 32.69
21. If I were angry at the way things had turned out .63* .09 .19* −.05 59.10 31.52
22. If other people treated me unfairly .83* −.08 .08 −.03 63.06 31.39
24. If pressure built up at work or school or home .72* .05 .11 .05 57.20 30.64
25. If someone criticized me .79* .04 −.07 .11 64.64 31.64
26. If I felt satisfied with something I had done .17 .10 −.02 .63* 77.38 27.80
27. If I were relaxed with a good friend and wanted to have a good time −.12 .70* .03 .28* 63.35 31.15
30. If I felt confused about what I should do .67* −.14* .17* .21* 66.23 30.62
31. If I felt under a lot of pressure from family members .59* .06 .15* .05 64.94 31.23
32. If my stomach felt like it was tied in knots .69* −.05 −.04 .17 66.91 33.98
33. If I were not getting along well with others .80* .01 .04 .01 62.10 31.64
34. If other people around me made me tense .78* .09 .01 .03 57.72 32.81
35. If I were out with friends “on the town” and wanted to increase my enjoyment .02 .88* .03 .04 54.70 34.20
36. If I met a friend and he/she suggested that we have a drink or use together −.01 .86* .04 .03 54.16 33.63
40. If I hadn’t decided on my limits .17 .10 .51* .05 57.62 33.48
42. If I were already drinking/using my primary drug .02 .15* .69* −.05 45.04 33.83
43. If I were not keeping track of how much I was using .01 −.03 .93* −.08 45.52 33.23
44. If I had not thought about how to track how much I was using .03 −.06 .91* .06 46.18 33.31
45. If I didn’t set my own goal .04 −.02 .85* −.05 45.25 33.08
47. If someone else set my goal for me −.02 .01 .52* .01 44.47 35.74
51. If I ended up using more than I intended to drink/use .13 .06 .51* .02 53.26 32.84
52. If I hadn’t identified a skill(s) I could use to not exceed what I intended to drink/use −.00 .10 .66* .10 47.45 32.35
53. If I hadn’t thought about how I would use my skill(s) to not exceed what I intended to drink/use −.07 .09 .70* .13 49.50 31.54
% of items 18 7 9 3
Cronbach’s α .956 .954 .921 .813
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Note: Items 1–38 are based on the SCQ-39 and items 39–53 are newly developed.

Factor 1 contained 18 items, which we refer to as the negative emotions and situations subscale (highest loading item: “If there were problems with people at work or school”). This subscale had high internal consistency (α=.956) and contained items from the SCQ-39 unpleasant emotions, physical discomfort, social problems at work, and social tension subscales. Factor 2 contained 7 items, which we refer to as positive social situations subscale (highest loading item: “If I were at a party and other people were drinking/using”). This subscale had high internal consistency (α=.954) and contained 7 items from the positive social situations subscale of the SCQ-39. Factor 3 contained 9 items, which we refer to as the low self-regulation subscale (highest loading item: “If I were not keeping track of how much I was using”). This subscale had high internal consistency (α=.921) and contains items that our team created based on theories of self-regulation and other constructs related to substance use harm reduction. Factor 4 contained 3 items, all derived from the pleasant emotions subscale of the SCQ-39 (highest loading item: “If everything were going well”). This subscale had adequate internal consistency (α=.813).

Convergent Validity Analyses

At the bivariate level, nearly all HRSES subscales were significantly related to lower alcohol use indicators, except for the association between the low self-regulation subscale and binge frequency. All HRSES subscales were significantly related to higher psychological health. The negative emotions and situations subscale was also significantly related to higher physical health, social relationships, and environment health. The low self-regulation subscale was significantly related to higher social relationships. None of the subscales were significantly related to cannabis use indicators, although only a small subsample (n=38) of our total sample reported cannabis as their primary substance used.

In terms of unique prediction across a series of multiple regression analyses, holding all other HRSES subscales constant, the negative emotions and situations subscale was significantly related to lower binge drinking frequency, and higher quality of life across domains (physical health, psychological health, social relationships, environmental health). The positive social situations subscale was significantly related to lower frequency of intoxication. The low self-regulation subscale was significantly related to experiencing fewer substance use problems.

In ANOVA models to examine group differences based on participant identified goals, we found significant differences on the negative emotions and situations [F(2,223) = 6.66, p=.002, R2=.056] and positive social situations subscales [F(2,219) = 13.59, p<.001, R2=.110] across individuals with abstinence, harm reduction, or no limits goals. Specifically, for the negative emotions and situations subscale, individuals with an abstinence goal reported significantly higher self-efficacy (M=71.87) than individuals with a harm reduction (M=60.81) or no limits goal (M=53.34); the latter two groups did not differ significantly from each other. For the positive social situations subscale, individuals with an abstinence goal reported significantly higher self-efficacy (M=70.33) than individuals with a harm reduction (M=49.33) or no limits goal (M=47.03); the latter two groups did not differ significantly from each other.

Discussion

For the present study, we adapted items from an existing measure (i.e., SCQ) and generated new items based on self-regulation theories and other constructs related to substance use harm reduction to develop a measure of self-efficacy for alcohol and substance use harm reduction, the Harm Reduction Self-Efficacy Scale (HRSES). We conducted a preliminary test of its psychometric properties among a sample of people engaging with an online support group for alcohol and substance use (i.e., HAMS). Our aim was to extend the measurement of self-efficacy in relation to alcohol and substance use from abstinence to include harm reduction.

Based on the results of EFA, we found support for a four-factor structure of the HRSES with a total of 37 items which we reduced from an initial item pool of 53 items. The four factors were: negative emotions and situations (18 items), positive social situations (7 items), low self-regulation (9 items), and pleasant emotions (3 items). These subscales differentiate between the degree of self-efficacy for substance use harm reduction in certain situations/circumstances that might promote substance use. Given we largely adapted the HRSES from the SCQ, it is unsurprising that the factors we found for the HRSES are largely consistent with those found for the SCQ (e.g., Breslin et al., 2000; Miller et al., 1989). The positive social situations and pleasant emotions factors were entirely consistent across measures. However, the negative emotions and situations subscale we found for the HRSES was comprised of the negative valence factors of the SCQ (i.e., unpleasant emotions, physical discomfort, social tension, social problems at work, and testing control). The low self-regulation factor was formed from items we generated from self-regulation theories and other substance use addiction and harm reduction-related constructs, and thus is not a factor from the SCQ. Further, estimates of internal consistency were high for each of the four subscales, all of which were > .90 except for the pleasant emotions subscale which is unsurprising given it includes only 3 items. Future research could consider expanding this subscale to increase content coverage, if deemed appropriate.

Regarding the validity of the HRSES, each subscale was generally negatively correlated with alcohol use and positively correlated with quality of life. In other words, those who endorsed greater self-efficacy for alcohol and substance use harm reduction also reported drinking less and greater quality of life. These findings are consistent with decades of research demonstrating that self-efficacy for abstinence and drinking refusal are associated with less alcohol use and fewer alcohol-related problems as well as a mechanism of alcohol intervention (Forcehimes & Tonigan, 2008; Kadden & Litt, 2011; Sheeran et al., 2016). Importantly, our findings, in the context of validating the HRSES, extend this research to self-efficacy for harm reduction as opposed to abstinence or drinking refusal. This extension is critical given the emergence and support for harm reduction approaches and the need to measure salient antecedents, such as self-efficacy, in relation to non-abstinence goals.

Overall, the negative emotions and situations subscale had the strongest relationships with the criterion variables. A large body of literature has shown that drinking to cope with negative emotions, relative to other drinking motives, is the strongest predictor of alcohol-related problems (Bresin & Mekawi, 2021). Thus, it stands to reason that greater self-efficacy for alcohol and/or substance use harm reduction while experiencing negative emotions or a negative situation is especially protective.

The positive social situations subscale had the second strongest relations with criterion variables. Items of this subscale largely reflect positive emotions and mood in the context of drinking or using substances during enjoyable social settings. Drinking to enhance one’s mood, relative to other drinking motives, has been found to be the strongest predictor of alcohol use (Bresin & Mekawi, 2021). For this reason, self-efficacy for alcohol and/or other substance use harm reduction in positive social situations may also be especially protective. Low self-regulation and pleasant emotions subscales were less strongly related to substance use outcomes, with low self-regulation associated with consequences and pleasant emotions associated with frequency of intoxication. Future research is needed to continue to examine the utility of these subscales of the HRSES.

Limitations

There are several limitations of the present study. A major limitation of the present study is that we did not confirm this four-factor structure of the HRSES in an independent sample. The modest sample size prevented us from conducting a random split half of the data for exploratory and confirmatory approaches. For this reason, a four-factor structure of the HRSES is preliminary, and future research is needed to confirm this four-factor structure. For example, it may be that in other, larger samples, the negative emotions and situations factor breaks down into the more specific factors found for the SCQ. It is promising, however, that the items we adapted from the SCQ largely reflect their respective factors found in prior psychometric examinations of the SCQ, increasing confidence in these findings.

The cross-sectional, observational nature of the present study limits causal inference, specifically that self-efficacy for harm reduction of alcohol and other substance use, as assessed by the HRSES, predicts, or causes, changes in alcohol/substance use, negative consequences, and quality of life. Also, the sample was predominantly female, non-Hispanic, and white, limiting the generalizability of our findings. Future research with more racially, ethnically, and gender diverse samples is needed to further examine the psychometric properties of the HRSES and extend our findings by examining measurement invariance across participant subgroups based on sociodemographic characteristics (e.g., age, sex, race/ethnicity). It would also be beneficial to use a method like cognitive interviewing to ensure the language in the prompt and items are being interpreted as intended (Boness & Sher, 2020). Further, although our novel sample of individuals engaging with HAMS and having a range of different substance use goals (from abstinence to no limits) is a strength of the present study, our sample size was modest, and future research with larger samples is needed to increase confidence in the validity of the psychometric properties of the HRSES. Self-efficacy for alcohol and other substance harm reduction may be particularly important for individuals in recovery given support for self-efficacy as a mechanism of behavior change, but this construct is also important for other populations, such as those at risk for negative alcohol-/substance-related consequences (e.g., college students), and it may be less resource-intensive to collect larger samples with non-recovery populations. Another limitation is that we did not assess current substance use among individuals with an abstinence goal who endorsed current abstinence, though ostensibly, participants with an abstinence-based goal could have engaged in recent substance use; this decision decreased our sample size for some analyses. Finally, the HRSES was specifically designed to assess self-efficacy for alcohol or other substance use harm reduction, but the conflation of substances in addition to the fact that the sample was predominantly individuals whose primary substance is alcohol, is a limitation. This lack of representation is particularly concerning for the validity analyses for cannabis use, which were based on a small proportion of the sample. Future research is needed to determine the pros and cons of substance-specific versus substance-agnostic versions of the measure.

Conclusions

Our findings provide preliminary support for the psychometric properties of the HRSES, which we developed to extend the measurement of self-efficacy, a supported mechanism of behavior change, from alcohol and substance use abstinence to harm reduction. Most individuals do not seek nor achieve complete abstinence (Witkiewitz et al., 2021), and thus supporting harm reduction goals through the measurement of salient constructs in relation to these goals is essential for increasing intervention seeking and acceptability. Replication and extension of the promising psychometric properties of the HRSES is needed.

Supplementary Material

Supp 1

Table 3.

Bivariate correlations (Pearson r) between the four HRSES subscales and the criterion variables

Variable n NES PSS LSR PE
Alcohol – Intoxication Frequency 167 −.287** −.304** −.204** −.160*
Alcohol – Binge Frequency 167 −.300** −.240** −.143 −.222**
Alcohol – Peak Consumption 167 −.239** −.182* −.177* −.182*
Cannabis – Typical Intoxication 38 .021 −.042 .186 −.041
Cannabis – Peak Intoxication 38 .007 −.249 .290 .009
Cannabis – Peak Frequency 38 .105 −.033 −.100 .022
Substance Consequences (InDUC) 211 −.007 −.022 −.115 −.052
Quality of Life: Physical Health 216 .210** .107 .031 .029
Quality of Life: Psychological Health 217 .397** .246** .240** .175**
Quality of Life: Social Relationship 216 .218** .120 .197** .065
Quality of Life: Environmental Health 216 .205** .103 .055 .097
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Note. HRSES = Harm Reduction Self-Efficacy Scale, n = smallest sample size for the correlations between the four HRSES subscales and the respective criterion variable, NES = Negative emotions and situations, PSS = Positive social situations, LSR = Low self-regulation, PE = Pleasant emotions.

**

p < .01

*

p < .05.

Table 4.

Multiple regressions (standardized regression coefficients) between the four HRSES subscales and the criterion variables

Variable n NES PSS LSR PE R2
Alcohol – Intoxication Frequency 164 −.189 −.216* .002 .015 .126
Alcohol – Binge Frequency 167 −.270* −.106 .078 −.093 .125
Alcohol – Peak Consumption 167 −.196 −.042 −.023 −.078 .079
Substance Consequences (InDUC) 208 .094 .050 −.184* −.066 .023
Quality of Life: Physical Health 213 .320* .002 −.127 −.086 .057
Quality of Life: Psychological Health 217 .383* −.037 .057 −.009 .153
Quality of Life: Social Relationship 216 .205* −.099 .154 −.025 .065
Quality of Life: Environmental Health 216 .272* −.030 −.077 .006 .050
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Note. HRSES = Harm Reduction Self-Efficacy Scale, n = sample size, NES = Negative emotions and situations, PSS = Positive social situations, LSR = Low self-regulation, PE = Pleasant emotions.

*

p < .05.

Acknowledgement

The authors would like to thank Dr. Verlin Joseph for reviewing an early version of the HRSES.

Funding

This work was supported in part by the National Institute on Alcohol Abuse & Alcoholism (NIAAA) under Grants (T32AA018108, PI: Witkiewitz; K01AA030789, PI: Richards); and the National Institute on Drug Abuse (NIDA) under Grant (RM1DA055301-01S1, PI: Schwebel). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIAAA, NIDA, or National Institute of Health.

Footnotes

Disclosure statement

The authors report there are no competing interests to declare.

Ethics statement

This study was approved by the Institutional Review Board of record. All participants provided electronic informed consent.

1

Sitharthan and Kavanagh (1991) refer to the measure as both the Self-Efficacy for Drinking Control Scale and the Problem Drinking Self-Efficacy Scale.

Data availability statement

Data are available from the corresponding author upon reasonable request.

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Associated Data

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Supplementary Materials

Supp 1
NIHMS1956487-supplement-Supp_1.docx (31.8KB, docx)

Data Availability Statement

Data are available from the corresponding author upon reasonable request.

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