Psychology Ph.D. Dissertations

Applying the Relapse Model to Harm Reduction: The Development and Evaluation of the Harm Reduction Self-Efficacy Questionnaire

Date of Award


Document Type


Degree Name

Doctor of Philosophy (Ph.D.)



First Advisor

Harold Rosenberg


My study was designed to develop and evaluate a measure to assess harm reduction self- efficacy in intravenous (IV) opiate users. Using Marlatt and Gordon’s (1985) Cognitive Behavioral Model of Relapse, I developed the Harm Reduction Self-Efficacy Questionnaire (HRSEQ) to examine drug users’ perceived confidence in their ability to utilize specific harm reduction strategies in select high-risk situations. The study consisted of two major phases: 1) instrument development using focus groups of drug-takers and expert feedback and 2) experimental study of the influence of type of high-risk situation on self-efficacy to use harm reduction coping skills using a different sample of active or recently active drug users. In addition, I examined the reliability and construct/discriminant validity of the HRSEQ measure. After the HRSEQ was designed, I administered it along with other drug use measures, to 101 IV opiate users. Results indicated that harm reduction self-efficacy varied as predicted depending on type of high-risk situation. The HRSEQ demonstrated high internal consistency and was reliable across a one-week time period. The three HRSEQ scales were significantly associated (at a moderate to strong level) with the Harm Reduction Use Measure (HRUM), a scale that assessed use of harm reduction coping behaviors, thus providing support for construct validity. In addition, weak correlations and lack of associations between the HRSEQ scales and measures examining health self-efficacy, exercise self-efficacy, and self-efficacy to resist heavy drug use provided support for the discriminant validity of the HRSEQ. After further development, the HRSEQ could be a useful tool to gain a better understanding of clients’ confidence to utilize harm reduction interventions that will improve their health and well-being.