Abstract
Motivation for change has historically been viewed as the crucial element affecting responsiveness to drug treatment. Various external pressures, such as legal coercion, may engender motivation in an individual previously resistant to change. Dramatic relief may be the change process that is most salient as individuals internalize such external pressures. Results of structural equation modeling on data from 465 drug users (58.9% male; 21.3% Black, 34.2% Hispanic/Latino, and 35.1% White) entering drug treatment indicated that internal motivation and external pressure significantly and positively predicted dramatic relief and that dramatic relief significantly predicted attitudes towards drug treatment: χ 2 = 142.20, df = 100, p < 0.01; Robust Comparative Fit Index = 0.97, Root Mean Squared Error of Approximation = 0.03. These results indicate that when external pressure and internal motivation are high, dramatic relief is also likely to be high. When dramatic relief is high, attitudes towards drug treatment are likely to be positive. The findings indicate that interventions to get individuals into drug treatment should include processes that promote Dramatic Relief. Implications for addictions health services are discussed.
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De Leon G, Melnick G, Hawke J. The motivation-readiness factor in drug treatment: implications for research and policy. Advances in Medical Sociology. 2000;7:103–129.
Longshore D, Teruya C. Treatment motivation in drug users: a theory-based analysis. Drug and Alcohol Dependence. 2006;81:179–188.
Joe GW, Broome KM, Rowan-Szal GA, et al. Measuring patient attributes and engagement in treatment. Journal of Substance Abuse Treatment. 2002;22:183–196.
Simpson DD, Joe GW. Motivation as a predictor of early dropout from drug abuse treatment. Psychotherapy. 1993;30:357–368.
Ryan RM, Plant RW, O’Malley S. Initial motivations for alcohol treatment: relations with patient characteristics, treatment involvement, and dropout. Addictive Behaviors. 1995;20:279–297.
Glanz K, Lewis F, Rimer B. Linking theory, research, and practice. In: Glanz K, Lewis F, Rimer B, eds. Health behavior and health education: theory, research and practice. 2nd edn. San Francisco: Jossey-Bass; 1999.
Whitelaw S, Baldwin S, Bunton R, et al. The status of evidence and outcomes in Stages of Change research. Health Education Research. 2000;15:707–718.
Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behavior. American Psychologist. 1992;47:1102–1114.
Prochaska JO, Norcross JC, DiClemente CC. Changing for good. New York: Morrow; 1994.
DiClemente CC, Scott CW. Stages of change: interaction with treatment compliance and involvement. In: Onken L, Blaine J, Boren J, eds. Beyond the therapeutic alliance: keeping the drug-dependent individual in treatment. NIDA research monograph series (no. 165). Washington, DC: U.S. Government Printing Office; 1997:131–156.
DiClemente CC, Schlundt D, Gemmell L. Readiness and stages of change in addiction treatment. American Journal on Addictions. 2004;13:103–119.
Norman GJ, Velicer WF, Fava JL, et al. Dynamic typology clustering within the stages of change for smoking cessation. Addictive Behaviors. 1998;23:139–153.
Czuchry M, Dansereau DF. Cognitive skills training: impact on drug abuse counseling and readiness for treatment. American Journal of Drug and Alcohol Abuse. 2003;29:1–18.
Abrams DB, Herzog TA, Emmons KM, et al. Stages of change versus addiction: a replication and extension. Nicotine & Tobacco Research. 2000;2:223–229.
Perz CA, DiClemente CC, Carbonari JP. Doing the right thing at the right time? The interaction of stages and processes of change in successful smoking cessation. Health Psychology. 1996;15:462–468.
Prochaska JO. Moving beyond the transtheoretical model. Addiction. 2006;101:768–774.
Prochaska JO, Levesque DA. Enhancing motivation of offenders at each stage of change phase of therapy. In: McMurran M, ed. Motivating offenders to change. New York: Wiley; 2002:57–74.
Schumann A, Meyer C, Rumpf H-J, et al. Stage of change transitions and processes of change, decisional balance, and self-efficacy in smokers: a transtheoretical model validation using longitudinal data. Psychology of Addictive Behaviors. 2005;19:3–9.
Ryan RM, Plant RW, O’Malley S. Initial motivations for alcohol treatment: relations with patient characteristics, treatment involvement, and dropout. Addictive Behaviors. 1995;20:279–297.
Belding MA, Iguchi MY, Lamb RJ, et al. Stages and processes of change among polydrug users in methadone maintenance treatment. Drug and Alcohol Dependence. 1995;39:45–53.
Neff JA, Zule WA. Predicting treatment-seeking behavior: psychometric properties of a brief self-report scale. Substance Use and Misuse. 2000;35:585–599.
Bentler PM. EQS 6 structural equations program manual. Encino: Multivariate Software; 2006.
Satorra A, Bentler PM. A scaled difference chi-square test statistic for moment structure analysis. Psychometrika. 2001;66:507–514.
Bentler PM, Dudgeon P. Covariance structure analysis: statistical practice, theory, and directions. Annual Review of Psychology. 1996;47:563–592.
Yuan K-H, Chan W, Bentler PM. Robust transformation with applications to structural equation modeling. British Journal of Mathematical and Statistical Psychology. 2000;53:31–50.
Curran PJ, West SG, Finch JF. The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods. 1996;1:16–29.
Hu L-T, Bentler PM. Cutoff criteria for fit indexes in covariance structural analysis: conventional criteria versus new alternatives. Structural Equation Modeling. 1999;6:1–55.
Velasquez MM, Maurer GG, Crouch C, et al. Group treatment for substance abuse: a stages of change therapy manual. New York: Guildford; 2001.
Evans E, Longshore D. Evaluation of the substance abuse and crime prevention act: treatment clients and program types during the first year of implementation. Journal of Psychoactive Drugs. 2004;(Suppl. 2):165–174, May.
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Support for this research was provided by Grants R03-DA23131, R01-DA12476, and K05-DA00146. Dr. Anglin is also supported by NIDA Senior Research Scientist Award K05 DA00146.
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Conner, B.T., Longshore, D. & Anglin, M.D. Modeling Attitude towards Drug Treament: The Role of Internal Motivation, External Pressure, and Dramatic Relief. J Behav Health Serv Res 36, 150–158 (2009). https://doi.org/10.1007/s11414-008-9119-1
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DOI: https://doi.org/10.1007/s11414-008-9119-1