effects on client outcomes. showed these scores to be relatively powerful, independent predictors of retention. Melnick, G; Hawke, J; Wexler, H.K.(2004) USA To evaluate the growing number of prison-based substance abuse treatment programs from the perspective of the clients 1,059 participants from 13 prison-based substance abuse treatment programs Tested whether participants from prison-based substance abuse treatment programs could be grouped according to elevated, moderate, or low perceptions of the treatment environment and according to their perceptions of the program climate. Despite being coerced into treatment, the majority of participants were positive about their treatment experience. PRESSURES Storbjork, J.(2013) Sweden Explores how and treatment-entry pressures are associated with treatment outcome (dependence symptoms, 0-6, 12 months) among alcohol and drug misusers (N = 1,210) representative of the addiction treatment system of Stockholm Informal pressures (from family and friends), formal pressures (related to work, healthcare, social services, social allowances, child custody) and legal pressures (related to the police, criminal justice system, and compulsory treatment) were analysed. Interviewed when starting a new treatment episode and after one year Pressures were generally associated with poorer outcome. Alcohol misusers who had experienced threats regarding child custody did better in comparison with those not experiencing such pressure. Analyses indicated that self-choice and pressures are associated with outcome among alcohol misusers but not among drug misusers when controlling for background factors and severity. Self-choice (without pressures) correlated with a good outcome (a lower number of dependence criteria). Polcin, D. L; Beattie, M. (2007). USA Assess how pressure from different sources varies 698 individuals entering residential or outpatient treatment Pressure was assessed by asking participants if others had suggested they enter treatment, including family, friends, and professionals within institutions. Additional assessments included the Addiction Severity Index and readiness to change Interview and completion of addiction severity measures Being on parole or probation, not being employed full time, and having more severe legal problems predicted pressure from institutions. Most of the participants (73%) reported some type of pressure: 29% from personal relationships, 30% from institutions, and 14% from both. The remaining 27% reported no pressure to enter treatment. In addition, institutional pressure was associated with lower motivation at baseline, whereas relationship pressure was not
related to motivation at all. Compared with participants receiving only relationship pressure, those receiving only institutional pressure had lower alcohol, drug, family, psychiatric, and medical severity. When controlling for problem severity, baseline pressure was not associated with 12-month outcomes. Correlates of pressure from institutions for individuals to enter treatment differ from those associated with pressure from personal relationships to enter treatment. Schaub, M; Stevens, A; Haug, S; B, Daniele; Hunt, Neil; Kerschl, Viktoria; McSweeney, T; Oeuvray, K; Puppo, I; Maria, Alberto S; Trinkl, B; Werdenich, W; Uchtenhagen, A.(2011) European Aimed to identify such predictors in Quasi Compulsory Treatment (QCT) and voluntary treatment Participants were treated in one of 65 institutions in 5 European countries. 430 QCT and 415 voluntary treatment participants. Interviewed at intake on substance use, crimes committed, perceived pressure for treatment, European Addiction Severity Index and Questionnaire (RCQ) Predictors of substance abuse treatment retention are quite similar across both QCT and voluntary treatments. Perceived medical pressure is of higher relevance than the often-believed legal pressure for treatment retention in QCT. Higher perceived medical pressure resulted in higher treatment retention rates only for participants in QCT. There was a higher proportion of male participants in the QCT group (86.1%) than in the voluntary group (77.4%, p=.01, effect size w=0.11). Furthermore, the QCT and voluntary groups differed in terms of the number of years of school education, with a higher educational level in the voluntary group (10.1 years, QCT group 9.6 years, p=.01, d=0.21). A higher number of working days in the previous month was positively associated with treatment retention, while use of heroin, crack, and multiple drugs, psychiatric problems in the previous month, and lifetime depression were negatively associated with treatment retention. efficacy.
READINESS FOR CHANGE Burke AC; Gregoire TK. (2007). USA The relationships of coerced care to post treatment substance use and addiction severity. 289 participants in five large outpatient programs. Prospective study of substance abuse treatment outcomes. The findings are based on analyses for the 141 (48.8 percent of the original sample) individuals who completed a six-month follow-up interview using the short form of the Addiction Severity Index. Controlling for two important factors: readiness to change and addiction severity at admission to treatment. Interview Legally coerced participants were more likely than coerced participants to report abstaining from alcohol and other drugs in the 30 days before their follow-up interview. They were also more likely to demonstrate reduced addiction severity at Readiness to change at admission showed no relation to treatment outcomes. Gregoire TK; Burke AC.(2004) USA Examined the relationship between legal coercion and Readiness to Change. 295 consecutive admissions to five publicly funded outpatient treatment programs Addiction Severity Index and readiness to change scale. Persons entering treatment due to legal coercion were over three times more likely to have engaged in recovery-oriented behaviour in the month preceding admission. That legal coercion was associated with greater readiness to change after controlling for addiction severity, prior treatment history, and gender. Marlowe DB; Merikle EP; Kirby KC; Festinger DS; McLellan AT. (2001). USA Investigate why a client may be motivated to change, and suggest how retain an unmotivated client in treatment. interviewed 415 substance abuse clients Exploratory cluster analysis yielded five types of clients characterised by different profiles of perceived treatment-entry pressures. Interviews Cluster membership was predictive of treatment outcomes, and the clusters differed by demographic variables. These data support the discriminative and predictive utility of performing a multidimensional assessment of pressures to enter treatment. To establish reasons for entering treatment and scored the responses along the dimensions of (a) negative versus positive treatment-entry pressures, (b) internal versus external sources of those pressures, and (c) the life domain from which the pressures emanated.
over 12 months than those discharged on the pre-existing Section 17 leave of absence? differ between groups and did not support compulsory treatment as any more effective than not being on a CTO. Brown, R.T., Allison, P.A., Nieto,J.(2010) USA To describe the relationship between the imposition of short term jail sanctions and substance abuse treatment drop out. Also to explore the impact of jail sanctions during drug court participation upon substance abuse treatment completion. Administrative information collected by the Dane County Wisconsin Drug Treatment Court from 1996–2004 on all 573 participants achieving a final disposition of treatment completion or failure during those program years. Derived from iterative cox proportional models of time to treatment failure created. Theoretical framework and specific statistical criteria from administrative data. An initial jail sanction for non-adherence may be more likely to foster treatment compliance in less refractory individuals (i.e. those not already acclimated or socialised to incarceration or other corrections interventions). More stringent supervisory conditions and individualised services may be required to reintegrate such offenders and promote longer-term public safety. Brecht, ML. Anglin, M.D., and Wang, J.C. (1993). USA Whether addicts reporting themselves coerced into drug abuse treatment by actions of the criminal justice system differed from voluntary admissions in their response to treatment. 618 methadone maintenance clients admitted to programs in six southern California counties were categorised into high, moderate, and low legal coercion levels Data obtained from addiction career histories in a representative sample between four and six years after initial treatment. Standardised structured interview questionnaire. Dependent variables included criminal justice system contact, criminal activities, drug and alcohol involvement, and measures of social functioning. Few differences within any measured domain were found among the three groups. All groups were similar in showing substantial improvement in levels of narcotics use, criminal activities, and most other behaviours during treatment with some regression in these behaviours post treatment. Results support legal coercion as a valid motivation for treatment entry; those coerced into treatment respond in ways similar to voluntary admissions regardless of gender or ethnicity.