A latent class approach to treatment readiness corresponds to a transtheoretical (“Stages of Change”) model

Abstract

Motivation for treatment among people with substance use problems is an important aspect of treatment success. Models for treatment motivation are widely debated. Latent Class Analysis can help to demonstrate the appropriateness of available models. The current study utilizes Latent Class Analysis to analyze treatment readiness statements as they relate to the reduction or cessation of marijuana, cocaine, and opioid use among 539 cocaine and opioid users recruited from the community of Baltimore, MD, USA. Participants completed an in-person structured interview including demographic questions, a treatment readiness questionnaire with items on Intention to Stop Use (ISU) and Problem Recognition (PR), current substance abuse treatment utilization, and urinalysis testing for marijuana, cocaine, and heroin. Latent class models were fit to the treatment readiness questionnaire. A four-class model provided the best fit with one class low on both ISU and PR (“Pre-contemplative”), a second class low on ISU, but high on PR (“Contemplative”), a third class high on both (“Preparation/Action”), and a final class high on ISU, but low on PR (“Post-Action”). Compared to the “Contemplative” class, the “Pre-contemplative” class was significantly more likely to be positive for marijuana, and the “Post-Action” class was significantly less likely to be positive for opioids. The “Preparation/Action” class was significantly more likely to be in treatment. With the exception of the “Post-Action” class, the analysis appears similar to the “Stages of Change” model and suggests that problem recognition and intention to stop use are important domains in the model. However, further longitudinal research is needed to assess predictive validity of model.

Expectancies for Cigarettes, E-Cigarettes, and Nicotine Replacement Therapies Among E-Cigarette Users (aka Vapers)

“…It is known that expectancies can be altered by instructions or media campaigns 54,67 and are associated with different aspects of desire to change substance use behaviors. 68 As regulations for e-cigarettes are debated, this information can help guide labeling requirements, advertising restrictions, and the development of counter-messaging to discourage unhealthy behaviors. Expectancies may be targets for public health efforts to discourage de novo e-cigarette use among youth and adults, to encourage switching from cigarettes to e-cigarettes, or to encourage e-cigarette use after (or potentially even before) trying NRT and other approved medications, depending on the outcomes of future safety and efficacy studies.…”

Transtheoretical model of health behavioral change: A systematic review

“…[43] The results reported that TTM was used more in healthcare context than treatment and prevention of CDs. In healthcare context, TTM was used to change exercise behaviors,[8444546474849] change the attitude of diet behaviors,[5051525354] addiction treatment behaviors,[55565758] air pollution prevention behaviors,[43] and oral health behaviors. [59]…”

Outcome expectations and associated treatment outcomes in motivational enhancement therapy delivered in English and Spanish

“…For instance, there is some overlap between a “treatment readiness statement” and the language in the item, as the item uses the words “ I will ”, which explicitly taps into commitment language. 11 This may have caused some individuals to respond as ‘Unsure’, as opposed to using wording without commitment language for the item (e.g., “What do you expect will be the outcome of your treatment?”). We also found that those with a higher motivation score were more likely to be in the ‘Sure’ group, indicating that while the constructs of outcome expectations and motivation are distinct, they may be related.…”

“…Similar to outcome expectations, motivation has been associated with substance use treatment outcomes and treatment retention. 11 While motivation for treatment and treatment expectations are related, there is some evidence that these two constructs may be discriminable. 8 For instance, an individual may be motivated to change substance use behaviors, but at the same time expect that treatment will not be effective in doing so.…”

“…Motivation prior to treatment entry has been associated with single-item ratings regarding treatment expectations (i.e., “Being in drug treatment would help you with a lot of your problems”). 11 …”