Barriers and Facilitators to Treatment Engagement Among Clients in Inpatient Substance Abuse Treatment

Abstract

There is a call for drawing on client voice to provide a rich, nuanced understanding of factors influencing substance treatment engagement as to maximizing treatment benefits. We interviewed 60 clients in a short-term inpatient substance treatment program and examined facilitators and barriers to treatment engagement. Thematic analysis yielded four themes, including perceived treatment needs, trust and counselor rapport, peer inspiration, and organizational factors. Perceived treatment needs serve as both a facilitator and a barrier wherein the acknowledgment of needs led to greater treatment engagement whereas a lack of perceived needs hindered treatment engagement. The establishment of trust and counselor rapport and peer inspiration facilitated treatment engagement. Clients rated several organizational factors including a lack of treatment provision, gender-responsive treatment and infrastructure, and ineffective communication with nonclinical staff as barriers to treatment engagement. Clinical implications include enhancing treatment motivation and counselor rapport, establishing gender-responsive treatment programs, and providing trainings for staff.

Motivations for Treatment Engagement in a Residential Substance Use Disorder Treatment Program: A Qualitative Study

“…A recent qualitative study by Yang et al 6 indicated that a primary predictor of clients' engagement in a short-term inpatient rehabilitation program was their perceived need for treatment-a finding that aligns with a number of quantitative studies [40][41][42] ; the authors further noted that perceived treatment need and motivation for treatment engagement were more pronounced among those whose cumulative life experiences allowed them to appreciate the negative impacts of SUD. 6 Likewise, participants in the present study recounted often lengthy histories of negative consequences associated with SUD, including deteriorating health, fractured relationships, and legal consequences. These accumulated experiences, coupled with previous failed recovery attempts, led participants to perceive their substance use behaviors as being outside of their control and, thus, required formal long-term treatment in order to achieve and maintain sobriety.…”

“…Between 20% and 70% of clients receiving residential substance abuse treatment will dropout before completing it. [3][4][5][6] Among those who complete SUD treatment, an estimated 40% to 60% of them experience a post-treatment relapse. 7 Given the challenges associated with retaining clients in SUD treatment, addressing their biopsychosocial needs (eg, co-occurring disorders, housing, employment, etc.)…”

“…These studies note, for example, that clients' treatment engagement is influenced, in part, by interpersonal relationships with staff members, [17][18][19][20] the availability of tangible resources (eg, birth control, diapers, housing assistance, childcare), 17,18 and clients' internal motivations. 20 A recent qualitative study by Yang et al 6 examined treatment engagement from the perspective of 60 clients receiving SUD treatment in a short-term inpatient facility located in the Southern United States; drawing on semi-structured, one-on-one interviews, authors identified four interconnected factors associated with treatment engagement: (i) perceived treatment needs, (ii) trust and counselor support, (iii) peer inspiration, and (iv) organizational barriers. 6 We build upon and extend this previous work in the present qualitative study by examining SUD treatment engagement from the perspective of 30 clients who were participated in a long-term (ie, 12-month) residential rehabilitation program located in the Mid-South region of the United States.…”

“…20 A recent qualitative study by Yang et al 6 examined treatment engagement from the perspective of 60 clients receiving SUD treatment in a short-term inpatient facility located in the Southern United States; drawing on semi-structured, one-on-one interviews, authors identified four interconnected factors associated with treatment engagement: (i) perceived treatment needs, (ii) trust and counselor support, (iii) peer inspiration, and (iv) organizational barriers. 6 We build upon and extend this previous work in the present qualitative study by examining SUD treatment engagement from the perspective of 30 clients who were participated in a long-term (ie, 12-month) residential rehabilitation program located in the Mid-South region of the United States. Grounded in the framework of the Health Belief Model (HBM), 21,22 the present study addresses the stated need for theoretically-informed qualitative studies that can inform practitioners, researchers, policymakers in their efforts to develop treatment programs designed to address SUD and its associated adverse outcomes in the United States.…”

“…Grounded in the framework of the Health Belief Model (HBM), 21,22 the present study addresses the stated need for theoretically-informed qualitative studies that can inform practitioners, researchers, policymakers in their efforts to develop treatment programs designed to address SUD and its associated adverse outcomes in the United States. 6,[23][24][25] The HBM framework has been applied to many behavioral contexts-including to predict the adoption and maintenance of treatment for a diagnosed illness, adherence to medical treatment, and engagement in preventative health behaviors, such as exercise, health screenings, and vaccinations. [26][27][28] It has also been applied to SUD behaviors, such as alcohol consumption, [29][30][31] illicit drug use, 29,31 and smoking.…”