Motivation and Readiness for Therapeutic Community Treatment among Adolescents and Adult Substance Abusers

Abstract

A growing body of research has demonstrated the importance of motivation and readiness among drug abusers in seeking, complying with, and remaining in treatment. To date, however, there is little research on these factors among adolescent substance abusers. The present study reports findings from a large scale investigation of motivation and readiness differences across adolescent (range = 14-18 years, n > 1000) and adult (range = 19-26 + years, n > 1400) admissions to residential therapeutic communities (TCs). Data were collected with an instrument assessing circumstances, motivation, readiness, and suitability for TC treatment (i.e., CMRS). Results showed that: (1) there is a significant positive linear relationship between CMRS scores and age; (2) the CMRS scores were the largest and most consistent predictors of short term retention across all age groups. Although confined to TC samples, the present findings support clinical observations that adolescent drug abusers are less motivated to change or ready for treatment than adults; and they confirm the importance of motivational and readiness factors in the treatment process, regardless of age.

Reasons for Quitting Among Emerging Adults and Adolescents in Substance-Use-Disorder Treatment

“…First, we found no significant differences on overall reasons for quitting between emerging adults and adolescents, and with the exception of the interpersonal motivation items, few differences existed at the item level when controlling for baseline differences between age cohorts. This runs counterintuitive to previous findings from other studies showing associations between age and treatment readiness, and we think this is likely because of the far greater variation in age in those studies (Melnick et al, 1997;Satre et al, 2003). However, adolescents and emerging adults endorsed, on average, nearly half of all forced-choice reasons for quitting that were presented to them.…”

“…Studies have consistently shown an association between age and readiness for change, which is hypothesized to be the result of a longer substance-use history that results in increasingly more consequences (DiClemente et al, 2009;Handelsman et al, 2005;Melnick et al, 1997). Thus, although it has never been examined, it seems logical that emerging adults should, on average, endorse more overall reasons for quitting compared with younger adolescents.…”

“…Rather than using stage-based categorizations, large adolescent and emerging adult studies have also measured readiness for change by focusing on external pressure to make changes, the attractiveness of the intervention(s) being offered, and outside obligations and influences that may prevent an individual from entering treatment (De Leon et al, 1994;Melnick et al, 1997). Melnick et al (1997) reported an inverse relationship between age and readiness for change among those in therapeutic communities.…”

“…Rather than using stage-based categorizations, large adolescent and emerging adult studies have also measured readiness for change by focusing on external pressure to make changes, the attractiveness of the intervention(s) being offered, and outside obligations and influences that may prevent an individual from entering treatment (De Leon et al, 1994;Melnick et al, 1997). Melnick et al (1997) reported an inverse relationship between age and readiness for change among those in therapeutic communities. Broome et al (2001) modified De Leon's Circumstances, Motivation, Readiness and Suitability (or CMRS) scale for adolescents in the Drug Abuse Treatment Outcome Study-A (or DATOS-A) research and showed that readiness predicts treatment engagement.…”

“…Specialty sector-provided treatments are grossly underutilized, and a major reason for this is the perception by those with alcohol-and drug-use problems that treatment is unnecessary (Grant, 1997). Studies have shown that both motivation for treatment and readiness for change wane with increasing age (DiClemente et al, 2009;Handelsman et al, 2005;Melnick et al, 1997), but no study has had a large enough sample of adolescents and young adults to examine age differences in specific reasons for quitting. Such knowledge could assist practitioners in refining clinical engagement strategies, because treatment entry remains low even among youth presenting for assessment (Smith et al, 2009).…”