Readiness to change among involuntarily and voluntarily admitted patients with substance use disorders

Anne Opsal, Øistein Kristensen, Thomas Clausen, Anne Opsal, Øistein Kristensen, Thomas Clausen

Abstract

Background: Health care workers in the addiction field have long emphasised the importance of a patient's motivation on the outcome of treatments for substance use disorders (SUDs). Many patients entering treatment are not yet ready to make the changes required for recovery and are often unprepared or sometimes unwilling to modify their behaviour. The present study compared stages of readiness to change and readiness to seek help among patients with SUDs involuntarily and voluntarily admitted to treatment to investigate whether changes in the stages of readiness at admission predict drug control outcomes at follow-up.

Methods: This prospective study included 65 involuntarily and 137 voluntarily admitted patients treated in three addiction centres in Southern Norway. Patients were evaluated using the Europ-ASI, Readiness to Change Questionnaire (RTCQ), and Treatment Readiness Tool (TReaT).

Results: The involuntarily admitted patients had significantly lower levels of motivation to change than the voluntarily admitted patients at the time of admission (39% vs. 59%). The majority of both involuntarily and voluntarily admitted patients were in the highest stage (preparation) for readiness to seek help at admission and continued to be in this stage at discharge. The stage of readiness to change at admission did not predict abstinence at follow-up. The only significant predictor of ongoing drug use at 6 months was SUD severity at baseline.

Conclusions: The majority of involuntarily admitted patients scored high on motivation to seek help. Their motivation was stable at a fairly high level during their stay, and even improved in some patients. Thus, they were approaching the motivation stage similar to the voluntarily admitted patients at the end of hospitalization. Therapists should focus on both motivating patients in treatment and adapting the treatment according to SUD severity.

Trial registration: ClinicalTrials.gov, NCT00970372. Registered 1 September 2008, https://ichgcp.net/clinical-trials-registry/NCT00970372. The trial was registered before the first participant was enrolled. The fist participant was enrolled September 02, 2009.

Keywords: Involuntary admission to treatment; Substance use disorder; Treatment motivation.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Modified Transtheoretical (Stages of Change) Model based on the theory that individuals follow a circular rather than linear path as they flow through a series of stages to modify behaviour (Modified from the work of Prochaska and DiClemente)
Fig. 2
Fig. 2
Percentage of patients admitted to the hospital based on stage of Readiness to Change
Fig. 3
Fig. 3
Changes in Treatment Readiness Tool (TReaT) stage from admission to discharge from addiction treatment centres. a Involuntarily admitted patients (n = 45). b Voluntarily admitted patients (n = 108). Unchanged stage: Yellow, changed to lower stage: Red, changed to higher stage: Green

References

    1. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol. 1992;47(9):1102–1114. doi: 10.1037/0003-066X.47.9.1102.
    1. Gregoire TK, Burke AC. The relationship of legal coercion to readiness to change among adults with alcohol and other drug problems. J Subst Abus Treat. 2004;26(1):337–343. doi: 10.1016/S0740-5472(03)00155-7.
    1. Heather N, Rollnick S, Bell A. Predictive validity of the readiness to change questionnaire. Addiction. 1993;88(12):1667–1677. doi: 10.1111/j.1360-0443.1993.tb02042.x.
    1. Rollnick S, Heather N, Gold R, Hall W. Development of a short 'readiness to change' questionnaire for use in brief, opportunistic interventions among excessive drinkers. Br J Addict. 1992;87(5):743–754. doi: 10.1111/j.1360-0443.1992.tb02720.x.
    1. Israelsson M, Gerdner A. Compulsory comittment to care of substance misusers: a worldwide comparative analysis of the legislation. Open Addiction J. 2010;3:117–130. doi: 10.2174/1874941001003010117.
    1. Israelsson M. Welfare, temperance, and compulsory commitment to care for persons with substance misuse problems: a comparative study of 38 European countries. Eur Addict Res. 2011;17:329–341. doi: 10.1159/000331003.
    1. Urbanoski KA. Coerced addiction treatment: client perspectives and the implications of their neglect. Harm Reduct J. 2010;7:1–10. doi: 10.1186/1477-7517-7-13.
    1. Wild TC, Newton-Taylor B, Alletto R. Perceived coercion among clients entering substance abuse treatment: structural and psychological determinants. Addict Behav. 1998;23(1):81–95. doi: 10.1016/S0306-4603(97)00034-8.
    1. LOV 2011-06-24 nr 30: Lov om kommunale helse- og omsorgstjenester m.m. [Helse- og omsorgstjenesteloven], [The Act of public health and care services] [].
    1. Nilssen E. Coercion and justice: a critical analysis of compulsory intervention towards adult substance abusers in Scandinavian social law. Int J Soc Welf. 2005;14(2):134–144. doi: 10.1111/j.1369-6866.2005.00350.x.
    1. Tvångsvård vid missbruk - effekt och kvalitet (Review on compulsory care for substance misuse – Effect and quality) [].
    1. Klag S, O'Callaghan F, Creed P. The use of legal coercion in the treatment of substance abusers: an overview and critical analysis of thirty years of research. Subst Use Misuse. 2005;40(12):1777–1795. doi: 10.1080/10826080500260891.
    1. Pasareanu AR, Vederhus JK, Opsal A, Kristensen O, Clausen T. Improved drug-use patterns at 6 months post-discharge from inpatient substance use disorder treatment: results from compulsorily and voluntarily admitted patients. BMC Health Serv Res. 2016;16(1):291. doi: 10.1186/s12913-016-1548-6.
    1. Burke AC, Gregoire TK. Substance abuse treatment outcomes for coerced and noncoerced clients. Health Soc Work. 2007;32(1):7–15. doi: 10.1093/hsw/32.1.7.
    1. Opsal A, Kristensen O, Larsen TK, Syversen G, Rudshaug EB, Gerdner A, Clausen T. Factors associated with involuntary admissions among patients with substance use disorders and comorbidity: a cross-sectional study. BMC Health Serv Res. 2013;13:57. doi: 10.1186/1472-6963-13-57.
    1. Janca A, Ustun TB, Early TS, Sartorius N. The ICD-10 symptom checklist: a companion to the ICD-10 classification of mental and behavioural disorders. Soc Psychiatry Psychiatr Epidemiol. 1993;28(5):239–242.
    1. Kokkevi A, Hartgers C. European addiction severity index EuropASI. Zürich: EuropASI Working Group Cost A6; 1994.
    1. Heather N, Rollnick S: Readiness to change questionnaire: user’s manual (revised version). In: Technical Report No 19. 1993.
    1. Freyer J, Tonigan JS, Keller S, John U, Rumpf HJ, Hapke U. Readiness to change versus readiness to seek help for alcohol problems: the development of the treatment readiness tool (TReaT) J Stud Alcohol. 2004;65(6):801–809. doi: 10.15288/jsa.2004.65.801.
    1. Newcombe R, Altman D: Proportions and their differences. In: Statistics with Confidence: Confidence Intervals and Statistical Guidelines, 2nd Edition. edn. Edited by Altman D, Machin D, Bryant T, Gardner M: BMJ Books; 2000: 45–56.
    1. Altman DG. Practical statistics for medical research. London: Chapman & Hall/CRC; 1991.
    1. Siegel S, Castellan NJ: Nonparametric statistics for the behavioral sciences. 2nd ed. New York: Mcgraw-Hill Book Company; 1988.
    1. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–112. doi: 10.1016/j.nedt.2003.10.001.
    1. Shaffer HJ, Simoneau G. Reducing resistance and denial by exercising ambivalence during the treatment of addiction. J Subst Abus Treat. 2001;20(1):99–105. doi: 10.1016/S0740-5472(00)00152-5.
    1. Freyer-Adam J, Coder B, Ottersbach C, Tonigan JS, Rumpf HJ, John U, Hapke U. The performance of two motivation measures and outcome after alcohol detoxification. Alcohol Alcohol. 2009;44(1):77–83. doi: 10.1093/alcalc/agn088.
    1. Freyer J, Tonigan JS, Keller S, Rumpf HJ, John U, Hapke U. Readiness for change and readiness for help-seeking: a composite assessment of client motivation. Alcohol Alcohol. 2005;40(6):540–544. doi: 10.1093/alcalc/agh195.
    1. Johnson V. Intervention: how to help someone who doesn't want help. Minneapolis: Johnson Institute Books; 1986.
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. doi: 10.1186/1748-5908-6-42.
    1. SOU: LVM-utredningens betänkande . "Tvång och förändring". In: Socialdepartementet. Edited by change. GrCa. Stockholm: Ministry of Health and Social Affairs; 2004.
    1. Meyers B, van der Westhuizen C, Naledi T, Stein D, Sorsdahl K. Readiness to change is a predictor of reduced substance use involvement: findings from a randomized controlled trial of patients attending south African emergency departments. BMC Psychiatry. 2016.
    1. Lundeberg I, Mjåland K, Søvig K. Tvang i rusfeltet - Regelverk, praksis og. erfaringer med tvang. Oslo: Gyldendal Juridisk; 2014.
    1. Pasareanu AR, Opsal A, Vederhus JK, Kristensen O, Clausen T. Quality of life improved following in-patient substance use disorder treatment. Health Qual Life Outcomes. 2015;13(1):35. doi: 10.1186/s12955-015-0231-7.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir