Assessment of coercive and noncoercive pressures to enter drug abuse treatment

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Abstract

This paper reports preliminary data derived from a standardized interview scoring procedure for detecting and characterizing coercive and noncoercive pressures to enter substance abuse treatment. Coercive and noncoercive pressures stemming from multiple psychosocial domains are operationalized through recourse to established behavioral principles. Inter-rater reliability for the scoring procedure was exceptional over numerous rater trials. Substantive analyses indicate that, among clients in outpatient cocaine treatment, ‘coercion’ is operative in multiple psychosocial domains, and that subjects perceive legal pressures as exerting substantially less influence over their decisions to enter treatment than informal psychosocial pressures. Implications for drug treatment planning, legal and ethical issues, and directions for future research are proposed.

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      Social pressure in the context of substance use treatment is defined as confrontation from members of one's social environment regarding the negative aspects of one's substance use and the need for treatment. Early studies on social pressure examined mandated forms of social controls (e.g., court order, welfare conditions) (Wild et al. 2006; Polcin & Beattie, 2007); however, recent research has recognized that informal social pressures also have a strong impact on treatment processes (Marlowe et al. 1996; Marlowe, Merikle, Kimberly, Festinger, & McLellan, 2001). In many cases, individuals in treatment for substance disorders have identified these types of pressure as being more influential than formally mandated social controls (Marlowe et al. 1996; Polcin & Weisner, 1999).

    • Outcomes of mandated treatment for women with histories of abuse and co-occurring disorders

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      A study of people addicted to alcohol found that most ultimatums were not associated with high levels of alcohol severity (Polcin, 1999). In a study of 260 clients in an outpatient cocaine treatment setting (Marlowe et al., 1996), 25% were referred to treatment by government agencies (courts, child protective services), but only 3% of the reasons offered for entering drug treatment reflected legal pressures or influences. Clients were found to be partially motivated by internal pressures, such as negative affect and a desire to improve themselves, undermining the common assumption that people with addictions lack internal motivation.

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      Most importantly, the present approach to the measurement of coercion is the narrow conceptualization. Specifically, it is regarded as a function of legal involvement rather than one type of a broader set of diverse social pressures (Marlowe et al., 1996; Wild, 2006). The study findings also need to be considered in the context of how treatment dropout was measured.

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