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What have we learned to this point about involuntary DOA treatment?

There are roles for all parties involved in involuntary DOA treatment: the client, the clinician, the workplace and the court system.

There are special complications in providing involuntary treatment services to DOA clients, which can include managing both treatment and policing roles.

There are important knowledge bases that must be known by the treatment provider, including special issues related to confidentiality.

There is a five-stage model of therapeutic change related to DOA treatment that has important considerations for choices in timing and intervention on the part of the treatment provider.

Earlier in our training, we discussed the system of treatment as consisting of the client, the clinician and the referring party (the workplace or the court system). In an optimal situation, all of these parties would work together to produce a common result: the client achieving and maintaining sobriety.

In a very real way, the client's position within the five-stage model of change has a very important role in determining the effectiveness or failure of the decisions made by all parties involved in involuntary treatment. Analysis of this factor will help us to pull together much of the important information in this training.

Both the referring party and the treatment providers are in the position of needing to utilize their treatment and sanctioning capacities to help the client's success in overcoming his/her DOA problems. The mission, in other words, is to create systems of support that will be successful in creating sobriety.

The client's receptiveness to efforts to create change, however, is the single greatest determinant of the degree to which the systems of support will be successful in achieving sobriety. This is the factor of motivational congruence we discussed earlier in this training. This receptiveness, to a significant degree, will be based upon where the client resides in the stages of change.

Yet neither the court system nor the workplace has necessarily integrated this key knowledge element into their decisions about interventions and approaches to DOA abusers.

Many court systems and workplaces will utilize the same intervention approaches - regardless of what stage of change the offender or employee is at. The client may be referred to the same "one size fits all" treatment program - whether he/she is in the precontemplation stage or in the action stage. Clearly, this factor may explain to some degree the great variability in success rates that is found in mandated DOA treatment.

To reiterate a point made earlier in this training, a key element of the success of treatment approaches to mandated DOA clients is the flexibility of the program in providing a wide range of services - working with an understanding of our principle of motivational congruence.

One final note: the research shows whether a person comes to treatment on a voluntary or involuntary basis is not necessarily significant. What is significant is the skill of treatment personnel in assessing people’s motivation for change - including where they are in the stages of change - and utilizing in a flexible manner a range of knowledge and techniques to meet the client's needs.

It is our hope that this program has contributed to the trainee's body of knowledge in a way will aid in this process.

This completes our course material. We will have two additional sections prior to moving to our course test material. The first will be an addendum of materials supporting the information in this course. The second will be our course bibliography. All of this information is provided on pages that are easily printable.