CMT8824 - SECTION 8: ENHANCING MOTIVATION FOR CHANGE
Motivation for Treatment
Seeking help is influenced by the interactive influence of internal and external barriers and incentives. Most treatment personnel emphasize intrinsic motivations for help-seeking under the belief that while extrinsic motivators such as social pressures and legal sanctions can be useful in getting clients to, and keeping them in, treatment, intrinsic factors are commonly considered more significant to the recovery process. People who refuse, do not comply with, or fail in, treatment are often said to be “in denial” and not motivated enough for the treatment to be effective and until that denial is confronted, AOD treatment cannot be successful.
In this set of understandings, there can be a kind of treatment "Catch-22" for individuals in involuntary treatment. Because the individual is thought to be unmotivated to seek treatment on his/her own, mandated treatment is used. However, when the individual enters mandated treatment, he/she is thought to be insufficiently motivated to use the treatment constructively.
This dilemma points us in the direction of our next important area.
At one end of the continuum of motivation for change, there lies “amotivation,” where there is a distinct lack of motivation to engage in new behavior. Many court ordered DOA clients begin their treatment with a relative absence of motivation for real change.
The change process can be entered, however, through “extrinsic motivation,” where behavior change may occur in response to specific environmental contingencies.
Usually, the most effective change is created through autonomous change processes, where behavior change occurs in response to an individual’s self-determined reasons.
Ideal voluntary clients would be people who recognize they have problems they cannot solve, are willing to seek assistance in addressing these problems, and are willing to make whatever changes are necessary. Ambivalence about one or more of these factors can be expected in most counseling situations especially when working with involuntary clients.
In AOD treatment, retention is more or less the outcome. Better retention tends to be associated with better outcomes in terms of reductions in AOD use. In addition, studies show that most individuals who drop out of treatment do so within the first month and dropouts usually seek treatment again.
Most AOD treatment programs do not offer many treatment alternatives. Rather, they tend to offer the same general program for everyone who enters. It is possible that rather than being unmotivated, people may drop out of treatment because - for a variety of reasons - the program is not working for them at that time.
Early attrition may reflect self-selection, where people find themselves in the wrong treatment setting, wrong therapy group, with the wrong therapist, participating in a treatment program that they feel is not oriented to their particular needs. In short - there is not a good "fit". This is confirmed by the fact that treatment drop-outs usually seek treatment again somewhere else.
It is increasingly becoming clear that retention in treatment is dependent on a combination of factors including program, therapist, and client characteristics and these variables need to be addressed in any type of treatment, perhaps taking into consideration the items listed on the following pages that help determine the "fit" of the program.
Is the program short-term or long-term - based upon needs of clients?
Is the program set up to be culturally sensitive to needs of clients?
Does the program have flexibility in its schedule to accommodate scheduling needs of clients' work and home life?
Does the program address relevant psychosocial or medical issues in addition to the substance abuse problems?
Does the program offer a variety of approaches to substance abuse problems, with flexibility in designing individualized treatment plans?
Does the program offer flexibility in terms of fees and payment, so that the program will be affordable?
Are the clinicians who provide services skilled, experienced and knowledgeable in providing substance abuse treatment and in handling problems with resistance and lack of motivation?
Are the clinicians culturally sensitive in their approaches?
Are the clinicians able to demonstrate flexibility in their approaches to handle the changing circumstances and treatment needs of the clients?
Do the clinicians have skills, knowledge and experience in handling relevant psychosocial or medical issues in addition to the substance abuse problems?
Do the clinicians in the treatment team work well collaboratively, supporting one another in following the treatment plan?
Does the client have long-standing or severe substance abuse problems that may require more intensive or long-term treatment?
Does the client have other significant dual-diagnosis treatment issues that require specific program needs?
Does the client have work and/or home issues that may interfere with the course of treatment, such as the presence of severe triggers?
Does the client have any medical issues that may affect treatment or the maintenance of sobriety?
Does the client have any cultural or disability issues that may create barriers to treatment?
Treatment personnel need to find ways to get people into treatment earlier, keep them in treatment longer, and have better outcomes.
One very productive approach involves a capacity to assess the level of client motivation. Like many other processes, there are different “stages of change” in this area. We will next turn our attention to a detailed analysis of this topic.
Review Questions Section VIII
What factors determine if a program is a good “fit” with a DOA patient?
Is it true or false that most clients who drop out of a treatment setting usually seek treatment somewhere else?