Examining the Relationship between Treatment Readiness and Substance Use Treatment Initiation and Engagement

Abstract

With nearly 70 percent of the criminal justice population experiencing substance use related issues, treatment is a sound strategy to combat these issues (Chandler, Fletcher, & Volkow, 2009). Despite the promising nature of substance use treatment, roughly 40 percent of individuals terminate treatment within six months of initiating (Joe, Simpson, Dansereau, & Rowan-Szal, 2014). To achieve gains in efforts to use treatment as a tool to address substance abuse needs, it is important to understand the factors that influence positive or negative treatment outcomes. One under researched area is treatment readiness, which is defined as, “the presence of characteristics (states or dispositions) within either the client or the therapeutic situation, which are likely to promote engagement in therapy and which, thereby, are likely to enhance therapeutic change” (Ward, Day, Howells, & Birgden, 2004, p. 650). It is theorized to be important to both initiation and engagement in substance use treatment services, without which it is nearly impossible to complete treatment. Initiation and engagement are referred to as treatment process measures and are important because they are actionable and they help to identify ways to improve substance use services offered to individuals (Horgan & Garnick, 2005). This dissertation examines the impact of treatment readiness on initiation and engagement in substance use treatment programs. Using the transtheoretical model (TTM) of change, this research explores the following general hypotheses: 1) Treatment readiness will significantly predict substance use treatment initiation; 2) Treatment readiness will significantly predict substance use treatment engagement; 3) Treatment readiness will increase the likelihood of initiating substance use treatment, controlling for other relevant factors; and 4) Treatment readiness will increase the likelihood of engaging in substance use treatment, controlling for the other factors. Data for these analyses are derived from the 2012 Substance Abuse and Mental Health Services Administration and the Center for Substance Abuse Treatment (SAMHSA/CSAT) data set (n = 5,443). Stepwise binary logistic regression models were created to identify the factors that affect both treatment initiation and engagement. The findings of this dissertation provide support for the overall effect of treatment readiness on substance use treatment initiation but not engagement. Individuals having support from family and friends are more likely to initiate substance use treatment. Engagement is more likely to occur for those individuals who experience more substance use and have more physical health problems. Treatment readiness is also affected by demographics (e.g., race, gender, age). Treatment readiness significantly predicts initiating but does not predict engaging in substance use treatment. From a policy perspective, interventions should be used to enhance individuals’ levels of treatment readiness before being referred to treatment services thus increasing their likelihood of initiating and engaging in treatment services. Further research is needed in the area of engagement to better understand factors that predict outcomes.