Motivation for change has received extensive attention in the alcohol and drug literature. However, most studies have found only modest associations between motivation and outcome. One limitation of most studies is motivation is measured 0nly at treatment entry (i.e., baseline) and assessed in terms of predicting subsequent alcohol and drug use. There are a number of shortcomings to this approach. First, little is known about the impact of motivation when it is more proximal to assessments of outcome (i.e., measured at follow up time points). Second, little is known about how motivation can change over time and when its impact might be strongest. Third, motivation at treatment entry is conceptualized in terms of a desire to change or eliminate alcohol and drug use. Motivation to maintain abstinence or reduced use of substances is therefore ignored. Fourth, little is known about the circumstances of when motivation impacts alcohol and drug use outcome (i.e., moderators). Finally, motivation has typically been studied within the context of formal treatment programs. However, the field is increasingly conceptualizing serious addictive disorders as chronic diseases that require ongoing monitoring. Assessing motivation over time and outside the context of formal treatment is therefore increasingly important. This application addresses these shortcomings by studying how motivation to maintain sobriety is associated with abstinence and reduced substance use over 18 months. Rather than yet another study of motivation within a formal treatment program, this application proposes to study it among a population of individuals entering sober living recovery homes. Hypotheses suggest 1) motivation will be associated with alcohol and drug use within and across time points and 2) moderators of the impact of motivation on alcohol and drug use will include measures of supportive confrontation and drinking and drug use in the social network. The study will consist of a secondary analysis of data from two previous grants, "An Evaluation of Sober Living Houses" (R01 AA014030) (N=323), and "Measuring Confrontation during Recovery" (R21 DA023677). Both studies tracked outcomes of Sober Living House (SLH) residents (N=323) at entry into the house and 6-, 12-, and 18-month follow up. Longitudinal improvements were noted in multiple areas of functioning, including alcohol and drug use, arrests, employment, and psychiatric severity. At 18 months, over 42% had been completely abstinent from substances for at least 6 months even though nearly all had left the sober living houses. Findings from the study will add substantively to our knowledge about how motivation impacts the recovery process over time in the community. Findings will also inform a new intervention in the early stages of development that is designed to help sustain long term recovery, motivational interviewing case management. Key informant interviews will add SLH provider and consumer perspectives on study findings and contribute to the development of guidelines for increasing and sustaining motivation among SLH residents.
Study findings will illustrate when and how motivation influences alcohol and drug outcome. Public policy makers and a wide variety of service providers will be able to use this information to maximize long term recovery in community settings. Practical implications for public health include: a) development of guidelines for how operators of SLHs can increase social support and maximize motivation to maintain long term, sustained abstinence, b) improved management of substance abuse disorders in other settings, such as case managers working with pervasive and persistent co-occurring addiction and mental health disorders in outpatient mental health settings, and c) informed development of a novel, long-term motivational interviewing/case management (MICM) intervention for individuals in SLHs and similar settings.