What motivates individuals to seek help for alcohol or drug problems? What expectations do they have upon entering treatment? Exactly what do patients do during the course of treatment and how helpful do they think these activities and experiences are? When they are discharged, what do patients say they got out of treatment, and how do they assess their own ability to implement the process of recovery initiated by the inpatient stay? This series of interrelated questions is the focus of this grant. The overarching objective is to examine the structural components of the treatment process and to determine how they interact with individual characteristics. Specific attention will be focused on clinical indicators and such cognitive mediators as motivation for seeking help, treatment expectations, perceived effort and involvement in the treatment process, and self-efficacy assessments as they pertain to the capability to maintain recovery. The sample will consist of approximately 700 alcohol and other drug abusing inpatients (70% alcohol dependent; 40% females) undergoing treatment in a standard 3-5 week abstinence-based, AA-oriented treatment program predicated on the disease model of alcoholism. A comprehensive set of instruments will be used to collect socio-demographic, cognitive, personality and psychological symptom measures in addition to complete descriptive information about alcohol and other drug use. Newly developed instruments will be employed to track the structural components of service delivery, to measure treatment expectations, and to assess the perceived impact of services. Particular emphasis will be placed on the predictive power of these elements as they relate to confidence in the ability to abstain from use.
