The ethics and utility of forcing individuals to receive substance abuse or mental health services is the topic of heated debate. Research in the area generally has been confined to uncontrolled trials in narrow legal contexts, such as court-ordered treatment or involuntary civil commitment. Findings from the drug treatment literature suggest, however, that there is no rational basis for focusing predominantly on legal sources of coercion and compulsion because: a) state agency mandates are frequently ineffective; b) data indicate that coercion and compulsion are operative in multiple psychosocial domains; and c) the most influential pressures operate in informal, extra-legal spheres. Some studies suggest that these informal pressures can be successfully leveraged in favor of mutually agreed-upon treatment goals. This revised application outlines preliminary research examining coercive and noncoercive factors in treatment entry. We have specified clear operational formulations of coercion, compulsion, and noncoercion through established behavioral principles; devised reliable assessment procedures for these constructs; and estimated levels and types of coercive and noncoercive pressures in drug-free outpatient cocaine treatment. The revised proposal will examine: 1) perceptions of coercion, compulsion, and noncoercive pressures across diverse drug treatment programs; 2) perceptions of these constructs between gender and racial groups; 3) patient and therapist vantages on these pressures. We will also examine the relationship of these pressures to 4) treatment tenure, compliance, and outcome; 5) subjects motivation for change; and 6) loci of control. Three hundred subjects at five different treatment sites will be interviewed on perceived coercive and noncoercive pressures to treatment, and will complete stages-of-change and locus-of-control questionnaires. Patients perceptions of coercions and noncoercion will be compared with those of their primary therapists; related to therapists global ratings of tenure, compliance, and outcome; and stage-of-change and locus-of-control data. The results will have important implications for social policies governing legal mandates to drug treatment and development of ethical and practice guidelines for the field. Understanding factors influencing treatment outcomes will also assist in tailoring more effective clinical interventions.
| Marlowe, D B; Merikle, E P; Kirby, K C et al. (2001) Multidimensional assessment of perceived treatment-entry pressures among substance abusers. Psychol Addict Behav 15:97-108 |
