EFFECTS OF READINESS FOR DRUG-ABUSE TREATMENT ON CLIENT RETENTION ANDASSESSMENT OF PROCESS

This study examined client motivation as a predictor of retention and therapeutic engagement across the major types of treatment settings re presented in the third national drug abuse treatment outcome study (DA TOS) conducted in the United States. Design. Sequential admissions dur ing 1991-93 to 37 programs provided representative samples of communit y-based treatment populations. Based on this naturalistic non-experime ntal evaluation design, hierarchical linear model (HLM) analysis for n ested data was used to control for systematic variations in retention rates and client attributes among programs within modalities. Setting. The data were collected from long-term residential (LTR), outpatient methadone (OMT) and outpatient drug-free (ODF) programs located in II large cities. Participants. A total of 2265 clients in 18 LTR, 981 cli ents in 13 OMT and 1791 clients in 16 ODF programs were studied. Measu rements. Pre-treatment variables included problem recognition and trea tment readiness (two stages of motivation), socio-demographic indicato rs, drug use history and dependence, criminality, co-morbid psychiatri c diagnosis and previous treatment. Retention and engagement (based on ratings of client and counselor relationships) served as outcome crit eria. Findings. Pre-treatment motivation was related to retention in a ll three modalities, and the treatment readiness scale was the stronge st predictor in LTR and OMT. Higher treatment readiness also was signi ficantly related to early therapeutic engagement in each modality. Con clusions. Indicators of intrinsic motivation-especially readiness for treatment-were not only significant predictors of engagement and reten tion, but were more important than socio-demographic, drug use and oth er background variables. Improved assessments and planning of interven tions that focus on stages of readiness for change and recovery should help improve treatment systems.