Joe G W, Simpson D D, Broome K M
Institute of Behavioral Research, Texas Christian University, Fort Worth 76129, USA. www.ibr.tcu.edu
Addiction. 1998 Aug;93(8):1177-90. doi: 10.1080/09652149835008.
This study examined client motivation as a predictor of retention and therapeutic engagement across the major types of treatment settings represented in the third national drug abuse treatment outcome study (DATOS) conducted in the United States.
Sequential admissions during 1991-93 to 37 programs provided representative samples of community-based treatment populations. Based on this naturalistic non-experimental evaluation design, hierarchical linear model (HLM) analysis for nested data was used to control for systematic variations in retention rates and client attributes among programs within modalities.
The data were collected from long-term residential (LTR), outpatient methadone (OMT) and outpatient drug-free (ODF) programs located in 11 large cities.
A total of 2265 clients in 18 LTR, 981 clients in 13 OMT and 1791 clients in 16 ODF programs were studied.
Pre-treatment variables included problem recognition and treatment readiness (two stages of motivation), socio-demographic indicators, drug use history and dependence, criminality, co-morbid psychiatric diagnosis and previous treatment. Retention and engagement (based on ratings of client and counselor relationships) served as outcome criteria.
Pre-treatment motivation was related to retention in all three modalities, and the treatment readiness scale was the strongest predictor in LTR and OMT. Higher treatment readiness also was significantly related to early therapeutic engagement in each modality.
Indicators of intrinsic motivation--especially readiness for treatment--were not only significant predictors of engagement and retention, but were more important than socio-demographic, drug use and other background variables. Improved assessments and planning of interventions that focus on stages of readiness for change and recovery should help improve treatment systems.
本研究在美国进行的第三次全国药物滥用治疗结果研究（DATOS）所涵盖的主要治疗环境类型中，考察了服务对象的动机作为留存率和治疗参与度预测指标的情况。
1991年至1993年期间，对37个项目的连续入院情况进行了研究，这些项目提供了基于社区的治疗人群的代表性样本。基于这种自然主义的非实验性评估设计，采用分层线性模型（HLM）对嵌套数据进行分析，以控制不同治疗方式下各项目留存率和服务对象属性的系统差异。
数据收集自位于11个大城市的长期住院治疗（LTR）、门诊美沙酮治疗（OMT）和门诊戒毒治疗（ODF）项目。
对18个LTR项目中的2265名服务对象、13个OMT项目中的981名服务对象和16个ODF项目中的1791名服务对象进行了研究。
治疗前变量包括问题认知和治疗准备度（动机的两个阶段）、社会人口学指标、药物使用史和依赖情况、犯罪情况、共病精神诊断以及既往治疗情况。留存率和参与度（基于服务对象与咨询师关系的评分）作为结果标准。
治疗前动机与所有三种治疗方式下的留存率均相关，治疗准备度量表是LTR和OMT中最强的预测指标。较高的治疗准备度在每种治疗方式中也与早期治疗参与度显著相关。
内在动机指标——尤其是治疗准备度——不仅是参与度和留存率的重要预测指标，而且比社会人口学、药物使用和其他背景变量更重要。改进针对改变和康复准备阶段的评估及干预计划，应有助于改善治疗系统。
