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National Institute on Drug Abuse

Behavioral Therapies Development Program


Drug Abuse Treatment Entry and Engagement: Report of a Meeting on Treatment Readiness

December 3-4, 1997


While the effectiveness of drug abuse treatment has been demonstrated repeatedly, many drug abusers do not enter treatment or leave prematurely, and relapse following treatment is common. To further research on treatment entry and engagement, the National Institute on Drug Abuse convened a scientific meeting in December 1996. Presentations focused on treatment readiness/motivation for change, ethnographic reports of drug abusers' perceptions of and attitudes toward treatment, and reports on alternative treatments for high-risk drug abusers.

Preliminary ethnographic investigations reported at the meeting revealed considerable diversity among drug abusers in their attitudes toward treatment and readiness for making changes in their drug-using lifestyles and for engaging in treatment. A substantial number of drug abusers were ambivalent about changing their lives and about entering and/or engaging in treatment. Many drug abusers perceived some benefits of treatment, but they also perceived considerable barriers. Potential benefits often come with considerable cost, and, for many of these drug abusers, the perceived barriers outweighed the potential benefits.

Shifting the balance of costs and benefits of treatment, perceived and real, requires motivating both the drug abuser and the program to engage in a dynamic recovery process that encourages a partnership where the consumer-patient is an active planner in his or her recovery. A consistent message throughout the meeting was the need for practitioners and researchers to focus more clearly on the needs of the patient as perceived by the patient. Working with patients to achieve their goals can have a positive impact on increasing retention in treatment and a sense that treatment can have a positive impact. Inadequate services and lengthy waiting periods were seen as a serious barriers to engagement of these multi-problem patients.

Research priorities that emerged from the meeting discussion included the following: (1) use of qualitative research methods both independently and in conjunction with quantitative investigations, focusing on factors that facilitate and hinder treatment entry, recruitment into treatment, treatment engagement, lapses and relapses to drug use, treatment termination, and readmission; (2) the life course of addiction, including drug abusers with various treatment experiences; (3) treatment need, availability, and services provided by the existing treatment system, and on how organizational structures and management practices impact attracting and engaging high-risk patients; (4) motivation and readiness, including development of assessment techniques and recruitment strategies and treatment interventions appropriate to various motivations and goals; (5) the effects of rules and enforcement strategies on various target groups, assessment of alternative sanctions and enforcement strategies that encourage successive approximations of treatment goals; (6) development of comprehensive, multi-component interventions that link community resources with drug abuse treatment; (7) for drug abusers who seek to reduce their drug use, rather than achieve long term abstinence, development of interventions that target intermediate treatment goals, contributing to reduction in use and its negative consequences, particularly HIV risk behaviors, and to eventual abstinence; (8) qualitative research to clarify the role of social networks in addiction and recovery and development of interventions to address the influence of social networks; (9) given the important role of the criminal justice system in treatment entry and continuation, research on criminal justice-based treatment and treatment linkages.

[Behavioral Therapies Development Program Index]

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