Motivations for Treatment Engagement in a Residential Substance Use Disorder Treatment Program: A Qualitative Study

Abstract

Aims: The aim of this study was to explore perspectives on motivations for treatment engagement from substance use disorder (SUD) clients in a long-term residential rehabilitation program. Design and Methods: A convenience sample of 30 clients who were enrolled in a year-long SUD treatment program at a residential rehabilitation facility took part in in-depth interviews. Interview transcripts were analyzed using the directed content analysis approach. Results: Participant accounts indicated that their treatment engagement was motivated by factors that aligned with the six primary constructs of the Health Belief Model: (i) perceived susceptibility (eg, believing that their substance use required intervention and that they were prone to relapse), (ii) perceived severity (eg, substance use negatively impacted their health and harmed their close relationships), (iii) perceived benefits (eg, opportunities for a better life, reconnecting with family members and close friends, & avoiding legal consequences), (iv) perceived barriers (eg, the length of the treatment program), (v) cues to actions (eg, decisive moments, elements of the treatment program, & faith and spirituality), and (vi) self-efficacy in remaining abstinent (eg, treatment program provided them with skills and experiences to maintain long-term sobriety). Discussion: Our analysis indicates that participants’ treatment engagement was linked to their beliefs regarding the severity of their substance use disorder, their treatment program’s ability to help them avoid future relapse, and their own capability to act upon the strategies and resources provided by the treatment program. A theoretical understanding of these aspects can contribute to the future planning of precision interventions.

A realist review of residential treatment for adults with substance use disorder

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When men living with dual diagnosis (substance use and mental health disorder) [C] experienced activities as meaningful (contributing to feelings of improved quality of life or wellness) [M‐resources] , they believed those experiences connected them with others or to purpose in life [M‐reasoning] leading to a new identity [O] and to harm reduction [O] .

A sense of isolation from others [C] prevents the above mechanism from activating .

Skills were resources when used in activities that residents with a dual diagnosis found meaningful (e.g., had a positive effect on their quality of life) [54] and when the residents believed the skills would provide treatment benefits [44, 53]. Residents reasoned that using skills in meaningful activities meant they had re‐gained a purpose in life [54], or they could see how using the skills linked to a goal (e.g., re‐connecting to family) [44], or facilitated connectedness with others in the treatment program [53].…”

“…Skills were resources when used in activities that residents with a dual diagnosis found meaningful (e.g., had a positive effect on their quality of life) [54] and when the residents believed the skills would provide treatment benefits [44,53]. Residents reasoned that using skills in meaningful activities meant they had re-gained There appear to be some analytical leaps between the data provided and the conclusions drawn.…”

Perspectives on Motivation and Change in an Intervention for Men Who Use Substances and Perpetrate Intimate Partner Abuse: Findings From a Qualitative Evaluation of the Advance Intervention

“…Echoing previous research ( Dillon et al, 2020 ; Holtrop et al, 2017 ; Sotskova et al, 2016 ) men talked about the importance of the relationships they built with facilitators and peers, which they felt were safe, supportive, and nonjudgemental. These factors were especially important in our population since men were discussing two behaviors that are stigmatizing.…”

“…Some of these men reportedly simulated rather than truly experienced change ( McGinn et al, 2020 ). Intrinsic and existential motivation—for example, desire to have better health and a better life, rather than extrinsic motivation—for example, wanting to avoid jail—has also been linked to substance use treatment engagement ( Dillon et al, 2020 ; Yang et al, 2018 ).…”

“…Therapeutic alliance with program facilitators has been reported as another important factor in the change process in IPA and substance use interventions ( Dillon et al, 2020 ; Holtrop et al, 2017 ; Sotskova et al, 2016 ) and lack of alliance a major reason for attrition ( Palmer et al, 2009 ). Notably, from substance use research, clients and service staff have said that the substance service’s ability to meet holistic needs such as mental health, physical health, and family violence is key in engaging clients and motivating them to continue treatment ( Browne et al, 2016 ; Dillon et al, 2020 ). Group cohesion and group dynamics can also be a factor in eliciting change.…”