Cam Wild, professor

Health services practitioners and researchers typically assume that people receiving treatment for addictions seek help voluntarily because they have concerns about their health. However, in addiction treatment, this is only partly true, notes Dr. Cameron Wild, director of the Addiction and Mental Health Research Laboratory (AMHRL) at the University of Alberta. “Increasingly, societies around the world use ‘social controls’ to pressure, persuade, or coerce people to seek addiction treatment. These social control tactics include court orders, mandatory treatment referrals by employers, and ultimatums issued by friends and family. Although these tactics are commonly used, we don’t know much about their impact on the effectiveness of addiction treatment.”

From 2008 to 2011, Dr. Wild, his team at the AMHRL, and colleagues from the Centre for Addiction and Mental Health in Ontario launched a series of projects to fill in some of the knowledge gaps around social controls. One of the projects explored the relationship between drop-out rates and engagement in addiction treatment. About half of all people who enter addiction treatment drop out before the program ends, regardless of whether they enrolled voluntarily or involuntarily. This project, which was funded by the Canadian Institutes for Health Research, tracked more than 350 clients as they entered selected addiction treatment programs in Ontario and Alberta and followed them for six weeks. The team measured the treatment motivation of these clients using a specially developed questionnaire to determine why they were in the addiction program. Motivations can range from “I’m here because I want to make a change in my life” (a type of motivation called identified motivation) to “I’m here because someone made me get help” (external motivation).

Preliminary results support Dr. Wild’s previous research, which showed that the referral source doesn’t predict the outcome of treatment. For example, when the team looked at clients required by the legal system to enter a program, the deciding factor for retention was the client’s motivation for treatment. Some clients welcome the use of social control because they are ready to commit to treatment—these clients have low drop-out rates. For others, the situation is the opposite. They see the use of social control as a coercive imposition and are more likely to drop out of treatment. If the motivation isn’t there, positive outcomes are much less likely—even if the justice system says clients have to be in treatment.

The results suggest that better outcomes may be possible by using the motivational questionnaire as part of routine assessment procedures when clients enter treatment. “Externally motivated clients can be helped with an intervention to transform the feeling ‘I’m here because I’m under someone’s thumb’ to a feeling that they can truly benefit from treatment,” says Dr. Wild. “There are well-established interventions for helping people achieve this transformation, and so systematically assessing treatment motivation holds potential to improve retention and ultimately client outcomes.”

Material reprinted with the express permission of Research News (spring 2012 issue), a publication of Alberta Innovates - Health Solutions. Photos by Laughing Dog Photography.