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Dissertation
The effectiveness of perceived coercive and noncoercive pressures to enter methadone maintenance treatment for heroin addiction
Doctor of Philosophy (Ph.D.), Allegheny University of the Health Sciences; Villanova University, School of Law
Dec 1997
DOI:
https://doi.org/10.17918/00008311
Abstract
Coercion has been acknowledged as a common factor affecting clients' decisions to enter addictions treatment. Coercion may be present in many forms, some of which are formal, such as legal mandates from presentence diversion programs, probation, or parole, and some of which are more informal, such as pressure from family members and friends. Until recently, however, relatively little research has examined the effectiveness of either the informal forms of coercion or of other noncoercive pressures. This study examines the relationship between perceptions of both coercive and noncoercive pressures to enter treatment and treatment retention and outcome in participants in an outpatient treatment program for heroin addiction. Perceived pressures to enter treatment are measured using the two available instruments: the Treatment Coercion Interview (TCI), which measures perceived coercive and noncoercive pressures to enter treatment in multiple psychosocial domains (family, social. legal, financial, medical, psychiatric, religious, and drug), and the MacArthur Admission Experience Scale - Short Form (AES), which focuses on perceived coercive pressures exclusively. Substantive analyses indicate that among patients in outpatient methadone maintenance treatment for heroin addiction, coercion represents only a small part of the total range of reported pressures. Furthermore, perceived coercive and noncoercive pressures operate in multiple psychosocial domains, with legal sources of pressure representing a surprisingly small percent of total responses. Comparisons of the two instruments reveal that the TCI's broader definition of perceived pressure allows for greater and more detailed reporting of significant influences experienced by patients than does the AES, which tends to focus primarily on formal, legal coercion. Multiple regression analyses, using counseling session attendance, the number of weeks in treatment, and urinalysis results as criterion measures revealed that perceived pressures in the psychological, financial, and medical domains best predicted successful treatment outcome, and that perceived pressures in the legal domain were only predictive of linger treatment tenure without increased levels of drug sobriety. Additionally, the Voice subscale of the AES was found to be predictive of linger stays in treatment. Finally, exploratory factor analysis utilizing the coded interview answers from the TCI produced four interpretable factors that offer a tentative first look at how the different types of sources perceived pressure to enter treatment may work in concert. These four factors were named Medical Concerns, Financial Concerns, Family Concerns, and Legal Concerns. Implications for future drug treatment policy and other mental health treatment planning are discussed and directions for future research are proposed.
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Details
- Title
- The effectiveness of perceived coercive and noncoercive pressures to enter methadone maintenance treatment for heroin addiction
- Creators
- David J. Glass
- Awarding Institution
- Allegheny University of the Health Sciences; Villanova University, School of Law
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Allegheny University of the Health Sciences; Villanova University, School of Law; Philadelphia, Pennsylvania
- Number of pages
- viii, 107 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Allegheny University of the Health Sciences (1996-1998); Clinical and Health Psychology [Historical]; School of Health Professions (1996-1998)
- Other Identifier
- 991021888757204721