The relationship among stages of change, attitude towards treatment, and treatment investment in court-mandated outpatient substance abusers

This study examined whether differences in commitment to sobriety, conceptualized in terms of Prochaska\u27s stages of change, and attitude towards treatment exist between legally coerced and non-legally coerced substance abuse outpatients at intake, whether that commitment and attitude change over the course of treatment, and whether measures of commitment and attitude are related to other measures of treatment participation and outcome.^ Thirty-eight outpatients in substance abuse treatment at a semi-rural clinic were assessed. Consistent with earlier research, no significant differences were found between court and non-court mandated clients for the variables of number of sessions, length of time in treatment, or staff outcome ratings, suggesting that mandated clients are likely to participate in treatment to the same extent as so-called voluntary referrals. Significant differences were found between the two groups at intake and discharge on a global therapist rating of stage of change, a brief rating method designed for this study based upon the University of Rhode Island Change Assessment Scale (URICA). Court mandated clients tended to enter treatment at a significantly earlier stage in the change process than non-court mandated, and this difference remained present at discharge despite equivalent progress to a later stage of change by both groups over the course of treatment. The failure to find similar differences using a staging algorithm is discussed.^ This research suggests that a global therapist rating of stage of change may provide a clinically quick and easy way to assess commitment to abstinence and match clients to particular treatment interventions. Findings also may help explain the tendency for clinicians to view legally coerced clients as less motivated despite the failure of empirical research to demonstrate differences in participation; legally coerced clients were less ready to change when they began treatment and continued to lag behind those not legally coerced even though they made incrementally equivalent progress along the change continuum. An important direction for future research is the assessment of the relationship between the perceived amount of coercion and the type, or source, of coercion (e.g., marital, legal, work).