The Association between Motivation, Coercion, and Alcohol Abuse Treatment in Young Adults
The Association between Motivation, Coercion, and Alcohol Abuse Treatment in Young Adults
Alcohol and substance abuse/addiction is an increasing problem among adolescents and young adults in the United States, and the onset of problematic drinking usually occurs between the ages of 18 and 24 (Bukstein, Cornelius, Trunzo, Kelly, & Wood, 2005). Alcohol abuse and binge drinking among young adults in college and non-college populations can lead to sexual assault, injury, and in some cases, death. (Stone, Becker, Huber, & Catalano, 2012) According to a cross-sectional survey of college students from a sample of 119 public and private colleges, binge drinkers are over eight times more likely to have gotten hurt or gotten in trouble with the campus police or local police. (Stone et al., 2012) While there is no scientific cure for substance abuse/addiction, effective treatment can help an individual to obtain sobriety.
Three fundamental clinical issues are associated with treatment outcomes for populations with drug and alcohol addiction: coercion, motivation, and therapeutic alliance (Wolfe, Kay-Lambkin, Bowman, & Childs, 2013). The best predictors of who enters treatment and how successful they are in treatment are environmental factors such as family factors, motivation, and access to treatment (Bukstein et al., 2005). Motivated individuals are more willing to engage in therapy and to take an active role in the treatment process (Wolfe et al., 2013).
Motivation is categorized into two primary types: internal and external motivation. Internal motivation stems from an intrinsic desire to change upon recognition of one's substance use as problematic. (Goodman, Peterson-Badali, & Henderson, 2011) An example of internal motivation might be the desire to change upon noticing unpleasant results (e.g. getting fired from one's job due to inappropriate behavior caused by excessive drinking). Contrarily, external motivation is a result of pressure from family and friends (Wolfe et al., 2013).
The present study will examine young adults from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). The goals of the analysis will include 1) establishing the association between alcohol abuse and treatment seeking patterns in young adults, and 2) determining whether motivation (internal/external) or coercion has a higher success rate in terms of treatment outcome (e.g. will the individual continue to abuse alcohol after leaving treatment, or will they stay sober?)
The sample from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) represents the civilian, non-institutionalized adult population of the United States, and includes persons living in households, military personnel living off base, and persons residing in the following group quarters: boarding or rooming houses, non-transient hotels and motels, shelters, facilities for housing workers, college quarters, and group homes. The NESARC included over sampling of Blacks, Hispanics and young adults aged 18 to 24 years. The sample included 43,093 participants. The study was done by computer-assisted interviews.
Survey data from 18-24 year old respondents will be included, as the study will focus exclusively on young adult behavior. The study measures three categorical variables: internal motivation, external motivation, and coercion. Internal motivation was assessed through problems that directly affected the drinker ("Ever continue to drink even though causing health problem," "More than once want to stop or cut down on drinking" "Ever had job or school troubles because of drinking"). External motivation was assessed based on the influence of people in the drinker's social circle ("Ever continue to drink despite causing trouble with family/friends", "Did not seek help because afraid of what boss, friends family, or others might think.") [WCM3] Coercion was assessed by a history of arrest or legal problems tied to drug use/drinking ("Ever get arrested/have legal problems because of alcohol/drug use".) These variables are compared against the primary response variable ("Ever Went to Drug/Alcohol Rehabilitation Program").
The effects of alcohol abuse are disastrous, especially on college campuses. Hardly a week goes by without a newspaper headline announcing an alcohol-related death or accident. It is important for colleges to become better equipped to deal with alcohol abuse. For example, the study may find that young adults are less inclined to go to treatment and stay sober if they are worried about what their friends think. If that is the case, colleges should take that information and find ways of providing confidential treatment on campus to enable students to get help without worry about external judgment.
Bukstein, O. G., Cornelius, J., Trunzo, A. C., Kelly, T. M., & Wood, D. S. (2005). Clinical predictors of treatment in a population of adolescents with alcohol use disorders. Addictive Behaviors, 30(9), 1663-1673. doi: 10.1016/j.addbeh.2005.07.013
Goodman, I., Peterson-Badali, M., & Henderson, J. (2011). Understanding motivation for substance use treatment: The role of social pressure during the transition to adulthood. Addictive Behaviors, 36(6), 660-668. doi: 10.1016/j.addbeh.2011.01.011
Stone, A. L., Becker, L. G., Huber, A. M., & Catalano, R. F. (2012). Review of risk and protective factors of substance use and problem use in emerging adulthood. Addictive Behaviors, 37(7), 747-775. doi: http://dx.doi.org/10.1016/j.addbeh.2012.02.014
Wolfe, S., Kay-Lambkin, F., Bowman, J., & Childs, S. (2013). To enforce or engage: The relationship between coercion, treatment motivation and therapeutic alliance within community-based drug and alcohol clients. Addictive Behaviors, 38(5), 2187-2195. doi: 10.1016/j.addbeh.2013.01.017
