Reasons for Entering Treatment Reported by Initially Treatment-Resistant Patients with Substance Use Disorders

Abstract

Many individuals with substance use disorders are resistant to entering formal treatment, despite the negative consequences that plague their own lives and the lives of concerned significant others (CSOs). Community Reinforcement and Family Training (CRAFT) has been developed as an effective strategy for helping family members who are concerned about the alcohol/drug use of a loved one who refuses to seek treatment. The present study explored reasons and feelings that played a part in these resistant individuals' (identified patients [IPs]) decision to begin treatment. Written statements and feelings of 36 initially treatment-refusing IPs, who were engaged into treatment via their CRAFT-trained CSOs, were examined upon entering treatment. Self-report forms assessed three complementary domains about entering treatment: (1) feelings about coming for treatment, (2) important reasons for entering treatment, and (3) reasons for entering treatment narratives. It was shown that the occurrences of self-reported positive emotions and statements that expressed a positive wish for change outweighed negative feelings and statements. Although conceivably these CRAFT-exposed IPs may have provided different responses than other treatment-seeking populations, the current study's strong IP reports of positive feelings, reasons, and narrative statements regarding treatment entry nonetheless address potential concerns that treatment-refusing IPs might only enter treatment if felt coerced by family members and while experiencing salient negative feelings overall.

Keywords::

• treatment-resistant
• community reinforcement and family training
• CRAFT
• family
• addiction
• substance use disorder
• recovery
• evidence-based

Acknowledgements

We thank the National Institute on Drug Abuse Grant DA-08896 for funding, and Dr William R. Miller and the entire staff at CASAA UNM. Furthermore, we want to thank Dr Wobbe P. Zijlstra of Tilburg University for his statistical advice. The authors Meyers, Roozen, and Smith are authors of books on CRA, ACRA, and CRAFT for which they receive royalties, and they have consulting businesses in which they conduct CRA, ACRA, and CRAFT workshops.