Relationships Among Motivation to Change, Barriers to Care, and Substance-Related Consequences in People With Dual Disorders

Abstract

Despite the importance of motivation to change substance use and outcomes in primary substance abusers, less is known about motivation in people with serious mental illness and substance use disorders. The present study sought to better understand the relationships among substance use and consequences, perceived barriers to care, and motivation to change in a sample of people with serious mental illness and substance use disorders who were entering outpatient mental health care. Participants were 41 dually diagnosed outpatients who completed self-report measures at intake to outpatient mental health treatment. Participants endorsed many barriers to treatment and many negative consequences resulting from substance use. Findings showed positive relationships between substance-related problems and both motivation to change (r = .42, p < .01) and perceived importance of change (r = .68, p < .001). Higher maintenance stage scores were related to a greater number of barriers to care (r = .34, p < .03). Higher action scores were inversely related to past-month drug use (r = –.59, p < .001). Relationships among variables were similar to what has been found in primary substance abusers. Two ideas are discussed: (1) dually diagnosed patients may encounter unique challenges when seeking care, and 2) those who have made changes continue to perceive barriers to treatment.

KEYWORDS:

• Dual diagnosis
• motivation
• treatment
• barriers
• substance use problems

This research was supported by an intramural grant from the University of Maryland School of Medicine (M. Bennett, PI). The authors also acknowledge the help and support of the intake clinicians at the outpatient community mental health center operated by the Department of Psychiatry at the University of Maryland School of Medicine, who provided administrative assistance to the study.

Notes

∗The numbers listed here represent the number and percentage of participants who rated each of the selected items as a “very important” barrier to care.

∗Significant at the .05 level.

∗∗Significant at the .01 level.