Modeling Attitude towards Drug Treament: The Role of Internal Motivation, External Pressure, and Dramatic Relief

  • Bradley T. ConnerEmail author
  • Douglas Longshore
  • M. Douglas Anglin
Special Issue


Motivation for change has historically been viewed as the crucial element affecting responsiveness to drug treatment. Various external pressures, such as legal coercion, may engender motivation in an individual previously resistant to change. Dramatic relief may be the change process that is most salient as individuals internalize such external pressures. Results of structural equation modeling on data from 465 drug users (58.9% male; 21.3% Black, 34.2% Hispanic/Latino, and 35.1% White) entering drug treatment indicated that internal motivation and external pressure significantly and positively predicted dramatic relief and that dramatic relief significantly predicted attitudes towards drug treatment: χ 2 = 142.20, df = 100, p < 0.01; Robust Comparative Fit Index = 0.97, Root Mean Squared Error of Approximation = 0.03. These results indicate that when external pressure and internal motivation are high, dramatic relief is also likely to be high. When dramatic relief is high, attitudes towards drug treatment are likely to be positive. The findings indicate that interventions to get individuals into drug treatment should include processes that promote Dramatic Relief. Implications for addictions health services are discussed.


drug treatment process structural equation modeling heroin cocaine methamphetamine 



Support for this research was provided by Grants R03-DA23131, R01-DA12476, and K05-DA00146. Dr. Anglin is also supported by NIDA Senior Research Scientist Award K05 DA00146.


  1. 1.
    De Leon G, Melnick G, Hawke J. The motivation-readiness factor in drug treatment: implications for research and policy. Advances in Medical Sociology. 2000;7:103–129.CrossRefGoogle Scholar
  2. 2.
    Longshore D, Teruya C. Treatment motivation in drug users: a theory-based analysis. Drug and Alcohol Dependence. 2006;81:179–188.PubMedCrossRefGoogle Scholar
  3. 3.
    Joe GW, Broome KM, Rowan-Szal GA, et al. Measuring patient attributes and engagement in treatment. Journal of Substance Abuse Treatment. 2002;22:183–196.PubMedCrossRefGoogle Scholar
  4. 4.
    Simpson DD, Joe GW. Motivation as a predictor of early dropout from drug abuse treatment. Psychotherapy. 1993;30:357–368.Google Scholar
  5. 5.
    Ryan RM, Plant RW, O’Malley S. Initial motivations for alcohol treatment: relations with patient characteristics, treatment involvement, and dropout. Addictive Behaviors. 1995;20:279–297.PubMedCrossRefGoogle Scholar
  6. 6.
    Glanz K, Lewis F, Rimer B. Linking theory, research, and practice. In: Glanz K, Lewis F, Rimer B, eds. Health behavior and health education: theory, research and practice. 2nd edn. San Francisco: Jossey-Bass; 1999.Google Scholar
  7. 7.
    Whitelaw S, Baldwin S, Bunton R, et al. The status of evidence and outcomes in Stages of Change research. Health Education Research. 2000;15:707–718.PubMedCrossRefGoogle Scholar
  8. 8.
    Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behavior. American Psychologist. 1992;47:1102–1114.PubMedCrossRefGoogle Scholar
  9. 9.
    Prochaska JO, Norcross JC, DiClemente CC. Changing for good. New York: Morrow; 1994.Google Scholar
  10. 10.
    DiClemente CC, Scott CW. Stages of change: interaction with treatment compliance and involvement. In: Onken L, Blaine J, Boren J, eds. Beyond the therapeutic alliance: keeping the drug-dependent individual in treatment. NIDA research monograph series (no. 165). Washington, DC: U.S. Government Printing Office; 1997:131–156.Google Scholar
  11. 11.
    DiClemente CC, Schlundt D, Gemmell L. Readiness and stages of change in addiction treatment. American Journal on Addictions. 2004;13:103–119.PubMedCrossRefGoogle Scholar
  12. 12.
    Norman GJ, Velicer WF, Fava JL, et al. Dynamic typology clustering within the stages of change for smoking cessation. Addictive Behaviors. 1998;23:139–153.PubMedCrossRefGoogle Scholar
  13. 13.
    Czuchry M, Dansereau DF. Cognitive skills training: impact on drug abuse counseling and readiness for treatment. American Journal of Drug and Alcohol Abuse. 2003;29:1–18.PubMedCrossRefGoogle Scholar
  14. 14.
    Abrams DB, Herzog TA, Emmons KM, et al. Stages of change versus addiction: a replication and extension. Nicotine & Tobacco Research. 2000;2:223–229.CrossRefGoogle Scholar
  15. 15.
    Perz CA, DiClemente CC, Carbonari JP. Doing the right thing at the right time? The interaction of stages and processes of change in successful smoking cessation. Health Psychology. 1996;15:462–468.PubMedCrossRefGoogle Scholar
  16. 16.
    Prochaska JO. Moving beyond the transtheoretical model. Addiction. 2006;101:768–774.PubMedCrossRefGoogle Scholar
  17. 17.
    Prochaska JO, Levesque DA. Enhancing motivation of offenders at each stage of change phase of therapy. In: McMurran M, ed. Motivating offenders to change. New York: Wiley; 2002:57–74.CrossRefGoogle Scholar
  18. 18.
    Schumann A, Meyer C, Rumpf H-J, et al. Stage of change transitions and processes of change, decisional balance, and self-efficacy in smokers: a transtheoretical model validation using longitudinal data. Psychology of Addictive Behaviors. 2005;19:3–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Ryan RM, Plant RW, O’Malley S. Initial motivations for alcohol treatment: relations with patient characteristics, treatment involvement, and dropout. Addictive Behaviors. 1995;20:279–297.PubMedCrossRefGoogle Scholar
  20. 20.
    Belding MA, Iguchi MY, Lamb RJ, et al. Stages and processes of change among polydrug users in methadone maintenance treatment. Drug and Alcohol Dependence. 1995;39:45–53.PubMedCrossRefGoogle Scholar
  21. 21.
    Neff JA, Zule WA. Predicting treatment-seeking behavior: psychometric properties of a brief self-report scale. Substance Use and Misuse. 2000;35:585–599.PubMedCrossRefGoogle Scholar
  22. 22.
    Bentler PM. EQS 6 structural equations program manual. Encino: Multivariate Software; 2006.Google Scholar
  23. 23.
    Satorra A, Bentler PM. A scaled difference chi-square test statistic for moment structure analysis. Psychometrika. 2001;66:507–514.CrossRefGoogle Scholar
  24. 24.
    Bentler PM, Dudgeon P. Covariance structure analysis: statistical practice, theory, and directions. Annual Review of Psychology. 1996;47:563–592.PubMedCrossRefGoogle Scholar
  25. 25.
    Yuan K-H, Chan W, Bentler PM. Robust transformation with applications to structural equation modeling. British Journal of Mathematical and Statistical Psychology. 2000;53:31–50.PubMedCrossRefGoogle Scholar
  26. 26.
    Curran PJ, West SG, Finch JF. The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods. 1996;1:16–29.CrossRefGoogle Scholar
  27. 27.
    Hu L-T, Bentler PM. Cutoff criteria for fit indexes in covariance structural analysis: conventional criteria versus new alternatives. Structural Equation Modeling. 1999;6:1–55.CrossRefGoogle Scholar
  28. 28.
    Velasquez MM, Maurer GG, Crouch C, et al. Group treatment for substance abuse: a stages of change therapy manual. New York: Guildford; 2001.Google Scholar
  29. 29.
    Evans E, Longshore D. Evaluation of the substance abuse and crime prevention act: treatment clients and program types during the first year of implementation. Journal of Psychoactive Drugs. 2004;(Suppl. 2):165–174, May.Google Scholar

Copyright information

© National Council for Community Behavioral Healthcare 2008

Authors and Affiliations

  • Bradley T. Conner
    • 1
    Email author
  • Douglas Longshore
    • 1
    • 2
  • M. Douglas Anglin
    • 1
  1. 1.Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human BehaviorUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Drug Policy Research Center, RAND CorporationSanta MonicaUSA

Personalised recommendations