What Motivates People for Substance Abuse Treatment? An Analysis of Self-Determination Theory and its Relation to Treatment Outcomes

Drug abuse is a major problem affecting the substance abuser, his family, and the community; addiction is associated with criminal activity, illness, and death. High rates of treatment attrition, relapse, and re-offense have spurred the development of court-based drug diversion programs throughout the country. However, there is a dearth of research examining factors that contribute to positive treatment outcomes in drug diversion programs, such as Drug Courts and California based Proposition 36 courts. Additionally, previous efforts to analyze the role of motivation in substance abuse treatment outcomes have yielded inconsistent results that may be attributed to a lack of consensus regarding the definition of motivation. The current study examined the validity of Self-Determination Theory (SDT, Ryan & Deci, 2000; Ryan et al., 1995) and its concept of Perceived Locus of Causality (PLOC) with 213 males and females who were court-coerced to enter treatment. Additionally, the current study aimed to understand the role of social support on treatment outcomes, specifically, the differential effect of support received from friends versus family and the sobriety status of each. Results indicate that court-coerced clients can have both external and internal motivation and it is the presence of internal motivation that is associated with program completion. Results also validate the utility of SDT in describing motivation for treatment and find that internal motivation, confidence in treatment, and interpersonal help seeking, as assessed by the Treatment Motivation Questionnaire , are associated with graduating from treatment. Furthermore, analyses of social variables revealed that having non-supportive using friends was associated with being removed from treatment; however, leaving non-supportive using friends to be with supportive clean friends during treatment was associated with graduating from treatment. There was not a significant relationship between type of support received from family and treatment outcome, therefore, the adage “You can choose your friends but you can’t choose your family” may be an encouraging message for addicts with families who abuse drugs, especially based on the finding that choosing clean and supportive friends during treatment is associated with graduating from treatment. Furthermore, results indicated that participants in selective Drug Court programs had higher levels of internal motivation than did those in Proposition 36 court programs, which are available to all legally eligible non-violent drug offenders. Finally, demographic variables were analyzed in relation to treatment motivation and outcome and results indicated that females had higher internal motivation and confidence in treatment than did males and were less likely to drop out than would be expected by chance. The implications of these findings for research and practice in the field of addictions are discussed.