This study was conducted as part of Reducing Barriers to Substance Abuse Treatment Services, a National Institute on Drug Abuse funded clinical trial. Substance abusers who receive an assessment and referral at a centralized intake unit (CIU) are randomly assigned to: (1) a standard of care group; (2) one session of motivational interviewing; or (3) five sessions of strengths-based case management. The study is located at Samaritan Crisis Care, a centralized intake unit (CIU) in Dayton, Ohio. The CIU is the county’s only point of entry for uninsured individuals seeking treatment for substance abuse and mental health problems.
Eligibility requirements for the clinical trail included: Substance abusers who meet the following criteria are referred to the Reducing Barriers Project: (1) over 18 years of age; (2) diagnosed as having a substance abuse and/or dependence disorder using criteria from the Diagnostic and Statistical Manual (American Psychiatric Association, 2001) (subjects who were diagnosed only with alcohol abuse or dependence were not eligible); (3) not diagnosed with schizophrenia or any other psychotic disorder; and (4) referred to either residential or outpatient substance abuse services.
Eligible subjects are referred to RBP research staff by CIU assessment therapists. RBP research assistants provide a summary of the project, and if an individual is interested an informed consent approved by a university’s institutional review board is read to them. The confidential nature of the study is stressed as is the fact that refusal to participate does not affect CIU services for which an individual is otherwise eligible. Individuals who wish to enter the study then participate in a baseline interview lasting about 1 1/2 hours. Most interviews take place immediately following a clinical assessment, although some potential subjects are scheduled to return at a later time. Follow-up interviews are conducted at three and six months following baseline. Subjects are paid a $30 stipend for their time spent answering questions on each interview.
The Pre-Treatment Readiness Scale (PRS) was developed to assess readiness for treatment in substance abusers assessed and referred to treatment but not yet in treatment (9
). PRS items came from the Texas Christian University Treatment Motivation Assessment (TMA) made up of three factors: Problem Recognition, Desire for Help, and Treatment Readiness (5
). The scale consists of twenty-three items which make up the three constructs: (a) Problem Recognition (PR; 9 items) assesses an individual’s attitude toward their drug use (e.g., “Your drug use is causing problems in thinking or doing your work”); (b) Desire for Help (DH; 6 items) gauges the need for assistance (e.g., “You need help in dealing with your drug use”); and (c) Treatment Readiness (TR; 8 items) measures the level of readiness for seeking treatment (e.g., “Treatment may be your last chance to solve your drug problems”). Subjects were asked to respond to the items based on a five-point Likert-type scale that included: (1) strongly disagree, (2) disagree, (3) neutral, (4) agree, (5) strongly agree. Raw scores on negatively worded items, e.g., “Treatment will not be very helpful to you” were reversed to ensure intended relationships among items.
Exploratory and confirmatory factor analyses and difference tests demonstrated that a four factor model represented a significant improvement over the original three factor model. As in the original TMA, Problem Recognition and Treatment Readiness constructs were present. A Desire for Change scale was identified in this pre-treatment sample indicating a willingness to make changes rather than a willingness to get help. A Treatment Reluctance factor indicated ambivalence and negativity about entering treatment.
An extensive baseline questionnaire contain questions that are designed to gather lifetime, six month and 30 day information from subjects relative to gender, age, education level, marital status, drug use, housing, employment patterns, HIV risk behaviors, treatment history, and critical life events. The interview included all items from the Addiction Severity Index (ASI), Version 5 (35
). The ASI is a widely used instrument for assessing the severity of drug addiction problems in seven life areas–alcohol use, drug use, legal, family/social, medical, employment, and psychiatric. Composite scores from each of the seven ASI areas are based on items representing functioning during the 30 days before the interview.
The 59-item Barriers to Treatment Inventory was used to represent barriers that substance abusers identified prior to treatment (36
). The scores from each of the factors representing internal barriers–Absence of Problem, Negative Social Support, Fear of Treatment, and Privacy Concerns–were used in this analysis. The internal barrier constructs include: (a) Absence of Problem (AP; 6 items) assesses an individual’s attitude toward their drug use (e.g., “I do not think I have a problem with drugs); (b) Negative Social Support (NSS; 5 items) gauges the belief of family and peers that there is no need for treatment (e.g., “Friends tell me not to go to treatment’’); (c) Fear of Treatment (FT; 4 items) measures individuals’ concerns about being in treatment (e.g., “I am afraid of what might happen in treatment”); and (d) Privacy Concerns (PC; 3 items) representing individuals’ reticence to talk about themselves (e.g., I hate being asked personal questions). The BTI is read to subjects by a research assistant, taking an average of 15 minutes to complete. Subjects are asked to indicate on a five-point scale how much they believe that each barrier would affect their entry into treatment. The five point scale includes: (1) disagree strongly, (2) disagree, (3) uncertain, (4) agree, and (5) agree strongly.