Treatment motivation has historically been viewed as a crucial element promoting client responsiveness to treatment and favorable treatment outcomes.1,2
However, empirical research typically finds only modest association between motivation and treatment success.2
This may be because drug treatment motivation has routinely been measured solely as an internal characteristic.3,4
Simpson and Joe identified three dimensions of drug treatment motivation: drug problem recognition, desire for help, and treatment readiness.4
However, this model of motivation overlooks various external pressures, such as coercion from family members, loved ones, and the criminal justice system, that can lead someone to enter drug treatment despite resistance or doubt about its benefits. In other words, drug users enter treatment for a variety of internal and external reasons and treatment success more likely depends on the interplay of these reasons.5
For example, external pressure could translate to high motivation for drug treatment when that pressure is properly internalized.
Previous research has led to the development of multiple models of behavior change.6
Among them, the Transtheoretical Model of Change appears to be the best candidate for further study as it represents the combination of many tenants of the behavior change models that came before it (i.e., the Health Belief Model, the Theory of Reasoned Action, and Social Learning Theory).7
The Transtheoretical Model is a framework that describes behavior change through three major constructs: Stages, Levels, and Processes of Change.8–10
DiClemente and Scott state that the first major construct of the Transtheoretical Model, the Stages of Change, “represent the temporal, motivational, and developmental aspects of the process of change” (p. 139).10
As applied to drug abuse and dependence, the Stages of Change are (1) Precontemplation: the individual does not recognize problems arising from drug use and is not considering change, (2) Contemplation: the individual recognizes problems arising from drug use and is considering change but remains ambivalent, (3) Preparation: the individual plans to change behavior soon, (4) Action: the individual makes an overt behavior change (e.g., stops using drugs or enters drug treatment), and (5) Maintenance: the individual works to prevent relapse and to consolidate steps taken at the Action stage.
The second major construct, the Levels of Change, offers a framework for identifying significant problem areas for individuals attempting to initiate behavior change.8
The levels of change that are theorized to be involved in both the initiation and cessation of alcohol and drug use behaviors are Symptomatic/Situational, Maladaptive, Interpersonal Conflicts, Family Systems Conflicts, and Intrapersonal. They represent areas of functioning in which an individual may be experiencing significant problems. The levels help to identify the number and severity of problems. The problems can occur at any level or at multiple levels. The purpose of the levels, in terms of the change process, is to identify problems that may interfere with an individual’s ability to move through the stages of change to the Maintenance Stage.
The third major construct, the Processes of Change, facilitates movement through the Stages of Change.11
There are four types: cognitive, emotional, behavioral, and environmental. The Consciousness Raising (cognitive process of acquiring information about the problem) and Dramatic Relief (emotional response to problem recognition) Processes of Change are prominent as people move from the Precontemplation to Contemplation stages. Movement to the Preparation and Action stages tends to be a function of behavioral and environmental processes.
In the Transtheoretical Model, drug users highly ambivalent about stopping their use are at the Precontemplation stage of change. Dramatic relief involves emotional arousal about one’s current behavior and the psychological relief that can come from changing from Precontemplation to Contemplation.12
Dramatic Relief is a trigger that prompts people to acknowledge, at an emotional level, their problem behavior and its impact on those around them. Fear, inspiration, guilt, and hope are some of the emotions that can promote dramatic relief and move people from Precontemplation to Contemplation. Motivational interviewing, psychodrama, role playing, grieving, and personal testimonies are examples of techniques used to create such movement.13
While earlier behavior change research concluded that interventions using education and fear arousal techniques did not motivate behavior change, many of these intervention studies were evaluated by their ability to move people to immediate action (e.g., Abrams et al.14
). Processes like Dramatic Relief are intended to move people to the Contemplation stage, not necessarily the Action stage.15
Therefore, the effectiveness of these processes should be determined by whether they produce progress across these two initial stages as expected.16–18
The purpose of this study was to determine the role of a specific Process of Change taken from the Transtheoretical of Change in predicting attitudes towards drug treatment, which served as a proxy for readiness for change. It was hypothesized that there would be significant positive predictive relationships from External Pressure and Internal Motivation to Dramatic Relief and a significant negative predictive relationship between Dramatic Relief and Negative Drug Treatment Attitudes. These hypotheses were tested using structural equation modeling.