Relationship and Institutional Pressure to Enter Treatment: Differences by Demographics, Problem Severity, and Motivation

Alcohol Research Group, Public Health Institute, Emeryville, CA 94608, USA.
Journal of studies on alcohol and drugs (Impact Factor: 2.76). 06/2007; 68(3):428-36. DOI: 10.15288/jsad.2007.68.428
Source: PubMed


Studies have shown that individuals with substance-use problems frequently receive pressure to enter treatment. Pressure can come from institutions (e.g., criminal justice or welfare) or relationships (e.g., family or friends). Research has also shown that pressure can facilitate treatment entry. However, few studies have assessed how pressure from different sources varies.
Six hundred ninety-eight individuals entering residential or outpatient treatment for alcohol or drug problems completed face-to-face interviews soon after admission. Pressure was assessed by asking participants if others had suggested they enter treatment, including family, friends, and professionals within institutions. Additional assessments included the Addiction Severity Index and readiness to change.
Most of the participants (73%) reported some type of pressure: 29% from personal relationships, 30% from institutions, and 14% from both. The remaining 27% reported no pressure to enter treatment. Multinomial logistic regression of baseline data showed being on parole or probation, not being employed full time, and having more severe legal problems predicted pressure from institutions. In contrast, relationship pressure at baseline was predicted by severity of alcohol problems. Compared with participants receiving only relationship pressure, those receiving only institutional pressure had lower alcohol, drug, family, psychiatric, and medical severity. In addition, institutional pressure was associated with lower motivation at baseline, whereas relationship pressure was not related to motivation at all. When controlling for problem severity, baseline pressure was not associated with 12-month outcome.
Correlates of pressure from institutions for individuals to enter treatment differ from those associated with pressure from personal relationships to enter treatment. Implications of these findings for public policy, treatment, and further research are discussed.

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Available from: Douglas Polcin, Aug 07, 2014
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    • "This exploration examines subgroups of the population that receive FP but further work should identify how institutional pressure is exerted and if certain types of pressures within these institutions are effective. For example, Polcin and Beattie (Polcin & Beattie, 2007) found that persons that received only institutional pressure to enter treatment had lower severity scores for alcohol and drug use compared to those only receiving pressure from informal sources. Pressure to change alcohol use may be a staple discussion point for some institutions and less so for others. "
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    ABSTRACT: Background: General population studies have shown that pressure from others to change drinking can come from different sources. Receipt of informal pressure (IP) and formal pressure (FP) is known to vary by quantity and consequences of drinking, but less is known about how pressure varies among subgroups of the population. Method: This exploratory study utilizes data from the National Alcohol Surveys from 1995-2010 (N=26,311) and examines associations between receipt of pressure and subgroups of drinkers. Results: Increased relative risk of receiving IP and FP were observed for individuals reporting an arrest for driving after drinking and illicit drug use while poverty and lack of private health insurance increased risk of receipt of formal pressures. Regular marijuana use increased IP. Conclusion: The subgroups that were studied received increased pressures to change drinking behavior, though disentangling the societal role of pressure and how it may assist with interventions, help seeking, and natural recovery is needed.
    Journal of drug issues 10/2014; 44(4):457-465. DOI:10.1177/0022042614542509 · 0.38 Impact Factor
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    • "Selv når en pasient har status som frivillig innlagt, ser en at ulike former for opplevd naturlig press er vanlig hos majoriteten av de som kommer til behandling . Slikt press kan vaere et nødvendig virkemiddel for å fremme et ønske om endring hos pasienten selv (Polcin og Beattie, 2007). Det gjelder ulike former for uformelt press, eksempelvis ultimatum fra familien (trussel om skilsmisse mv.), til mer formelt press, eksempelvis AKAN-kontrakt med arbeidsgiver (krav om behandling hvis en vil beholde jobben) eller trussel om å miste stønaden fra NAV hvis en ikke er villig til å gå inn i behandling mv. "
    Makt og avmakt : etiske perspektiver på feltet psykisk helse., Edited by Paul Leer-Salvesen, Terje Mesel, 01/2013: chapter Tvangsinnleggelse av rusmiddelavhengige: noen etiske aspekter. [Coerced treatment of patients with substance use disorders - some ethical perspectives]: pages 242-260; Portal Forlag.
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    • "For example, Polcin and Weisner (1999) found individuals with more severe psychiatric and family problems were more likely to receive pressure . Polcin and Beattie (2007) found differences between pressure from institutions and interpersonal relationships. "
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    ABSTRACT: Individuals with alcohol problems often receive pressure to change their drinking. However, when they enter treatment it is unclear how often it is because of the pressure they received or other reasons. A secondary analysis was conducted using four cross sectional National Alcohol Surveys (NASs) collected at 5-year intervals between 1995 and 2010. Treatment seekers (N=476) were interviewed about 1) all reasons for seeking treatment, 2) their primary reason, 3) lifetime heavy drinking, and 4) whether they ever received pressure from six different sources (spouse, family, friends, doctor, work and police). Over 90% of the sample received pressure from at least one source. Thirty-four percent identified legal problems/felt forced as their primary reason for seeking treatment. Other primary reasons included a desire to improve relationships (25%) and health (15%). When asked about all reasons, 46% endorsed five or more reasons and 74% included legal problems/felt forced. When pressure was received from police it was often the primary reason for seeking treatment. When pressure was received from physicians or work, legal problems/felt forced was less likely to be the primary reason. Most reasons, including legal problems/felt forced, did not change significantly over time. A primary reason for seeking alcohol treatment is drinking-related legal problems or feeling forced. However, legal problems/feeling forced occurs along with a variety of additional reasons. Future research should assess pathways between receipt of pressure from different sources, recognition of different types of problems, and reasons given for seeking treatment.
    Contemporary drug problems 12/2012; 39(4):687-714. DOI:10.1177/009145091203900405
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