Court-mandated substance use treatment: Implications for treatment adherence based on drug of choice

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The ongoing opioid and stimulant epidemics place a significant burden on individuals, their families, and the broader community. The prevalence rates of substance use disorders (SUDs) among women in particular are accelerating quickly, and the criminal justice system is increasingly involved in the intervention process. A significant body of research has generated broad programmatic approaches to treatment; however, differentiations between the SUDs defined by drug of choice (DOC) are not well understood and therefore largely overlooked in treatment approaches. The researcher designed a study to explore this additional layer, theorizing that women’s primary drug of choice (opioids vs. stimulants) may reflect an approach or avoidance pattern to stimuli mimicking the stimulus effects of the drug itself. Researchers have observed that approach-avoidance dynamics activate motivational systems, which positively or negatively influence individuals’ affective evaluation of incoming stimuli (Neumann & Strack, 2000). These dynamics in turn serve as antecedents to active behavioral engagement necessary for the successful completion of a substance use treatment program. Very little research has specifically examined the relationship between primary drug of choice and approach and avoidance tendencies as they may influence treatment-seeking and treatment-engaging behaviors. In the current study, the researcher examined archival assessment data from 1,561 women court-ordered to participate in residential substance use treatment. A series of Multiple Analyses of Variance were utilized to explore factors related to the discrepancies between self-reports of the degree to which participants are troubled and the degree to which they place importance on seeking treatment counseling for these problems, in addition to clinical judgments of the severity of these problems. Consistent with most of the researcher’s predictions, results indicated that individuals who are drawn to opioids as their primary drug of choice have a broader-reaching tendency to avoid experiences in addition to avoiding pain; similarly, results indicated that individuals who are drawn to stimulants as the primary drug of choice also have a general approach-oriented tendency for life experiences beyond drug use. This novel approach-avoidance conceptualization is less pathologizing than traditional understanding about resistance to treatment and can be utilized to increase patients’ readiness for and engagement in mental health treatment. Implications for theory, practice, training, and research and directions for future research are discussed.

Opioid, Stimulant, Addiction, Approach-avoidance