Physical health as a motivator for substance abuse treatment among medically ill adults: Is it enough to keep them in treatment?

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2006.03.014 Byline: Thomas P. O'Toole (a), Robin A. Pollini (b), Daniel Ford (c), George Bigelow (d) Keywords: Motivation; Readiness for change; Medically ill; Substance abuse; Opiate; Treatment retention Abstract: Substance-using adults often present at medical facilities for acute complications of their drug or alcohol use with transiently high motivation for addiction treatment. We studied a cohort of medically ill polysubstance-using adults admitted to a partial hospitalization/day-hospital program in an acute hospital, serially tracking their reasons for treatment motivation, pain and withdrawal scores, and readiness for change. Physical health concerns were the most frequently cited reason for wanting to enter substance abuse treatment at baseline (27.8%), yet individuals who cited this as their primary motivator were significantly less likely to complete the treatment program (14.8% vs. 40.7%, p = .03). However, 43% of respondents also recorded a shift in their motivation during treatment; 100% of those transitioning from an extrinsic motivator (e.g., physical health concerns) to an intrinsic motivator (e.g., wanting to do more with one's life) completed treatment, compared with only 38.4% of those whose extrinsic motivating factors were static. This suggests that medical illness represents a 'treatable moment' to engage individuals in substance abuse treatment. Author Affiliation: (a) Georgetown University School of Medicine, NE111 Med Dent Building, 3900 Reservoir Road NW, Washington, DC 20057, USA (b) Department of Epidemology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA (c) Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA (d) Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA Article History: Received 18 July 2005; Revised 15 March 2006; Accepted 22 March 2006 Article Note: (footnote) Dr. O'Toole is funded by a National Institute on Drug Abuse career development award (K23DA13988-01).