Substantial barriers to successful treatment outcome are also presented by the addicted patients themselves, and several speakers at the ASAM conference described intervention modalities that motivate or facilitate participation. Carlo DiClemente, Ph.D., chair of the department of psychology at University of Maryland, Baltimore County, discussed Project MATCH (Matching Alcohol(Drug information on alcohol)ism Treatments to Client Heterogeneity) and research with motivational enhancement therapy (MET) to promote treatment participation and successful recovery from substance abuse.
DiClemente (1999) previously suggested that the readiness of drug dependent patients for treatment and successful recovery occurs in stages: considering change (precontemplation stage); intermediate decision-making (contemplation stage); planning (preparation stage); making the change (action stage); and sustaining the change over time (maintenance stage). "Most treatment programs are action-oriented," DiClemente pointed out to conference attendees, "but clients seeking treatment at these programs are not always ready for action."
DiClemente (1999) distinguished between imposed and intentional change, noting that the former is often short-lived. Although supportive of therapeutic interventions within the corrections-penal system, he also noted that court-mandated attendance at treatment programs does not indicate that individuals are necessarily motivated to change substance-abusing behavior. DiClemente also contrasted readiness for change to readiness for treatment. He notes that many substance-dependent patients will relapse after the first attempt at treatment and suggested that treatment, as a time-limited event, should be considered as a part of the larger process of change.
One method to increase the level of participation intensity and the likelihood of treatment success is to incorporate contingency management, according to a presentation at the ASAM conference by Nancy Petry, Ph.D., associate professor at University of Connecticut Health Center. Petry and colleagues (2001) recently argued, "A primary benefit of positive-incentive contingency management approaches is that they increase the percent of patients who respond favorably to treatment."
Often taking the form of contingency contracting with the patient, this treatment strategy involves frequent monitoring of target behaviors, such as drug abstinence and obtaining employment; tangible, positive reinforcers for the target behavior; and withdrawal of the reinforcer when the target behavior does not occur. (For more information on contingency management, please see related article "Contingency Management in Addiction Treatment" -- Ed.)
Petry has acknowledged criticism of contingency management approaches, however, on the basis of cost and the question of their applicability in community-based treatment programs. Clinics without research funding are unlikely to be able to offer voucher programs or other tangible reinforcers, and less expensive approaches may be necessary for adaptation in community-based settings.
Still, as noted in their research, Petry and colleagues (2001) remain hopeful:
As more and more clinicians and researchers apply contingency management procedures to treat substance-abusing patients, new developments and refinement in the techniques may emerge. We may discover less expensive yet efficacious reinforcers, determine the best behaviors to target, and evaluate the time course and optimal duration of interventions.
