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Substance abuse is a global issue that causes detrimental effects to millions of people annually (McCaffrey, 1997). The war against drugs takes numerous forms, and it has improved law enforcement response regarding the proliferation of drugs, which has, in turn, led to an unprecedented increase in the number of convicts with a substance abuse background within the prison system (Hayes and Schimmel, 1993).
It is reported that about 1 in every 100 American citizens is in prison or jail. The rates of incarceration in the United States are literally higher among the young population between the ages of 24 and 30, as compared to other groups, which is a clear indication that this problem is more prevalent among the most productive and industrious group of society.
More than 50 % of convicts test positive for illegal drugs on arrest (Hayes and Schimmel, 1993). However, it is worth noting that incarceration alone does not play an important role as far as the treatment of drug and substance abuse is concerned. Most drug and substance abusers, about 60 % to 80 %, after being released from prison, get involved in new crimes, most of which are related to drugs.
Furthermore, about 95 % continue with drug abuse after being released from prison. Research studies indicate that substance abuse treatment without accountability has proven to be ineffective and costly (Hayes and Schimmel, 1993; McCaffrey, 1997).
About 60 % to 80 % of the participants do not complete their treatment or successfully graduate unless they are supervised regularly (Hayes and Schimmel, 1993). This, therefore, indicates that the criminal justice system requires a new direction if effectiveness is to be attained about the treatment of substance abuse.
The impacts of substance abuse are devastating and affect not only the individual, but also their family, community, and entire society (McCaffrey, 1997). Furthermore, it is worth highlighting that substance abuse generates significant costs to the economy. However, even though the treatment is readily available, the issue of relapse is a common one (Hayes and Schimmel, 1993). Considering the complexity of this problem, researchers have for a long time examined different factors related to the treatment outcomes.
The motivation for change as well as readiness for change are some of the factors that are widely considered to be significant in determining successful outcomes as far as substance abuse treatment is concerned. Medical practitioners have been considering the aspect of motivation in the treatment of substance abuse, contending that medical interventions were ineffective until a substance-dependent patient was self-motivated and ready to be transformed.
Recognizing the important role that motivation for change plays in substance abuse treatment, clinicians and researchers have over the recent past displayed an interest in the aspect of motivation as far as substance abuse treatment is concerned (Hayes and Schimmel, 1993). This research seeks to examine the relationship between motivation for change and substance abuse treatment.
Background of the Study
The establishment of significant rehabilitation programs to deal with drug abusers within the criminal justice system took place after the 1966 Narcotic Addict Rehabilitation Act had been passed. During the following two decades, there was a decline in the popularity of its mission, hence resulting in a subsequent reduction in the programs. There were only three rehabilitation programs in 1987 (Hayes and Schimmel, 1993).
However, the designation of the coordinator for the Federal Bureau of Prisons national drug abuse in 1988 brought a new commitment about federal offenders, which led to an increase in substance abuse programs (Hayes and Schimmel, 1993; Pelissier et al., 1998; McCaffrey, 1997).
The Federal Bureau of Prisons provides imprisoned criminals with a documented history of substance abuse along with a wide range of treatment options. Regrettably, only a few federal inmates experiencing problems associated with substance dependence report participating in such programs (White et al., 2001).
Drug abuse programs provided various treatments depending on the strength, from Residential Drug Abuse Treatment Programs that take 500 hours to Non-Residential Drug Abuse Treatment Programs that are less rigorous and the Drug Abuse Education Program that only take 15 hours. Residential Drug Abuse Treatment Programs are considered to be very staff intensive and are basically provided in more than half of drug courts.
Chatham County Drug Court is one of the institutions that have helped to deal with cases of substance abuse. According to the Chatham County public health department, alcohol and drug abuse cases are prevalent in the county. The levels of excessive drinking in this region are higher than those of excessive drinking within the state.
Moreover, the use of other drugs such as prescription pills, marijuana, cocaine, heroin, and other prohibited substances is also common within the county (White et al., 2001). The program has rescued convicts that the court serves from issues of despair, incarceration, and addiction.
The treatment program is often conducted for 24 months and consists of five different phases. Also, the participants are required to attend the group as well as individual counseling sessions that are provided several times a week. They are also required to submit random drug screens twice a week to ensure they comply with provisions of the treatment program, failure to which the participant is sanctioned by the court.
Also, the participants have to maintain productive employment to continue with the program and avoid cases of idleness that can prompt them to go back to substance abuse (White et al., 2001). Chatham County Drug Court has, however, had some success in fighting drug use by helping people stay off drugs.
However, like any other drug court that provides treatment and support for drug abusers, together with sanctions in the event they fail to follow the instructions provided, the programs offered are considered to be more costly, taking into account the fact that cases of relapse are prevalent.
Research indicates that Residential Drug Abuse Programs are heavily funded and have been the subject of increased study since 1989 to examine their effectiveness regarding their ability to enhance the participants' institutional adjustment, minimizing the levels of drugs and substance abuse, and minimizing relapse recidivism levels after being released among many other issues (Pelissier et al., 1998). They have gone through wide-ranging investigations for various reasons; also, most significantly perhaps is to justify the considerable funding obtained from Congress and to illustrate how taxpayers' funds are being utilized.
Motivation appears to be a vital factor in influencing drug and substance abusers to look for, adhere to, and complete treatment, as well as to make permanent changes in their habits (DiClemente and Scott, 1997). Research studies regarding substance abuse have demonstrated the significance of motivation for treatment in determining participation in treatment programs as well as recovery (Simpson and Joe, 1993; DeLeon et al., 1997). It is noted that most substance-abusing patients go for treatment because of the pressure they get from other people, though they may lack the inner drive to change their behaviors.
Therefore, understanding patients' motivation for changing their criminal and addictive behaviors could help ensure the success of treatment programs, while minimizing cases of recidivism and relapse. Basing on the statistics provided regarding the effectiveness of the criminal justice system in tackling substance abuse, it is reported that drug courts do little to stem the tide of drug abuse and crime-related activities. Upon release, between 60 % and 80 % of substance and drug abusers take part in other crimes that are commonly associated with drugs, while about 85 % to 90 % quickly relapse into drug abuse (Hayes and Schimmel, 1993).
However, the fact that some positive results have been also reported cannot be refuted. Chatham County Drug Court, for instance, has reported significant success because there are inmates who have managed to comply with treatment programs and completed them successfully. One big problem that Chatham County Drug Court is experiencing at this time is how to enhance motivation for change since numerous cases of relapse and dropout have been reported.
The significance of this study revolves around various factors, including rising economic and social tolls that the problem of substance abuse and incarceration is imposing on the economy. There are relatively low utilization rates and availability of substance abuse treatment and education programs by incarcerated criminals, a high correlation between incarceration and substance abuse, and the uncertainty that the application of substance abuse treatment and education programs will enhance their motivation for change and minimize cases of recidivism and relapse (Hayes and Schimmel, 1993).
Purpose of the Study
The purpose of this study is to examine the relationship between motivation for change and substance abuse treatment among individuals participating in a drug court. The study also seeks to determine an individual's motivational readiness to change based on the Transtheoretical Model.
Indeed, studies have proved that motivation plays a significant role in the treatment of substance abuse. However, even though studies have indicated that motivation-based programs could enhance treatment outcomes, it is noted that clinicians and researchers still have to learn a lot about influencing motivation among patients.
Therefore, the findings of this study will serve as a major step towards enhancing the understanding of the motivation for change among substance abusers. The study is also beneficial as far as the costs are related because significant funding has been directed towards such programs. Most of them have failed to accomplish the intended objective, hence resulting in significant losses.
It is expected that the study will provide greater understanding and a greater capacity to foretell the motivation for change among inmates through their enrollment in prison-based substance abuse treatment programs. Furthermore, there is no standard determinant of stages of change regarding drug abuse that has been documented in the literature (Naffer et al., 2008).
The study clarifies and sheds some light on the predictive ability of the Transtheoretical Model in determining successful inmate outcomes from Residential Drug Abuse Programs, as well as completion in terms of successful community integration and refraining from such behaviors.
This research might also offer support for the future development of instruments aimed at determining stages of change in motivation, designed for the correctional population. Findings of the study are also expected to generate adequate information that will help drug courts treatment staff to establish and match conflicting focuses of the treatment provided for inmates who are at different stages of change.
Also, the findings will help tailor treatment for some individuals involved in substance abuse treatment, education, and aftercare programs while in prison and after being released, to strengthen their general motivation and maintain a healthy lifestyle.
This study is grounded on the Transtheoretical Model, also referred to as the stages of change, which seeks to provide an integrative framework that could be applied in examining an individual's readiness to change behavior (DiClemente and Prochaska, 1998). Having been developed in the mid-1970s, the model examines the structure regarding how people change their health-related behaviors intentionally, whether professionally facilitated or sew-initiated (Prochaska et al., 1992).
An analysis of 18 different behavioral and psychological theories was conducted to determine commonalities about how change happens, and the Transtheoretical Model was established based on the common traits drawn from these theories (Miller, 2003; Prochaska, 1979). The variables that were originally determined in the comparative analysis conducted on these theories include therapy preconditions, change processes, therapeutic relationships, and content to be changed (Prochaska and DiClemente, 1982).
According to DiClemente and Prochaska, (1998) the Transtheoretical Model is defined by three main constructs, which are levels of change, processes of change, and stages of change. However, according to Velicer et al., (1998), the stages of change are considered to be the central organizing construct.
Basically, this model has generated key constructs that have been widely applied in examining and describing the processes and stages of change to gain a deeper understanding of the way people change their addictive behaviors. Studies have indicated that people with drug and substance abuse issues seeking or undergoing treatment significantly differ in terms of their levels of motivation for change (DiClemente and Hughes, 1990; Prochaska et al., 1992).
The most commonly applied dimension of the model is the stages of change, which depicts the dynamic and motivational fluctuations of change processes over time (DiClemente, 2003). Every stage entails tasks and a time period required to advance to the following stage. Five stages were identified, which are pre-contemplation, contemplation, preparation, action, and maintenance (Prochaska et al., 1992).
The pre-contemplation stage is characterized by individuals being not so sure of the need to change or not willing to accept change. Patients who are at the pre-contemplation stage are more likely to refute being substance abusers. The main task at this stage is awareness, as the individual needs to recognize that such behavior is present and there is a change possibility.
Its main goal is for the individual to start considering a change of behavior. At the contemplation stage, the individual becomes aware of the need to change. This stage is aimed at helping the individual resolving their ambivalence to progress to the next stage.
During the preparation and action stages, an individual is more likely to acknowledge that they face the problem. The main task at these stages is to make an effort in changing the individual's behavior and to go on with the change for a specified time (Prochsaka et al., 1992; DiClemente, 2003). The final stage, which is maintenance, is basically concerned with incorporating behavior changes into diverse life areas while preventing incidents of relapse (Prochaska et al., 1992).
To determine an individual's motivational readiness to change, which is also considered as a stage of change, the study will apply two stages of change instruments, which include the University of Rhode Island Change Assessment (URICA) and the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). The URICA is a self-report measure that is composed of 32 items applied in the research and treatment that examines the motivation for change, basically, during the program admission (Allen and Wilson, 2003). It also comprises four eight-item subscales that determine four stages of change, which are pre-contemplation, contemplation, action, and maintenance. Just like the URICA, the SOCRATES is applied in determining readiness for change.
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This research attempts to answer several questions. However, it is important to note that the main research question for this study is: Do inmates' motivation for changing their addictive behaviors and criminal lifestyles increase by taking part in prison-based substance abuse treatment programs? Also, the study seeks to find out how an individual's motivation for change can be determined. More specifically, can the participant's score on the URICA and SOCRATES instruments for stages of change that are designed to help in determining an individual's motivation for changing a criminal or an addictive behavior be applied to determine post-release rehabilitation?
The Hypothesis of the Study
Most previous studies examining the significance of motivation for change in substance abuse treatment have concurred that motivation is a key element as far as the treatment is concerned. However, the relationship between motivation for change and substance abuse treatment is not so clear.
Furthermore, it is presumed that the instruments for determining an individual's readiness to change, namely the SOCRATES and the URICA, could be successfully applied to determine post-release stability and adjustment, as well as post-release maladjustment in terms of recidivism and relapse. However, basing on the previous studies, this study has hypothesized that:
- H1: Motivation for change enhances the outcome of prison-based substance abuse treatment programs.
- H2: The SOCRATES and the URICA could be applied to determine post-release rehabilitation.
Nature of Study
This study seeks to analyze both primary and secondary data. The secondary data are basically collected from books, journals, and articles about the topic of study. Essentially, case studies will be analyzed as secondary sources to examine what the existing literature states regarding the relationship between motivation for change and substance abuse treatment among inmates.
The study also seeks to examine the effectiveness of the instruments that have been designed to determine the stages of change in substance abuse treatment. Primary data are obtained through the use of questionnaires, which will be randomly distributed to sampled respondents.
The term "motivation" has been defined differently by authors. According to Princeton University Cognitive Science Laboratory's WordNet, which is a lexical database that documents the English language, the term "motivation" is defined as a psychological feature that stimulates an organism to act to attain the desired goal; the motive for action; something that provides direction and purpose to behavior (Motivation, n.d.).
Another definition was provided by cognitive scientists who defined motivation as an internal force that generates actions based on the momentary balance between environmental demands and an individual's needs (DiClemente, 2003). In this study, motivation is considered as an inner drive that inspires an individual's willingness to do something without being forced.
This is considered a form of transformation from one state to another. About the study, it is expected that motivation for change will transform individuals from their previous addictive behaviors to a new state of a healthy lifestyle. Therefore, the process of transformation from old habits to a new lifestyle free of crimes and addictive behaviors is what is considered a change in the study.
Also referred to as drug abuse, substance abuse is the routine use of drugs in amounts or through methods that are not approved by medical practitioners, resulting in addictive behaviors. It is important to note that substance abuse has not only been used to denote dependency, but it also applies to non-medical contexts (Naffer et al., 2008).