Examining the Relationship Between Treatment Readiness and Substance Use Treatment Initiation and Engagement

Lincoln Sloas

Major Professor: Faye S. Taxman, PhD, Department of Criminology, Law and Society

Committee Members: Danielle Rudes, Devon Johnson, Michael Caudy

Commerce Building, #3006
April 13, 2015, 10:00 AM to 07:00 AM


With nearly 70 percent of the criminal justice population experiencing substance use related issues, treatment is a sound strategy to combat these issues (Chandler, Fletcher, & Volkow, 2009). Despite the promising nature of substance use treatment, roughly 40 percent of individuals terminate treatment within six months (Joe, Simpson, Dansereau, & Rowan-Szal, 2014).  To achieve gains in efforts to use treatment as a tool to address substance abuse needs, it is important to understand the factors that influence positive or poor treatment outcomes.  One under researched area is treatment readiness which is theorized to be important to both initiate and engage in substance use treatment services, without which it is nearly impossible to complete treatment. Initiation refers to receiving a treatment session within 14 days after assessment (Garnick et al., 2014) whereas engagement refers to receiving 2 or more treatment sessions within 30 days after initiation (Garnick et al., 2014). This dissertation examines the impact of treatment readiness on initiation and engagement in substance use treatment programs. Using the transtheoretical model (TTM) of change, this research explores the following general hypotheses: 1) Treatment readiness will significantly predict substance use treatment initiation; 2) Treatment readiness will significantly predict substance use treatment engagement; 3)  Treatment readiness will increase the likelihood of initiating substance use treatment, controlling for other factors; and 4) Treatment readiness will increase the likelihood of engaging in substance use treatment, controlling for other factors. Data for these analyses are derived from the 2012 Substance Abuse and Mental Health Services Administration and the Center for Substance Abuse Treatment (SAMHSA/CSAT) data set (n = 5,443).  Stepwise binary logistic regression models were created to understand the factors that affect both treatment initiation and engagement.  The findings for this dissertation provide support for the overall effect of treatment readiness on substance use treatment initiation and engagement. Individuals having support from family and friends are more likely to initiate substance use treatment.  Engagement is more likely to occur for those individuals who experience more substance use, commit more illegal activities and have more physical health problems.  Treatment readiness is affected by other factors including demographics (e.g., race, gender, age).  Treatment readiness significantly predicts initiating and marginally predicts engaging in substance use treatment. From a policy perspective, interventions should be used to enhance individuals’ levels of treatment readiness before being referred to treatment services thus increasing their likelihood of initiating and engaging in treatment services. Further research is needed in the area of engagement to better understand factors that predict outcomes.