Referral sources and substance abuse treatment outcomes at discharge

Background: Believing that individuals should be intrinsically motivated, rather than extrinsically forced to change, those who are forced into treatment are known to be less motivated and more resistant compared with those who enter voluntarily. Persons who are forced to participate in substance abuse treatment programs (i.e., engage treatment by being referred by criminal justice) therefore should be less likely to complete the treatment. On the contrary, studies have documented that legal pressure can effectively motivate and engage them in treatment. Hence, clients who enter treatment programs involuntarily should achieve better outcomes, compared to those who engage treatment programs voluntarily. Methods: Using descriptive statistics and multivariate analyses, we compared differences in three treatment outcomes (i.e., length of stay in the treatment, treatment completion, substance abstinence at discharge) between referral sources, especially between criminal justice and other referral sources such as self-referrals, health professionals, government agencies or other public organizations. Analyses were conducted using more than ten thousand individual clients admitted to treatment programs between 2001 and 2005 in a Midwestern state. Results: We found that self-referred clients were least likely to complete the program, with shorter lengths of stay. Clients who were referred by the criminal justice system were more likely to be abstinent at discharge. Conclusion: The results support the hypothesis that forced entry into treatment programs can be a more effective strategy for successful treatment. However, differences in the levels of treatment motivation and readiness among the clients between referral sources need to be further examined.