Factors associated with coercion in entering treatment for alcohol problems

Although the importance of coercion in entry to treatment for alcohol problems is recognized, few studies have focused on different types and levels of coercion among heterogeneous groups of clients entering treatment agencies. This paper describes demographic and problem characteristics associated with various sources and levels of coercion. More than 40% (n = 377) of individuals entering a representative sample of a county's HMO, public, and private indemnity-based non-DUI alcohol treatment services (n = 927) indicated they received an ultimatum to enter treatment from at least one person. The most common source of an ultimatum to enter treatment was from family members (n = 222), followed by the legal system (n = 78), and healthcare professionals (n = 55). Respondents experiencing pressure to enter treatment reported that ultimatums from more than one source were common. Individuals entering treatment who were most likely to report being coerced were white, young adults (age 18-39), and married or living with a partner. When controlling for demographic characteristics and problem severity, family problem severity and legal problem severity predicted having received an ultimatum to enter treatment. Alcohol and drug problem severity were not related to receiving a treatment ultimatum.