Relationship and institutional pressure to enter treatment: differences by demographics, problem severity, and...

Studies have shown that individuals with substance-use problems frequently receive pressure to enter treatment. Pressure can come from institutions (e.g., criminal justice or welfare) or relationships (e.g., family or friends). Research has also shown that pressure can facilitate treatment entry. However, few studies have assessed how pressure from different sources varies.

Six hundred ninety-eight individuals entering residential or outpatient treatment for alcohol or drug problems completed face-to-face interviews soon after admission. Pressure was assessed by asking participants if others had suggested they enter treatment, including family, friends, and professionals within institutions. Additional assessments included the Addiction Severity Index and readiness to change.

Most of the participants (73%) reported some type of pressure: 29% from personal relationships, 30% from institutions, and 14% from both. The remaining 27% reported no pressure to enter treatment. Multinomial logistic regression of baseline data showed being on parole or probation, not being employed full time, and having more severe legal problems predicted pressure from institutions. In contrast, relationship pressure at baseline was predicted by severity of alcohol problems. Compared with participants receiving only relationship pressure, those receiving only institutional pressure had lower alcohol, drug, family, psychiatric, and medical severity. In addition, institutional pressure was associated with lower motivation at baseline, whereas relationship pressure was not related to motivation at all. When controlling for problem severity, baseline pressure was not associated with 12-month outcome.

Correlates of pressure from institutions for individuals to enter treatment differ from those associated with pressure from personal relationships to enter treatment. Implications of these findings for public policy, treatment, and further research are discussed.