Reducing past harm appraisals during treatment predicts worse substance use outcome

Appraisals of the past harm from substance use have been associated with increased motivation and treatment seeking behaviors. Harm appraisals are subjective evaluations of the harm caused by substance use and differ from traditional consequences measures which assess the occurrence of adverse events related to substance use. Although influencing these appraisals is a central component to most treatments, no studies have examined how changes in these appraisals during treatment influence outcome. The present study examined how changes in appraisals of the past harm from substance use over the course of treatment influence short- and long-term substance use outcomes.

Participants were 252 individuals seeking outpatient treatment for a substance use problem. Participants were assessed at treatment entry, end of treatment (13 weeks), and 9 months post-baseline. All participants were given a battery of measures that assessed substance use, consequences, self-efficacy, motivation, treatment intensity, 12-step affiliation, and appraisals of harm. Past harm change scores from baseline to end of treatment recoded into 3 groups: increased, remained the same, and decreased (reduced their perception of the harm from substance use).

Reductions in appraisals of past harm from baseline to end of treatment predicted lower PDA and higher objective consequences at end of treatment and 9-month follow-up. There were no significant differences in outcome between those who increased versus maintained harm appraisals from baseline to end of treatment. Higher treatment intensity and 12-step affiliation were associated with fewer reductions in past harm appraisals.

Results of the present study suggest subjective appraisals of the past harm from substance use wane for some people during treatment and that helping clients maintain or increase their perceptions of the past harm from substance use over the course of treatment is associated with better short- and long-term outcomes.