Perceived coercion among clients entering substance abuse treatment: structural and psychological determinants

Little is known about the extent to which admission to alcohol and other drug treatment programs is perceived as a coercive imposition. This is because coercion is typically inferred from referral source rather than measured. In this study, clients (N = 300) entering substance abuse treatment were assessed on structural variables (sociodemographic background, criminal history, current legal status, referral source), psychological variables (personal beliefs about substance abuse, perceived interpersonal pressures), alcohol/drug use, and perceived coercion. Mandated treatment status predicted perceived coercion; however, many mandated clients did not, and many self-referrals did, report being coerced into treatment. Psychological factors accounted for additional variance in perceived coercion, controlling for referral source. Substance dependence did not add to the predictability of perceived coercion beyond structural and psychological variables. These findings are inconsistent with the notion that coercion can be inferred from referral source. Instead, results support self-determination theory (Deci & Ryan, 1985), which proposes that multiple social and psychological events promote perceived coercion by undermining personal autonomy.