Examining the Relationship Between Psychological Functioning, Trauma History, and Perceived Coercion Among Drug Court Enrollees

Background/Purpose: Despite high rates of co-occurring post-traumatic stress disorder among individuals in treatment for substance use disorders, agencies rarely screen for trauma (SAMHSA, 2013); this is particularly true in mandated treatment settings. Psychological functioning and trauma history have been empirically linked to substance use outcomes among drug court enrollees; however, the role of trauma in relation to treatment motivation remains unclear. Very little research has examined the degree to which trauma history is uniquely related to perceived coercion (i.e., an important factor in motivation) in mandated populations (while considering pre-arrest substance use and other psychological factors). The purpose of this study was to describe the degree to which adverse trauma history and psychological functioning are associated with perceived coercion in a population of drug court enrollees.

Study Objectives: This study had the following exploratory objectives 1) examine the relationship between trauma history, psychological functioning, pre-arrest alcohol and other drug use (AOD), and perceived coercion in a population of drug court enrollees and 2) examine the variance in perceived coercion uniquely explained by trauma history, controlling for psychological functioning and pre-arrest AOD use.

Methods: To be eligible, study participants had to be 18 years of age or older, understand English, and score > 6 on either the Alcohol Use Disorders Identification Test (AUDIT) or the Drug Abuse Screening Test (DAST). Fifty-five participants completed the survey packet. Recruitment of new drug court enrollees occurred outside of the drug court session.  Eligible and consenting participants were offered a monetary incentive to complete a series of self-report measures. The current analysis focused on a single item to measure pre-arrest substance use: “Prior to arrest, how many days during the week did you use any alcohol or drugs?”  Trauma history was assessed with the Adverse Childhood Experiences (ACE; Felitti, et al., 1998) instrument and psychological functioning was measured with the Brief Symptoms Inventory (BSI; Derogatis, 1975). Perceived coercion was measured with the Perceived Coercion Questionnaire (PCQ, Klag, Creed, & O’Callaghan, 2006).

Results: A hierarchical multiple regression analysis demonstrated the degree to which trauma history and psychological functioning were associated with perceived coercion. The overall regression model explained 24% of the variance in perceived coercion (F(4, 48) = 5.072, p < .01).  In this sample of drug court enrollees, higher BSI and ACE scores were associated with higher perceived coercion (β= 6.65, p<.05 and β=3.60, p<.01 respectively), controlling for gender and pre-arrest AOD use. ACE scores accounted for a significant proportion of variance after controlling for gender, pre-arrest AOD use, and BSI scores, R²change= .11, F (1, 48)=7.60, p<.01.  

Implications:  Based on these preliminary findings, drug court practitioners are urged to assess the behavioral health and trauma histories of clients entering treatment. While pilot sample size is a limitation, findings suggest a need for trauma-informed practices combined with motivational enhancement techniques in practice with individuals mandated to treatment via drug courts. Ultimately, findings point to the importance of assessing trauma in mandated populations.