The Effect of Motivation and Housing on Substance Abuse Treatment Participation in Probationers

Background and Purpose: People with substance abuse problems are overrepresented in justice systems. Behavioral health treatment can positively affect outcomes for this population. However, treatment’s impact depends on utilization. In the general population, motivation and economic stability are facilitators of treatment participation. Given coercion and economic and social instability are common among justice-involved people, these facilitators may not be relevant indicators of treatment readiness in this population. Drawing on probationers’ self-reported motivation for treatment and indicators of housing instability (proxies for economic instability), the current study investigates the way in which these potential facilitators of treatment participation operate among probationers with substance abuse problems, asking:

• Is treatment motivation associated with behavioral health treatment participation?
• Is housing instability associated with behavioral health treatment participation?
• And, does housing instability alter the effect of treatment motivation on treatment participation (i.e., does housing instability moderate the association between treatment motivation and treatment participation)?

Methods:This study uses a longitudinal design to assess predictors of treatment participation across 12 months for a cohort of probationers with substance abuse problems in San Francisco, California (N=3,025). Predictors include self-reported treatment motivation (perceived potential benefit of alcohol or drug treatment), housing instability (number of moves in year prior to start), and homelessness. Dependent variables included treatment initiation (any treatment within 12 months) and treatment engagement (# of days receiving treatment within 12 months). Controls included age, race, and gender.  We used logistic- and negative binomial regressions to measure the associations between independent and dependent variables, and test moderation.

Results:Results indicate treatment motivation is positively associated with treatment initiation and engagement; probationers who perceived a benefit to drug or alcohol treatment had 85% (OR=1.85, p < .01) greater odds of initiating treatment than those who did not perceive a benefit to treatment; probationers who perceived a benefit to drug or alcohol treatment had a treatment rate 1.72 times the treatment rate of those who did not perceive a benefit to treatment (B=0.54, p<0.05) or, on average, received 2.5 more treatment days. Housing instability and homelessness were not associated with treatment initiation or treatment engagement, and interactions between motivation and housing variables were not statistically significant.

Conclusions and Implications:Results indicate that motivation for treatment is associated with treatment participation, including initiation and engagement, among probationers with substance abuse problems, as it is among non-justice involved populations. However, social and economic instability (as indicated by housing stability and homelessness) are not associated with treatment participation.  In addition, probationers’ motivation to receive treatment appears independent of socioeconomic instability. These results provide insights for social work, suggesting (1) stated motivation for treatment is an adequate criteria for targeting limited treatment resources among receptive probationers, and (2) motivation enhancing interventions are likely to increase participation in substance abuse treatment among the justice involved.