Psychology

Many research studies explore the role of motivation in the management substance abuse - a worldwide social problem, and prove that motivation for treatment is a core variable for a drug addicted persons engagement in the treatment programs.

Motivation is a predictor of participation in the treatment, responsiveness to treatment, treatment completion as well as positive outcomes among treated individuals and needs to be the primary focus during treatment interventions (Conner, Longshore,  Anglin, 2009 Davey-Rothwell, Frydl,  Latkin, 2009 DiClemente, Bellino,  Neavins, 1999 Joe, Simpson,  Broome, 1998 Knight, Hiller, Broome,  Simpson, 2000 Longshore,  Teruya, 2006 Prendergast, Greenwell, Farabee,  Hser, 2009).

Findings from numerous studies indicate that highly motivated individuals are more likely than low motivated ones to be actively involved in treatment, to undergo the entire prescribed course of treatment, and to have better outcomes (De Leon  Jainchill, 1986 Prendergast et al., 2009).  Low motivated individuals were more likely to drop out of treatment early (De Leon  Jainchill, 1986).

Prendergast et al. (2009) cites the works of Simpson, Joe, and Rowan-Szal, who reported that among patients in community treatment programs, those with high motivation for change at the moment of treatment admission (measured as desire for help) were nearly twice as likely to have positive outcomes for substance use as those with low motivation.

Results from other study, which explored effectiveness of the Californias Substance Abuse and Crime Prevention Act (SACPA) program showed that motivation is related to severity of drug use, and was weak, but important predictor of program completion however motivation did not prove to be significant predictor of post-treatment relapse (Prendergast et al., 2009).

Purpose of the literature research is to review published clinical studies exploring the motivation as a construct and treatment readiness as a particular motivational dimension in  the treatment engagement in individuals with substance abuse potential predicting factors for treatment retention as well as interventions that can reinforce and enhance the motivation will be reviewed.

Literature review will serve as a theoretical framework for the study, which has to test the motivation in order to make a prediction of the therapeutic engagement in Drug Treatments Programs in Greece.
Readiness for treatment as a Predictor of Therapeutic Engagement in Drug Treatment

Literature Review
Motivation is seen by DiClemente et al. (1999) as a dynamic, changing and changeable process, as a state of readiness to change, and it is significant predictor of participation in the treatment.  More and more patients are identified through screening programs and directed for early interventions or court-ordered treatment interventions, and these individual are usually ambivalent and unmotivated, as DiClemente et al. state, the earlier the intervention occurs, the less is the motivation.  Authors emphasize that is not the same to be motivated for treatment and to be motivated for change, as it is important  to be motivated to change the behaviour and not only participate in treatment of one or another substance abuse.  Thus motivation is a part of the change process, through which individuals are moving either with treatment of through self-change.

Currently, identification and early intervention programs become more proactive and the attempts to interfere effectively with problems of substance abuse in primary care settings, court diversion programs, prison intervention programs, and more usual inpatient and outpatient treatment programs must focus and pay more attention to individuals motivation (Carroll et al., 2009 Conner, Longshore,  Anglin, 2009 DiClemente et al., 1999 Falck et al., 2007 Hiller et al., 2002 Williams et al., 2006).
Internal motivation for the drug treatment has three dimensions as identified by Simpson and Joe (cited in Conner et al., 2009).  They are recognition of drug problem, desire for help, and treatment readiness.  It is argued that internal motivation is usually influenced by other factors, such as social factors, pressure from family members, loved ones, and the criminal justice system that can guide someone to start drug treatment, thus results and outcomes should be seen as a complex interplay of all factors (Conner et al., 2009 Falck et al., 2007 Gyarmathy  Latkin, 2008 Ryan, Plant,  OMalley, 1995).

Motivation is considered to be part of the process of change, and it can be influenced but not totally coerced (DiClemente et al., 1999).

Perceived need for treatment as one of the motivation dimensions is basic in the explanation of treatment use, as it is believed that treatment success depends on the willingness of those  receiving help to desire that help (Conner et al., 2009 Edlund, Unutzer,  Curran, 2006 Falck et al., 2007).

According to survey results, only one third of people who need treatment are participating in treatment programs (Gyarmathy  Latkin, 2008), and only 37 of individuals with alcohol, drug and mental disorders perceive the need for treatment (Edlund et al., 2006).

Conceptually, perceived need for substance abuse treatment is a complex embracing drug problem recognition, the desire for professional help, and a belief in problem solution (Falck et al., 2007).  For adults with dependency and drug abuse disorders, seeing a need for treatment may well be the necessary first step in the help-seeking process (Falck et al., 2007 Kertesz et al., 2006).  Individuals perceiving a need for treatment are more likely to enter treatment than those who do not.  Some existing evidence also suggests that perceiving a need for treatment is a predictive factor of staying in treatment as well as achieving better outcomes (Falck et al., 2007 Kertesz et al., 2006).

Knowing which factors are associated with perceived need for treatment can provide more understanding on who seeks substance abuse treatment and why.

In the multi-site, cross-sectional study Falk et al. (2007) explored perceived treatment need among non-incarcerated, not-in-treatment drug users in rural settings as well as the influence of various socio-demographic characteristics, social and legal issues, self-reported state of health, and recent drug use practices on perceived treatment need.

Results showed that 26.5 of participants reported a need for drug abuse treatment. It was also found that previous substance abuse treatment experience was significantly associated with perceived need for treatment.  Results of this study also suggest that individuals, who have participated in treatment program were more likely to have found it enough helpful to see the need in trying it again, despite of their return to substance abuse.

Impaired family and social relationships as well as legal issues are recognized indicators of drug abuse, but on the other hand, research also suggests that problems in these areas are frequently predictive of treatment entry (Falck et al., 2007).  From the practical perspective, authors suggest that quick screening of health status could be helpful to identify people who already perceive treatment need and then guide them towards possible treatment.

Entry into program for the alcohol or other substance abuse treatment is believed to be related to personal factors, such as severity of alcohol abuse symptoms, family and friend influence, previous treatment experience, and negative social consequence caused by alcohol abuse (Davey-Rothwell et al., 2009).  Treatment-seeking and avoiding drug users, is also associated with entry into substance abuse treatment.

Readiness for treatment as a dimension of motivation has been confirmed to be an important factor in predicting treatment retention, participation, and engagement (Joe et al., 1998 Davey-Rothwell et al., 2009 Longshore  Terya, 2006 Knight et al., 2000).

Treatment readiness has had different definitions it has been defined as the degree of commitment to reduce consumption of alcohol or other substances through participation in treatment (Joe et al., 1998) and it has been defined by as individuals perception of treatment need in order to change the behavior (De Leon, Melnick,  Kressel, 1997).

Davey-Rothwell et al. (2009) suggest looking at readiness for treatment as at a multidimensional system, which can be assessed through behavioral actions.  One of such core behavioural factor is the strategies that individuals use to control their substance abuse practice.  Such strategies include choosing alternative activities to drug use, avoiding alcohol andor drugs, creating closer relationship with people who do not use alcohol or drugs.

Findings from longitudinal study where Davey-Rothwell et al. (2009) explored the relationship between behaviors done to control substance abuse and treatment entry supported that avoiding people and places for drug consumption and reducing frequency and amount of drug used may be a successful strategy for the treatment entry.  Researchers also found that each additional activity performed to control drug use increased the likelihood of entering into treatment program by 10, thus took a person closer to the readiness for treatment.

Findings from the third national drug abuse treatment outcome study (DATOS), proved that motivation in general and readiness for treatment in particular were the significant factors predicting treatment engagement and retention and they were more important than socio-demographic and drug usage factors (Jo et al., 1998).

Longshore and Teruya (2006) suggest that readiness for the treatment should be considered together with resistance (skepticism with regards to the benefits of treatment).  As show the research findings, readiness for treatment predicted treatment retention during the 6-month period and resistance predicted drug use, especially in the cases when the treatment referral was coercive.

Both the dimentions and extent of the individuals motivation for behavior change are significantly potential moderators of participation in the treatment and success in the recovery process (DiClemente et al., 1999).

Motivation, as a cor element in the treatment and recovery, influences individuals move and progression through the stages of change- from addmiting and thinking about change, to take the decision to change, to leading to the planned action into sustained recovery (DiClemente et al., 1999).  Dimensions of motivation, especially readiness for treatment can be explored and better understood using models of behavioral change.

Multiple models of behavioural change were previously developed (Conner et al., 2009).  The Transtheoretical Model developed by Procaska and DiClemente (1983) is currently the most prominent and widely used model as it unifies many concepts of the previous models of behavioral change (Conner et al., 2009 Duvall et al., 2009 Prendergast et al., 2009 Williams et al., 2006 Withelaw, Baldwin, Bunton,  Flynn, 2000).

The Transtheoretical Model outlines behavior change through three core systems Stages, Levels, and Processes of Change (Conner et al., 2009 Prendergast et al., 2009 Withelaw et al., 2000).

The first major systems of the Transtheoretical Model, the Stages of Change represent transitory, motivational and developmental sides (features) of progressively greater commitment to change (motivation) (Conner et al., 2009 Prendergast et al., 2009 Prochaska, DiClemente,  Norcross, 1992).
As further described by Conner et al. (2009), there are five stages relevant to alcohol and drug abuse 1) pre-contemplation stage when the individual does not yet recognize problem arising from drug use and is not thinking about change 2) contemplation stage when the individual recognizes problems arising from drug use and is considering change but remains ambivalent  3) preparation stage when  the individual plans upcoming change of behaviour 4) action when the individual takes an action, thus change the behavior (e.g., stops using drugs or enters drug treatment) and 5) maintenance stage when the individual works on relapse prevention and  consolidation of the steps taken earlier.
The second major systems of the Transtheoretical Model, the Levels of Change, is a framework for identification of important problem areas that individuals are facing while attempting to start behaviour change (Conner et al., 2009 Prochaska et al., 1992).

Following are the levels of change that are believed to be involved in commencement and cessation of behavior change in alcohol use and substance abuse SymptomaticSituational, Maladaptive, Interpersonal Conflicts, Family Systems Conflicts, and Intrapersonal.

The levels help to identify the amount and gravity of problems. The problems can appear at any level or at several levels. The purpose of the levels with regards to the change process is to identify issues that may interfere with an individuals ability to move through the stages of change to the Maintenance Stage (Conner et al., 2009).

The third major system of the Transtheoretical Model, the Processes of Change helps moving and progressing through the stages of change (Conner et al., 2009).  There are defined four types of processes of change cognitive, emotional, behavioral, and environmental.

The two processes of change - Consciousness Raising (is a cognitive process of getting information regarding the problem) and Dramatic Relief (emotional response to problem recognition), are prominent when individual is moving from pre-contemplation to contemplation stages (Conner et al., 2009 Withelaw et al., 2000). Stages  preparation and action are considered function of behavioral and environmental processes of change.

Research in understanding what motivates individuals to seek treatment and to change the behavior more often explores internal factors however external reasons are interrelated with the internal reasons and both are important in seeking treatment, treatment readiness and success (Conner et al., 2009 Ryan et al., 1995).

Conner et al. (2009) explored the relationship between external pressure and internal motivation for change with regards to dramatic relief, which is the component of process of change.  Results from the study using structural equation modelling on data from 465 drug users who were entering the treatment showed that internal motivation together with external pressure positively and predicted dramatic relief, which further significantly predicted attitudes towards drug treatment dramatic relief is high when external pressure and internal motivation are high, and this interrelation results in positive attitude toward drug treatment.

The findings from this study signify that, along with internal motivation, external pressure can also be effective for motivating change, but this pressure must become internalized.  Dramatic relief is often experienced when those with drug dependence are seeking treatment and are recognizing the association between the drug use, the caused problems, and the concerns that people around them expressed.  It is thought necessary to identify and implement processes that support dramatic relief (Conner et al., 2009).

Dramatic relief is an emotional dimension of process of change, which urge individuals to admit their addictive behaviour and it impact on themselves and relatives and dramatic relieve is believed to be one of the processes that takes individuals with drug abuse and dependence disorders from the pre-contemplation stage to the contemplation stage (Conner et al., 2009).

Existing research evidence prove that motivational interviewing, grieving losses, psychodrama and role playing as well as facilitated group discussions among drug users are the intervention promoting Dramatic Relief (Conner et al., 2009 Prochaska et al., 1992).

Several other studies also explore treatment readiness from the perspective of the behavioural change of Transtheoretical Model (Duvall et al., 2009, Rapp et al., 2007 Williams et al., 2006).

Exploring the treatment readiness of pre-treatment population Rapp et al. (2007) found that both factors - desire for change and treatment reluctance - were important in the readiness process.  Further, Rapp et al. argue that  staff may assist individuals become ready to start treatment program by professional interacting with them during assessment period and  can facilitated the process not by directly promoting treatment- as desire for help, but by guiding person to identify personal reasons for change.

It is important to emphasize behavioural change rather than the need for help, at least for those individual who are low motivated (Rapp et al., 2007).  Friendly and supportive relationship may help individuals to overcome barriers interfering with treatment readiness.

Duval et al. (2009) studied the specificity of rural population of substance abuses with regards to readiness to change based on Transtheoretical Model.  Findings from the research suggest that increasing intentions to change were effective in reducing frequency of drug use and other drug abuse related behaviors for rural substance abusers.

The effect and focus of brief counseling in the primary care setting for patients, who were found positive after screening for alcohol misuse depend on patients receptivity and the presence of denial or readiness (Dijkstra, De Vries,  Roijackers, 1999 Williams et al., 2006).

In the study performed in the primary care setting with 6419 participants, readiness for change was measured using a brief questionnaire this questionnaire later was analysed based on the algorithm  and categorized patients who misuse alcohol into pre-contemplation, contemplation, or action groups according to the transtheoretical model.  Findings showed that 75 of the patients expressed some readiness to change and authors argue that such sample questionnaire can be used at the primary setting and may help better tailor brief counseling to patients stage of readiness (Williams et al., 2006).

The importance of motivation and readiness for treatment and readiness for change is leading research in finding out predictors of the motivation as well as possible ways to enhance and maintain individuals motivation and readiness.  Finding from several studies support effectiveness of brief motivational interventions, such as motivational interviewing (MI) in increasing participation in treatment programs in substance abusing population (Bertholet, Horton,  Saitz, 2009 Carroll et al., 2009 Stein et al., 2009 Winhusen et al., 2008).

In primary care brief intervention is recommended and clinicians are encouraged to assess motivation and readiness to change (Bertholet et al., 2009). Changes in readiness are presented as short term goals towards decreased consumption.  Bertholet et al. (2009) explored the change in readiness, importance and confidence with regards to changing drinking pattern after a single primary care physician visit and improvements in these dimensions and drinking pattern 6 months later. After the visit, significant increase in readiness, importance, and confidence was observed most patients with alcohol misuse improved 6 months after a brief intervention during primary care visit, expressed as a change of behavioral dimensions or drinking patterns (Bertholet et al., 2009).

The effect on motivation of brief motivational interviewing (BMI) and motivational interviewing were explored in clinical studies by Stein et al. (2009) and Carroll et al. (2009).

Results from earlier published studies evaluating MI impact on drug-using populations have shown that MI is more effective than no treatment however Caroll et al. (2009) argue that several well-structured and conducted studies evaluating MI with comparatively large samples of drug-using individuals have presented few significant differences between MI and standard care.

Results from randomised clinical trial by Caroll et al. evaluating MI effectiveness were similar 1) although overall treatment retention was comparatively high, participants from MI group were significantly more likely to still be enrolled in the program one month after randomization 2) regarding outcomes of substance use, overall significant decrease in frequency of substance use observed, but no significant differences by intervention condition. There were however some indications that it was most effective in enhancing retention for those, who stated that alcohol was their primary substance used.  Authors suggest that more future research is needed to determine the efficacy of MI in the patient groups with multiple substance use.

Among the predictors of pre-treatment readiness to change drinking pattern is a history of self-reported experience of negative consequences related to alcohol misuse this supports the thinking that there must be at least minimal  recognition of alcohol consequences present in order to achieve sustained effect after BMI (Stein et al., 2009).

Stein et al. (2009) found interesting outcomes that BMI is helpful for those, who are already highly motivated and two sessions of BMI are effective and helps research sustainable motivation to change.
Additionally, Stein et al. concluded that  patients, who received MI were more likely to create a plan for change  for reducing negative consequences from alcohol misuse and those, who received two sessions of MI were more likely to complete a quality change plan than were those, who received only one MI session, and those with a quality change plan were more likely to remain highly motivated to reduce consequences of alcohol misuse through at least 3 months and 12 months following the intervention.

Wide range of existing empirically supported treatment interventions for individuals with substance abuse challenges health care providers as they need to select the best available technology  and they should be effective and innovative (Brown, 2000 Herbeck, Hser,  Teruya, 2008).   As Herbeck et al. (2008) argue, majority of innovative and evidence-based substance abuse interventions have been shown to be clinically effective, they are not always widely used. Health care providers are the main and critical partners in the diffusion of innovative practices, and they can influence the practice and delivered care (Sullivan et al., 2005).  Better understanding effectiveness and use of new intervention positively implicates the extent at which the intervention is used thus can contribute to better patient outcomes (Herbeck et al., 2008).

Study performed by Herbeck et al. (2008) examined health care provider attitudes towards the effectiveness of empirically supported and innovative treatment interventions, and the extent, at which these interventions were used in relation to training and information resources about the program.  Results showed that majority of respondents (5580) reported using such programs as Supportive Expressive Psychotherapy, Motivational Enhancement Therapy, and Community Reinforcement Approach.  However, about half of the health care providers were not aware of the effectiveness of several pharmacological substances used in the treatment programs.  Knowing the providers perspective and training resources are helpful in enhancement of empirically supported interventions (Herbeck et al. (2008).

Recent studies have also explored cognitive indicators of treatment engagement by focusing on the individuals expressions of their commitment to treatment and change and progress during the treatment period (Broome, Knight, Hiller,  Simpson, 1996).  Further, Hiler et al. (2002) cited the published works from the Drug Abuse Treatment Outcome Studies (DATOS) by Simpson and Curry (cited in Hiler et al., 2002) of the community substance abuse treatment, where findings suggested that treatment motivation is associated with psychological measures of engagement in the treatment and higher motivation was associated with improved perceptions of personal progress and with stronger intentions to continue the treatment.

Hiler et al. (2002) found similar outcomes in their study investigating motivation and engagement in treatment in a correction-based community.  Higher personal involvement in the treatment program resulted in stronger feeling of psychological safety participating in the program.

The teams of substance abuse treatment system devote considerable resources into assessing substance abusers and directing them towards treatment.  However, due to existing barriers the rates of treatment entry following assessment are found to be very low (Rapp et al., 2006).

Several studies evaluated barriers that individuals with substance abuse indicate as challenges for the treatment engagement (Rapp et al., 2006 Redko, Rapp,  Carlson, 2006).  The waiting period, including being on a waiting list that is generated by the treatment program is often recorded among the most usual barriers for individuals seeking treatment (Appel, Ellison, Jansky,  Oldak, 2004).  The longer substance users have to wait to be assigned to treatment, the more likely they will not be following through the treatment program (Hser, Maglione, Polinsky,  Anglin, 1998 Redko et al., 2006).  Results from the qualitative study showed that 53.8 of the participants stressed that waiting time was important barrier in the treatment engagement (Redko et al., 2006).

The barriers faced at the treatment entry are believed to be a part of the lifestyle of majority of substance abusers, as well as the system of substance abuse treatment (Rapp et al., 20006).

It is important to identify, assess and evaluate existing barriers in each particular case. Rapp et al. (2006) suggest to use BTI (Barriers to Treatment Inventory) instrument can be used by assessment staff and substance abusers and help to find out existing barriers at a treatment entry.  Instrument comprises seven BTI factors that represent the three areas of Andersens model of health care utilization 1) Absence of Problem (representing situational need) 2) Negative Social Support, Fear of Treatment, and Privacy Concerns (representing inhibiting) and 3) Time Conflict, Poor Treatment Availability, and Admission Difficulty (representing system).

The above findings regarding treatment engagement and the reported barriers for the treatment correlate with the results from the study exploring the early treatment exits.  In the study using mixed-method, Stevens, Radcliffe, Sanders, and Hunt (2008) examined phenomenon of early exit from drug treatment and aimed to estimate early exit rates, to identify those individuals who are most likely to exit early from the treatment program, to investigate the possible causes.

Study results showed that over two-thirds of the drop out is occurring between assessment and treatment entry (Stevens et al., 2008).  Number of drug users from the study themselves attributed their disengagement to their own lack of motivation.  Lack of motivation as a reason for drop-out was supported as some drug users involved in criminal justice may be being referred when they have showed no willingness and need to enter the treatment program and thus contributed to high drop-out rate just after assessment (Stevens et al., 2008).

Researchers also state that  motivation may be viewed as a mutual process or as a result of the interplay between the service and the person, thus such factors as waiting times, prolonged assessment process, and  cancelled appointments can negatively influence and decrease persons motivation (Stevens et al., 2008).  Attrition was observed at each stage of process in the service- between referral and assessment, assessment and treatment and within the first month of treatment.  Stevens et al. (2008) suggested that staff of the treatment services need to find ways to improve contact with the drug users and ensure that this contact last as long as possible in order to achieve better treatment outcomes.

Knight et al. (2000) argue that patients are less likely to early discontinue treatment in residential drug treatment programs when they are either internally motivated - have a high level of treatment readiness, or externally pressured by the legal system to enter, participate, and remain in treatment.  Research results showed that even relationship between treatment readiness and external pressure were not statistically significant, that patients possessing higher levels of treatment readiness at the entry stayed in treatment at least 90 days, regardless of legal pressure.  The patients under legal pressure remained in treatment longer, regardless of treatment readiness.  Knight et al. conclude that motivational readiness for treatment was associated with greatest improvements in retention compared to legal pressure, and as legal pressure, was related to indicators of treatment engagement.
Treatment completion and retention rate in 2005 was reported to be only 44 in public funded programs and 36 in outpatient settings (Laudet, Stanick,  Sands, 2009).

Several studies examined the potential strategies to improve retention in treatment program and improvement in health and psychosocial outcomes (Hellemann, Conner, Anglin,  Longshore, 2009).
Hawkins et al. (cited in Laudet et al., 2009) argue that growing base of empirical knowledge regarding treatment attrition showed small impact on retention in services for individuals with addiction.  Prediction of retention were explored focusing on patient characteristics, treatment processes, client-counsellor alliance, as well as clients rating of personal satisfaction with the received services (Joe, Broome, Rowan-Szal,  Simpson, 2002 Hellemann et al., 2009 Laudet et al., 2009).  However, retention is a complex process and there is no single factor that may alone be considered as predictor of treatment retention (Hellemann et al., 2009).

Laudet et al., 2009 explored the reasons, for which the patients from outpatient setting were leaving the treatment and what factors would have kept them engaged in the treatment program.  Reasons for treatment exit were patient-related and service-related dislike of the program, substance abuse during treatment, interference with other activities, practical considerations, having no desire for help, personal issues, finance resources and not seeing the services helpful. Among the 33 of individuals who left the treatment and who admitted that something could have been done differently to retain them in services, unmet needs in social services were mentioned most (54.2) followed by willingness to see more supportive staff and greater flexibility in activity schedule (Laudet et al., 2009).

Problem recognition and substance use are two main patient-related barriers to retention problem recognition is crucial to desire for help.  In this study, 12 of patients who left the treatment reported that they were not willing or needing help and two thirds of the drop-outs reported that nothing could have been done differently to retain them in services. Authors point out that even it was not precisely defined the extent at which patient had not recognized the need for help compared to other obstacles, but it is likely to be significant.
 
Other question is the understanding of recovery (Laudet, 2007 Laudet et al., 2009) abstinence should be seen as a recovery however it patients accept it as the last resort when they have tried other strategies.

Findings show that motivation and especially treatment readiness dimension is important in retention. Laudet et al. (2009) argue that majority of patients know at the beginning if they are ready or not for the treatment, thus initial period of the program is very important to find out and assess the reasons for help seeking, experience with the treatment, and to overcome barriers to retention.  As it sis also suggested by Stein et al. (2009), it is necessary to assess patients motivation before entering the treatment.

There are several instruments for the assessment and evaluation of motivation by assessing stages of change (Prendergast et al., 2009).  These include the Recovery Attitude and Treatment Evaluator (RAATE), the Readiness to Change Questionnaire (RTCQ), the University of Rhode Island Change Assessment (URICA), the Texas Christian University motivation scales, and the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES).

Texas Christian University motivation scales (TCU) will be used in the study.

Conclusions
In conclusion, findings from literature review support the importance of motivation and treatment readiness as motivational dimension for the treatment engagement and positive treatment outcomes in the individuals with substance abuse.

It is believed that motivation, as a cor element in the treatment and recovery, influences individuals move and progression through the stages of change- from thinking and admitting change, to taking the decision to change, leading to the planned action into sustained recovery (DiClemente et al., 1999).

The treatment readiness was reviewed from the perspective of behavioral change based on stages of change according to Trastheoretical Model.

Low individuals motivation is also one of barriers for treatment entry and retention.

Brief motivational interventions, such as motivational interviewing (MI) are effective in enhancement of motivation and increasing participation in treatment programs in substance abusing population.