Is the patient ready? Is that even relevant?

If you've ever made or overheard the comment “He just wasn't ready” after witnessing an adverse patient outcome in treatment, a read of the latest research might have you rethinking that.

Researchers studying a number of variables for predicting engagement in treatment have found that the one in which they had the most faith going into the study—treatment readiness—did not show significant results.

While some individual-level characteristics did appear to be related to patients' level of engagement, the study as a whole suggests that programs and professionals might need to look elsewhere—namely, inward—for the most meaningful predictors of patient success.

“It's important to begin to think about some of these program-level issues,” Lincoln Sloas, PhD, lead author of the study and assistant professor at Florida Atlantic University's School of Criminology and Criminal Justice, tells Addiction Professional. “We need to look at how we can tailor programming to the needs of people.”

Details of study

First published online in the Journal of Drug Education in late February, the study used data from the Global Appraisal of Individual Needs-Intake (GAIN-I) 2012 data set, a nationally representative sample of adult patients. The data set included patients in a variety of levels of care from residential to outpatient, and included a combination of patients in voluntary and mandated treatment.

Treatment readiness was measured with use of indices that assessed motivation and resistance. To measure motivation, individuals are asked questions such as whether they believe they can get the help they need in a treatment program, and whether they need support from loved ones to deal with their substance use. To measure resistance, individuals are asked questions such as whether they believe being in treatment is too demanding, or whether they have too many other responsibilities that impede their ability to pursue treatment.

The researchers measured readiness and other variables against treatment engagement, defined as remaining in treatment for more than 30 days and attending more than two sessions. These were among their findings, some of which came as a surprise:

• There was a positive relationship between treatment readiness and treatment engagement, but this was not found to be statistically significant.

• Greater frequency of substance use slightly increased the odds of engaging in substance use treatment. “We might have thought the opposite,” says Sloas.

• Men were less likely than women to engage in treatment, and whites and blacks were less likely than other races to engage in treatment.

• Married individuals were 23% less likely to engage in treatment than never-married individuals (again, a somewhat surprising finding given the apparent importance of support from loved ones).

The researchers wrote that the findings suggest that “individual-level risk factors (across a variety of domains) may not be the most robust predictors of engagement.” They added, “To better inform efforts to improve treatment engagement, it is important to look beyond individual-level risk factors and consider the interaction between individual- and program-level factors.” such as the composition of a program's services and staff.

They said, however, that some of the individual-level findings could indicate a need for more attention to motivational enhancement strategies that specifically target certain subgroups, such as men.

The study paper points out that treatment readiness remains a challenging concept for the field to grasp because there is no uniform standard for how to measure it.