Assessing Motivation and Readiness for Treatment for Substance Use Disorders

Abstract

Background: Patients who complete inpatient treatment and receive appropriate aftercare such as follow-up doctor appointments and referral to outpatient therapy, have better sobriety rates and health outcomes. Patients who chose to leave a substance abuse treatment center against medical advice experienced worse health outcomes and re-admissions compared to those who were successfully discharged after thirty-day in-patient program completion. Patients who were discharged against medical advice were seven times more likely to be admitted or readmitted within fifteen days. Local Problem: Over the last three years a substance abuse treatment center experienced a significant increase of patients leaving treatment against medical advice. The against medical advice discharge rate at this facility increased almost ten percent over this timeframe. A designated team complete a quality improvement project, using a self-reporting assessment tool to determine if readiness for treatment improved retention rates. Interventions The purpose of this quality improvement project was to assess the circumstances, motivation and readiness for treatment of newly admitted substance use disorder patients at a Mid Atlantic substance abuse treatment center. The Circumstances, Motivation Readiness (CMR) scale was used for these purposes. Results: The majority of the patients scored in the moderately high to high for the CMR subscales and total scale, indicating lower risk of leaving against medical advice. Yet, there was no significant difference between the total scores of those who remained in treatment for the full 30-day requirement or left AMA. However, there were positive correlations between LOS and the readiness subscale (p= 0.047) and total scores (p= 0.0346). There was no significant difference scores for either gender, ethnicity or drug of choice. Conclusion The CMR scale presented a feasible mechanism to identify substance use disorder patients’ readiness for treatment and risk for dropping out. The CMR scale may be of greater use in assessing risk for AMA discharges by counselors during initial intake into the facility by focusing on the individual statements to specifically identify characteristics that would place patients at higher risk for AMA.