Treatment motivation among caregivers and adolescents with substance use disorders
Treatment motivation among caregivers and adolescents with substance use disorders
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DOI：
10.1016/j.jsat.2017.01.003
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发表时间：
2017-04-01
影响因子：
3.9
通讯作者：
Levy, S.
中科院分区：
文献类型：
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作者：
Cornelius, T.;Earnshaw, V. A.;Levy, S.
青少年物质使用障碍对健康有长期的负面影响，可通过成功的治疗加以缓解。照料者在青少年参与治疗方面发挥核心作用；然而，研究还没有检查治疗动机和进入治疗的压力在照顾者/青少年二人组。研究表明，内部激励治疗（与强迫治疗相反）往往会带来更好的结果。我们使用自决理论（SDT）来检查护理者和青少年在SUD治疗中的交叉动机叙述。研究还探讨了动机、照顾者压力解释、青少年自主性和亲缘关系之间的关系。对接受SUD治疗的青少年及其照顾者（N-Dyads = 15）进行治疗经历访谈。访谈对治疗动机进行了编码，包括外在动机（例如，受到惩罚的动机）、内在动机（例如，受到内疚的动机）和识别/整合动机（例如，将行为视为自我的一部分）。治疗动机的内化、自主支持/能力（例如，照顾者对青少年决策的支持）和相关性（例如，接受和支持）也被编码。确定了四种双重类别：同意治疗是由青少年（内在）驱动的；同意治疗是由照顾者（外在）驱动的；同意治疗的动机是两者兼而有之，或转向青少年控制（混合/过渡）；分歧（青少年和照顾者都声称自己推动了治疗；矛盾）。自主支持和亲缘性在内在组合中最显著，在外在组合中最不显著。混合/过渡组在自主性支持和相关性方面也很高。外在组将照顾者规则描述为一种不受欢迎的行为控制机制；其他组的照顾者将规则视为培养青少年能力和修复人际关系的一种方式，而青少年则将规则视为关怀而非控制。有内在动机的青少年最积极参与治疗。结果表明内在动机治疗的重要性，并强调自主支持和相关性作为可能促进治疗参与的机制。(C) 2017爱思唯尔公司版权所有。
Substance use disorders (SUDs) in adolescence have negative long-term health effects, which can be mitigated through successful treatment. Caregivers play a central role in adolescent treatment involvement; however, studies have not examined treatment motivation and pressures to enter treatment in caregiver/adolescent dyads. Research suggests that internally motivated treatment (in contrast to coerced treatment) tends to lead to better outcomes. We used Self-determination theory (SDT) to examine intersecting motivational narratives among caregivers and adolescents in SUD treatment. Relationships between motivation, interpretation of caregiver pressures, adolescent autonomy, and relatedness were also explored. Adolescents in SUD treatment and their caregivers (N-Dyads = 15) were interviewed about treatment experiences. Interviews were coded for treatment motivation, including extrinsic (e.g., motivated by punishment), introjected (e.g., motivated by guilt), and identified/integrated motivation (e.g., seeing a behavior as integral to the self). Internalization of treatment motivation, autonomy support/competence (e.g., caregiver support for adolescent decisions), and relatedness (e.g., acceptance and support) were also coded. Four dyadic categories were identified: agreement that treatment was motivated by the adolescent (intrinsic); agreement that treatment was motivated by the caregiver (extrinsic); agreement that treatment was motivated by both, or a shift towards adolescent control (mixed/transitional); and disagreement (adolescents and caregivers each claimed they motivated treatment; conflicting). Autonomy support and relatedness were most prominent in intrinsic dyads, and least prominent in extrinsic dyads. The mixed/transitional group was also high in autonomy support and relatedness. The extrinsic group characterized caregiver rules as an unwelcome mechanism for behavioral control; caregivers in the other groups saw rules as a way to build adolescent competence and repair relationships, and adolescents saw rules as indicating care rather than control. Adolescents with intrinsic motivations were the most engaged in treatment. Results suggest the importance of intrinsically motivated treatment, and highlight autonomy support and relatedness as mechanisms that might facilitate treatment engagement. (C) 2017 Elsevier Inc. All rights reserved.