MEASURING COERCION/COMPULSION TO DRUG TREATMENT

描述：（申请人的摘要）强迫的道德和效用 个人接受药物滥用或精神卫生服务是 激烈辩论的话题。 该领域的研究一般局限于 在狭隘的法律的范围内进行不受控制的审判，例如法院下令 治疗或非自愿民事承诺。 药物治疗的结果 然而，文献表明，没有合理的基础， 主要基于胁迫和强迫的法律的来源，因为： 行政机关的授权常常是无效的; B）数据表明，强制 和强迫在多个心理社会领域起作用;以及c） 最有影响力的压力是在非正式的、法外的领域。 一些 研究表明，这些非正式的压力可以成功地利用， 以达成双方一致的治疗目标 这份修订后的申请概述了初步研究， 和非强制性因素。 我们已经明确指出 强制、强制和非强制的操作性表述， 建立行为原则;设计可靠的评估程序 这些结构;估计的水平和类型的胁迫和 非强制性的压力在戒毒门诊可卡因治疗。 修订后的提案将审查：1）对胁迫、强迫、 和非强制性的压力在不同的药物治疗方案; 2） 性别和种族群体之间对这些结构的看法; 3）患者 和治疗师的优势。 我们亦会研究 这些压力与4）治疗期限、依从性和 结果; 5）受试者改变的动机;和6）控制点。 三 将对5个不同治疗中心的100名受试者进行访谈， 感受到的强制性和非强制性的压力，治疗，并将完成 变化阶段和控制点问卷。 患者感知 的强制和非强制将与他们的主要 治疗师;与治疗师的任期、依从性和 结果;以及变化阶段和控制位点数据。 研究结果将对社会政策产生重要影响， 药物治疗的法律的授权以及道德和实践的发展 外地的指导方针。 了解影响治疗的因素 结果也将有助于定制更有效的临床 干预措施。

DESCRIPTION: (Applicant's Abstract) The ethics and utility of forcing individuals to receive substance abuse or mental health services is the topic of heated debate. Research in the area generally has been confined to uncontrolled trials in narrow legal contexts, such as court-ordered treatment or involuntary civil commitment. Findings from the drug treatment literature suggest, however, that there is no rational basis for focusing predominantly on legal sources of coercion and compulsion because: a) state agency mandates are frequently ineffective; b) data indicate that coercion and compulsion are operative in multiple psychosocial domains; and c) the most influential pressures operate in informal, extra-legal spheres. Some studies suggest that these informal pressures can be successfully leveraged in favor of mutually agreed-upon treatment goals. This revised application outlines preliminary research examining coercive and noncoercive factors in treatment entry. We have specified clear operational formulations of coercion, compulsion, and noncoercion through established behavioral principles; devised reliable assessment procedures for these constructs; and estimated levels and types of coercive and noncoercive pressures in drug-free outpatient cocaine treatment. The revised proposal will examine: 1) perceptions of coercion, compulsion, and noncoercive pressures across diverse drug treatment programs; 2) perceptions of these constructs between gender and racial groups; 3) patient and therapist vantages on these pressures. We will also examine the relationship of these pressures to 4) treatment tenure, compliance, and outcome; 5) subjects motivation for change; and 6) loci of control. Three hundred subjects at five different treatment sites will be interviewed on perceived coercive and noncoercive pressures to treatment, and will complete stages-of-change and locus-of-control questionnaires. Patients perceptions of coercions and noncoercion will be compared with those of their primary therapists; related to therapists global ratings of tenure, compliance, and outcome; and stage-of-change and locus-of-control data. The results will have important implications for social policies governing legal mandates to drug treatment and development of ethical and practice guidelines for the field. Understanding factors influencing treatment outcomes will also assist in tailoring more effective clinical interventions.