MEASURING COERCION/COMPULSION TO DRUG TREATMENT

描述：(申请人摘要)强迫的道德和效用 接受药物滥用或精神健康服务的个人是 激烈辩论的话题。对这一领域的研究一般局限于 在狭隘的法律背景下进行不受控制的审判，如法院命令 治疗或非自愿民事承诺。药物治疗的结果 然而，文献表明，集中注意力没有合理的基础。 主要是关于胁迫和强迫的法律来源，因为：a)国家 机构的授权往往无效；b)数据表明，胁迫 和强迫在多个心理社会领域发挥作用；以及c) 最具影响力的压力是在非正式的、法律之外的领域运作的。一些人 研究表明，可以成功地利用这些非正式压力。 支持共同商定的治疗目标。 这份修订后的申请书概述了审查强制措施的初步研究 治疗进入中的非强制性因素。我们已经明确规定了 强制、强制和非强制的操作公式，通过 确立了行为准则；制定了可靠的评估程序 对于这些构造；以及强制和强制的估计水平和类型 非强制压力在非药物门诊可卡因治疗中的应用。 修订后的提案将审查：1)胁迫、强迫、 以及不同药物治疗方案中的非强制性压力；2) 性别和种族群体对这些结构的感知；3)患者 而心理医生则利用了这些压力。我们还将研究 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；6)控制点。三 来自五个不同治疗地点的100名受试者将于 感受到的强制性和非强制性治疗压力，并将完成 变革阶段和控制点问卷。患者的认知 强迫力和非强迫力将与它们的原始数据进行比较 治疗师；与治疗师全球终身制、遵从性和 结果；以及变化阶段和控制点数据。 研究结果将对政府的社会政策产生重要影响 毒品治疗的法律授权以及道德和实践的发展 该领域的指导方针。了解影响治疗的因素 结果也将有助于量身定制更有效的临床 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.