Encyclopedia of drugs, alcohol, & addictive behavior Vol 4 (S-Z, Index)

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Therefore, research on substance use treatment and rehabilitation programs and their implementation as well as an interest in the topic as a whole is growing day by day. Doubtless, the effectiveness of therapy is determined by cooperation with patients, their positive attitude to therapy, and their collaboration with the healthcare professional. Lack of motivation in a patient can cause them to quit therapy or find it hard to complete their course of treatment, leading to relapse or a number of other problems emerging during therapy 7. Particularly internal motivational factors desire to quit, urge to succeed, determination are seen to be the most important factors to achieve abstinence.

However, certain external motivational factors spouse, children, financial needs… undeniably also play a role in quitting substance use 8.


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Many addicts are reluctant to participate in treatment and rehabilitation programs. Particularly in individuals with low self-efficacy who consider themselves inadequate to reach abstinence, treatment compliance and motivation are reduced, and in this state, the participation of addicts in treatment and rehabilitation programs and their adherence with the treatment are affected negatively. Some studies show that the self-efficacy factor is important in quitting drinking and substance use.

Studies show that most addicts have experienced psychosocial problems and repeatedly tried to abstain but felt that they were too weak to quit their habit On the other hand, coping capacity is not only a motivational power regarding drug abstinence but at the same time reduces the relapse risk In the light of this information, for a successful treatment it is important to establish supportive psychological factors for drug users to start and complete addiction treatment and rehabilitation programs successfully and to eliminate risk factors.

METHOD This study was undertaken with individuals that had been referred to the Probation Directorate in Ankara after being sentenced for the consumption of illegal substances under article of the Turkish Penal Code. The study sample consisted of male participants who were part of a Cigarette, Alcohol, and Substance Addiction SAMBA 16 group program and had completed at least two sessions of the program. The participants were recruited from among the male addicts using random sample technique. Sociodemographic Data Form: Prepared by the researcher, this form includes entries collecting psychosocial data related to substance use behavior and risk factors as well as demographic questions about age, gender, and marital status.

This scale, developed to assess reasons to initiate and continue treatment, includes 4 subscales. According to the psychometric evaluation, the internal consistency coefficients for the instrument range between 0.

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The adaptation of the scale to Turkish was worked out in a study by Evren et al. They found internal consistency coefficients for the subscales between 0. The construct validity was assessed with 6 measures, and a sufficient correlation coefficient was found. However, the authors recommended using the item general self-efficacy subscale alone.

In several studies, the item general self-efficacy subscale was administered A validity and reliability study for the scale in Turkish was carried out by Yildirim et al. As this form was too long and did not show enough psychometric features, it was again Carver 23 to develop a Coping Strategies Questionnaire brief form. This version consists of 28 items measuring problem- and emotion-centered coping strategies. The scale consists of 14 subscales with 2 items each. For each subscale, a high score indicates a frequent use of the respective coping strategy.

The psychometric evaluation of the scale found internal consistency coefficients between 0. The instrument was adapted to Turkish by Tuna 24 , who found a total correlation coefficient for the scale between 0. Procedure Before beginning the tests, it is briefly explained the general aim of the study to the participants. Individuals who agreed to participate was received the scales and an informed consent form.

After beginning the tests, participants were informed that they could withdraw from the study if they were uneasy about the questions or they could request psychological support from the researchers. To avoid fatigue as a confounding factor, the scales were administered to each participant in a different order. In addition, for the question regarding the presence of a psychiatric disorder, a diagnosis by a psychiatrist was requested. Before beginning the study, the required permissions from the researchers who had adapted the measures to Turkish were obtained.

Statistical Analysis To test the study data for normal distribution, all scores were converted to z scores, confirming normal distribution.

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To assess the differences between psychological variables and treatment motivation, independent-samples t-test and ANOVA were used, and to find variables predicting treatment motivation, hierarchical multiple regression analysis was carried out. Before doing hierarchical multiple regression analysis, Pearson Product-Moment Correlation was calculated to determine multicollinearity between variables.

While The monthly income was between 1, and 2. Substance use had started before the age of 18 years in The most used substance was marijuana with In Self-harm behavior was reported by Of the attempted suicide cases, Treatment motivation of individuals with a monthly income between and 1. Another variable affecting treatment motivation was the number of substances used.

Comparing between groups, treatment motivation was higher in individuals experiencing drug use-related family problems than in those who did not have family problems for the same reason. Finally, it was seen that the presence of a psychiatric disorder is an important variable for treatment motivation.

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Results of Regression Analysis for Variables Predicting Treatment Motivation In order to identify predictive variables for treatment motivation, hierarchical multiple regression analysis was carried out. All details of the model can be seen in Table 3. For the first model, psychosocial variables related with substance use were added, for the second model the General Self-Efficacy Scale, and finally, for the third model the total Coping Strategies Questionnaire Brief Form scores. The results indicate that the best predictive variables for treatment motivation are the existence of a monthly income, the presence of at least one child, experiencing drug use-related family problems, and coping strategies.

While most substance user want to quit most of the time, it takes time to make the decision and implement it. Thus, to decide quitting and getting into action, it is important for substance user to believe in the capability to abstain and to possess sufficiently strong coping skills. Therefore, in order to increase the treatment motivation in substance users and improve compliance with therapy, it can be suggested that in addition to motivational interviewing techniques, cognitive and behavioral interventions strengthening coping strategies and skills should be applied.

Another important factors influencing treatment motivation are if the individual has experienced family problems due to substance use and if they have at least one child. While this study doubtlessly could not establish if the family problems were related to substance use, it is thought that problems in the family due to substance use can trigger an increased awareness of the relation between drug use and family problems.


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The study confirmed that self-efficacy is not a significant predictor for treatment motivation. In fact, almost half of our participants had been using drugs for more than 2 years and again half of them were using more than one substance. This may have affected the sense of self-efficacy negatively, which otherwise could have been an important push factor. This study found that the substance users in the sample had a low level of education and income, and the great majority had attempted suicide in the past.

It is known that substance use behavior, a significant public health issue, is related with numerous problems. We also know that in these individuals, particularly their low educational level and the drug-related inability to fulfill basic responsibilities in school or at work are preparing the ground for social problems such as poverty In a vicious circle, these problems may lead to relapse. Therefore, individuals have to cope not only with the substance use but at the same time with certain social issues such as educational problems and poverty.

Evidently, policies are needed to solve these issues. On the other hand, the high rate of suicide attempts in these subjects is a significant risk factor for completed suicide. Actually, suicide rates in substance users are higher than in other groups 4, Even though there is no conclusive information about the direction between the two variables, it will be advantageous for the prevention of self-harm and suicide to prevent substance use behavior.

This suggests that, in addition to drug prevention programs, in education and the planning of macro interventions, an increase of counseling about drug use in schools, and the offer of treatment and rehabilitation for children and adolescents who have been identified as drug users are necessary. This study has found a significant correlation between age groups and treatment motivation, which was greater among the to year-olds than among the individuals aged years. It can be assumed this difference to be a result of a longer history of unsuccessful efforts to quit their addiction among the older population, which may have affected their treatment motivation negatively.

It is known that substance use behavior in young adults is high, early substance use continues at a later age and gives rise to a number of problems such as educational difficulties, unemployment, poverty, crime, family problems, and so on 23, Thus, it can be argued that individuals who have to cope with problems caused by early substance use are more aware of the necessity to quit, which may increase their treatment adherence and motivation.


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  8. In the light of these results, it can be suggested that the identification of the problems causing substance use and the processing of these problems in rehabilitation programs as motivational factor and ambivalence are necessary. In this study it is found that a higher treatment motivation among persons with a monthly income below 1. While there is no clear information in the literature about the direction of the relation between income level and substance use, it has been said that substance use behavior is correlated with poverty and the rate of substance use among poor people is higher Even if the personal income may not be a critical factor for treatment adherence or help-seeking, some studies indicate that the opportunities for persons with a low income to benefit from treatment options are small and their perceived need for treatment greater accordingly 35, It is also assumed that while for the participants in the study has limited free access to other health and psychosocial services, the fact that they had the opportunity to benefit from free psychosocial and health interventions through probation services may have increased their therapy adherence and motivation.

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    This suggests the necessity to facilitate the access to treatment and psychosocial rehabilitation for substance users with low income, increasing health service options for the use of these individuals, and offer poor people easier access to psychosocial rehabilitation systems by employing the necessary staff. In this study, it is found that a higher treatment motivation in substance users using more than one substance as well as among those who had been using drugs for more than two years.

    The change of substance use behavior is a relatively complex process. The number of substances used and the duration of substance use are critical variables for quitting the drug Duration of use and number of substances are a risk factor in the development of addiction There is no doubt that addiction carries with it a number of biopsychosocial problems.

    One of the most important issues resides in the criminal justice system. A drug user is somehow involved in crime, or drug use itself may constitute criminal behavior Substance use behavior mostly comes with a psychiatric comorbidity 40 , or individuals with a psychiatric disorder may later on develop substance use behavior Studies show that persons with psychiatric comorbidity show greater adherence with substance use treatment and have higher internal motivation A similar study carried out by Hiller et al.

    The results also support the outcomes of earlier studies: Substance users with another psychiatric diagnosis had a higher treatment motivation than substance users who had not been previously received a diagnosis. Doubtless, substance use going along with psychiatric problems carries additional biopsychosocial problems for the individual. The data for this study have been collected in a single session in just one probation directorate. Thus, situational, temporal and procedural factors that might affect treatment motivastion could not be determined.

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    As this was a cross-sectional study, the cause-effect relation between the variables could not be established. Therefore, it is sugegsted that it will be necessary to undertake future experimental studies to work out the causality principle. Another limitation lies in the fact that the substance users were referred to the probation directorate through the legal system. Psychopharmacology Berl ; 13 Behav Brain Res ; Planta Medica ; 60 06 Solinas M, Panlilio LV, Justinova Z, et al: Using drug-discrimination techniques to study the abuse-related effects of psychoactive drugs in rats.

    Nat Protoc ; 1 3 Behavioural Brain Research ; 2 Mol Pharmacol ; 65 5 Kest B, Palmese CA, Hopkins E, et al: Naloxone-precipitated withdrawal jumping in 11 inbred mouse strains: evidence for common genetic mechanisms in acute and chronic morphine physical dependence. Neuroscience ; 2 Matsumoto K, Horie S, Takayama H, et al: Antinociception, tolerance and withdrawal symptoms induced by 7-hydroxymitragynine, an alkaloid from the Thai medicinal herb Mitragyna speciosa. Life Sci ; 78 1 Addict Biol ; 21 1 Shoaib M, Spanagel R, Stohr T, et al: Strain differences in the rewarding and dopamine-releasing effects of morphine in rats.

    Psychopharmacology Berl ; 2 Nature , Br J Pharmacol Chemother ; 15 4 Eur J Pharmacol ; Pharmacol Biochem Behav ; 69 Psychopharmacology Berl ; 1 Journal of Medicinal Chemistry ; 56 6 Eur J Med Chem ; Halpenny GM: Mitragyna speciosa: Balancing potential medical benefits and abuse.

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    Phytomedicine ; 18 5 Whitfield TW, Jr. J Neurosci ; 35 10 Matsumoto K, Yamamoto LT, Watanabe K, et al: Inhibitory effect of mitragynine, an analgesic alkaloid from Thai herbal medicine, on neurogenic contraction of the vas deferens. Life Sci ; 78 2 Neuroscience ; Barrios M, Baeyens JM: Differential effects of L-type calcium channel blockers and stimulants on naloxone-precipitated withdrawal in mice acutely dependent on morphine. Psychopharmacology ; 3 Seth V, Upadhyaya P, Moghe V, et al: Role of calcium in morphine dependence and naloxone-precipitated withdrawal in mice.

    J Exp Pharmacol ; Vitcheva V, Mitcheva M: Effects of nifedipine on behavioral and biochemical parameters in rats after multiple morphine administration. Methods Find Exp Clin Pharmacol ; 26 8 Brain Res Bull ; Drug Alcohol Depend ; Mackay L, Abrahams R: Novel case of maternal and neonatal kratom dependence and withdrawal.

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    Can Fam Physician ; 64 2 J Neurosci ; 29 22 Dahan A: Potent opioid analgesia without respiratory depression. Anesthesiology ; 5


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