Study illuminates factors influencing change in women

New research examining women's motivation in addiction treatment bolsters the argument that high baseline levels of depressive and anxiety symptoms trigger responses that actually serve to decrease drug use. The study also concluded that initial levels of motivation predict outcomes better than changes in motivation during treatment; this suggests that addiction professionals should use Motivational Interviewing approaches early in the treatment process.

Published in the Journal of Substance Abuse Treatment, the study breaks ground in its focus on motivational factors in women, as earlier conclusions on this topic have largely been based on studies that mainly looked at male participants.

The study was based on a secondary analysis of data from a trial showing that women receiving family therapy with their child decreased their substance use at a faster rate than women receiving individual therapy. The study tested hypotheses that higher initial motivation for change would be associated with a faster decline in substance use, and higher anxiety and depressive symptoms would be associated with increased emotion-oriented coping, which in turn would eventually lead to decreased substance use.

Emotion-oriented coping refers to efforts to reduce stress through emotional responses that might include expressing emotion and blaming self or others, for example. It is a coping strategy generally favored by women, according to researchers.

Details of study

The study included 183 treatment-seeking women with an alcohol or drug use disorder. Their motivation for change was assessed with the Stages of Change Readiness and Treatment Eagerness scale for substance use, which includes statements such as “I want to help to keep from going back to the drinking/drug problems that I had before.” Their emotion-oriented coping was measured with the Coping Inventory for Stressful Situations, with items such as “blame myself for getting into the situation” and “wish that I could change what had happened or how I felt.”

The researchers found that depressive and anxiety symptoms were associated with a faster decrease in drug use (but not alcohol use), in that they triggered higher emotion-oriented coping that is associated with motivation for change. The theory is that emotion-oriented coping generates self-reflection (with accompanying regret, guilt) that might motivate individuals to change in order to reduce the symptoms they are experiencing.

“The first step is achieving a level of self-awareness,” lead researcher Joanna Wu, who works in the Department of Human Sciences at The Ohio State University, tells Addiction Professional.

The researchers said the results suggest it is possible that different mechanisms are at work in motivation to change drug use and alcohol use, and they added that this needs to be explored further.

Takeaways for clinicians

The researchers pointed out that higher motivation among patients is also related to a better therapist-client relationship and a client's adherence to treatment. They suggested that substance use treatments should address the needs of individuals at all levels of readiness, including those who have not expressed much of a willingness to change.

They wrote, “Clinicians should focus on emotional processes during therapy for drug use, especially the coping process that women use to handle their negative experiences.”