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Given the scarce literature on alcohol use disorders (AUD) and their treatment in developing countries, this paper aims to explore motivation levels and their correlates among alcohol service users in two residential treatment centres in Kampala, Uganda. This study how motivation levels of Ugandan alcohol service users compare with those from American studies; and the specific factors affecting internal and external motivation in the Ugandan context.

The motivation for treatment was measured among 100 individuals entering AUD treatment using the Texas Christian University (TCU) Treatment needs and Motivation scale. The WHOQoL–BREF, Addiction Severity Index–6 and Hopkins Symptoms Check List–37 were used to measure addiction severity, quality of life (QoL) and psychopathology, respectively. Correlates of motivation were identified using linear regression analyses.

Ugandan service users demonstrated low treatment motivation in the treatment needs a domain. While addiction severity (recent heavy alcohol use) and participating in private treatment were associated with higher internal and external motivation, deterioration in physical and environmental QoL, depressive symptoms and lower education were linked with higher internal motivation.

Different elements affect domains of treatment motivation, requiring attention for clients’ unique needs as influenced by their background, addiction severity, QoL, psychological needs and contextual factors (e.g. treatment setting). Further studies are needed to explore additional correlates of motivation for treatment among alcohol service users in Uganda and to assess the longitudinal impact of motivation on treatment outcomes.

Although motivation has been extensively studied, clinicians are challenged in understanding and explaining motivational dynamics given the multiplicity of factors influencing change-related decisions and behaviours and the diversity in substance-using populations. This need is even bigger in non-Western societies as cultural differences may require differential therapeutic management. This is one of the first studies measuring motivation for AUD treatment in a low-income country and offers insight for understanding motivation dynamics in similar settings.

Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders.

The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates.

Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant.

These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders.

The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders.

This chapter presents empirical evidence on the effects of attributional retraining (AR), a motivation-enhancing treatment that can offset maladaptive explanatory mind-sets arising from adverse learning experiences. The evidence shows that AR is effective for assisting college students to adapt to competitive and challenging achievement settings.

This chapter describes the characteristics of AR protocols and details three primary advances in studying AR efficacy in terms of achievement performance, psychosocial outcomes, and processes that mediate AR-performance linkages. The psychological mechanisms that underpin AR effects on motivation and performance are outlined from the perspective of Weiner’s (1974, 1986, 2012) attribution theory.

Laboratory and field studies show that AR treatments are potent interventions that have short-term and long-lasting psychosocial, motivation, and performance benefits in achievement settings. Students who participate in AR programs are better off than their no-AR counterparts not just in their cognitive and affective prospects, but they also outperform their no-AR peers in class tests, course grades, and grade-point-averages, and are more persistent in terms of course credits and graduation rates.

This paper contributes to the emerging literature on treatment interventions in achievement settings by documenting key advances in the development of AR protocols and by identifying the next steps critical to moving the literature forward. Further progress in understanding AR efficacy will rest on examining the analysis of complex attributional thinking, the mediation of AR treatment effects, and the boundary conditions that moderate AR treatment efficacy.

The therapeutic community (TC) is a widely used intervention program in treating substance use disorders. Despite its documented utility, researchers and practitioners are still perplexed on how it exactly works. The purpose of this paper is to suggest the role of attachment styles and treatment motivation in the TC process.

Applying an explanatory correlational research, this notion was tested by examining the responses of 200 patients with substance use disorder in a TC using mediation analysis.

The results revealed that attachment styles indirectly affect client’s clinical progress by the path of treatment motivation. Although the current study cannot conclude causality, the results provide empirical evidence suggesting that attachment activates motivation in treatment within the social dynamics of the TC, thus influencing clinical progress.

From these findings, recommendations for the modification of TCs along with considerations for further research, and socio-political implications are discussed.

The Dutch juvenile justice system locks up an increasing number of adolescent boys and girls at a cost of approximately €250,000 for each inmate annually (Boone & Moerings, 2007; Tonry, 2005). Questions have been raised, however, about the cost‐effectiveness of treatment in closed institutions. This study, with a sample of 49 adolescents residing in a Dutch youth prison, examined the role of group climate in establishing and maintaining treatment effects. Results show that an open group climate, with group workers paying more attention to the psychological needs of the adolescents and giving them ‘space’ to experiment, led to inmates feeling that they were ‘being understood by the group workers’. This perception of being understood was associated with greater treatment motivation and higher internal locus of control. Positive prison workers in the living group turned out to be a key factor in building an open group climate and subsequently higher internal locus of control and greater treatment motivation.

This study is a post hoc service level investigation into the efficacy of a forensic dual diagnosis intervention. The treatment programme incorporated the principles of cognitive behavioural therapy and Motivational Interviewing, and was comprised of three stages: psycho-education into the links between mental/physical health, substance use and offending, the cultivation of coping strategies and relapse prevention planning. The paper aims to discuss these issues.

Treatment outcome was tracked using pre- and post- stage 1 and 2 measures, and included self-report questionnaires that probed service users’ readiness for change, motivations for treatment and perceived effectiveness of coping strategies (n=80 and 37 patients for stages 1 and 2, respectively). In addition, service users undertook a knowledge “quiz”, which probed information retention.

The results show that whilst psycho-education (stage 1) increased service users’ knowledge of key issues, this had no parallel effects on other measures. In contrast, completion of stage 2 led to an increase in external motivation for treatment, although this did not translate into a shift in service users’ readiness for change.

These findings are consistent with the Motivational Interviewing literature and highlight the need for a shift in internalised motivation for treatment if change is to be elicited. Further, they point towards the viability of using self-report measures to monitor treatment outcome in a secure forensic setting.

These findings have a number of implications for the design and on-going evaluation of forensic dual diagnosis services, an area of research that is currently under-represented in the literature.

Literature suggests that mentally disordered offenders are considerably more difficult to treat and slower to respond to psychological treatment. Less is known about the particular factors that can contribute to this resistance. A more comprehensive understanding of the factors that treating psychologists feel can promote or inhibit progression through rehabilitative treatment may increase the likelihood of positive clinical outcomes. This paper aims to discuss these issues.

Four practising psychologists employed within a male medium- and low-secure forensic unit in the North East of England took part in a semi-structured interview. Their views, opinions and experiences regarding patient progression through treatment pathways were recorded, transcribed and analysed.

This thematic analysis identified that numerous patient-specific parameters influenced perceived progression, and environmental and external factors had a significant impact on the patients’ expressed attitude towards treatment.

Alongside issues of motivation and engagement, participants identified external factors that influence perceived treatment success with their forensic patients.

Additional research is needed to identify the factors that are the most influential in promoting or inhibiting perceived and actual progress. This will hopefully optimise treatment engagement and the motivation to change problematic behaviours in mentally disordered offenders.

Substance abuse is a major public health concern, with over millions of people suffering from it worldwide. Although there is an abundance of treatment options, many of these rehabilitative trajectories are subject to “drop-out”. In addition, “drop-out” is a significant risk factor for relapse. There is an urgent demand for effective treatment, which would enable patients to reduce abuse and prevent relapse. Takiwasi is an addiction treatment centre that combines traditional Amazonian plant medicine with conventional western medicine and psychotherapy. The purpose of this paper is to explore whether socio-demographics factors, such as education level and occupation, psychiatric comorbidities and primary drug use, are associated with treatment non-completion of Ayahuasca (AYA)-assisted addiction therapy.

Data on the first treatment episode of 121 patients were collected from the patient database from the years 2012 to 2017. To determine whether there is an association between the variables of interest and treatment non-completion, a χ² analysis and a logistic regression analysis were performed.

Of the 121 patients analysed, 48.2 per cent completed their treatment, whilst 51.8 per cent did not. Students compared to those who are employed showed significantly higher odds for treatment non-completion (p=0.006; OR=3.7; 95% CI=1.5–9.6). Other variables in the multivariable analysis showed no significant relationship with treatment non-completion. While several limitations restricted the study, the findings suggest that the AYA-assisted treatment in Takiwasi may benefit from additional support for patients who are students. Moreover, it is advised to conduct more long-term follow-up of patients in order to gain better insight into the outcome of treatment at an AYA-assisted treatment centre.

It appears that AYA-assisted therapy in a therapeutic community is a feasible type of treatment for addiction, for which further studies should elucidate the role of motivation in relation to socio-demographic factors and type of addiction in the risk of treatment non-completion.

Cognitive-behavioural interventions, such as the substance related offending behaviour programme (SROBP), are being implemented across forensic contexts in an attempt to address the detrimental economic, social and personal impacts of substance use and offending. Whilst support exists for the effectiveness of such treatment, there remains to be limited knowledge of offenders’ experiences of treatment and factors that promote treatment efficacy and support desistance. This study aims to develop an idiographical understanding of those processes.

Six prisoners who had completed the SROBP were interviewed via a semi-structured schedule to collate their individual experiences of engaging in treatment. Interviews transcripts were analysed by the lead researcher using interpretative phenomenological analysis, and external auditing analysis was conducted by the research supervisors.

Three superordinate themes resulted: “Therapeutic processes and relationships,” “Therapeutic outcomes” and “Threats to post treatment recovery.” Participants identified factors which facilitated the effectiveness of treatment and were effective in meeting their needs, although there were other factors that required improvement.

The important role of motivation at various stages of treatment as this engenders commitment to treatment aims and longer-term recovery. Treatment efficacy is linked with perceived relevance and value of treatment outcomes in supporting desistence from substance use. Pro-social peer relationships are important for effective application of learning and recovery. Attentiveness to participants specific needs is required. The lack of post-programme support has the potential to threaten therapeutic alliances and reinforce experiences of rejection and abandonment. The management of the exit phase from programmes is critical.

Results are discussed in light of their implications for future working practices in supporting therapeutic processes and rehabilitative culture.

The purpose of this paper is to summarize the main findings and conclusions of four separate studies on treatment in therapeutic communities (TCs) for addictions.

The first two studies address the core characteristics of the TC approach: a study on the workable and destructive elements of the Synanon model; and a comparative study on the essential elements of TCs for addictions in Europe and in the USA. The final two studies highlight clients’ perceptions of the TC treatment process in relation to retention: a study on clients’ first month perceptions of the TC treatment process and the influence of fixed and dynamic client factors; and a longitudinal study on changes in clients’ perception of the TC treatment process and the impact of motivation, psychological distress and cluster B personality traits.

The first study showed that Synanon’s therapeutic and pedagogical methods are still highly valued despite its negative reputation. The results of the second study suggest that while traditional TCs operate as concept-based TCs in Europe, modified TCs might differ in the extent to which they apply the core principles and elements of the TC approach. The third study provides evidence that suitability for treatment is a very important predictor for clients’ first month perceptions of the community environment. The fourth study shows that with time in treatment clients develop more profound perceptions regarding the essence of TC treatment.

Finally, implications for clinical practice, general limitations and some concrete recommendations for future research are presented in this paper.

The PhD summary study contributes to the existing literature on TC treatment.