ABSTRACT Title of Document: DUI: TREATMENT COMPLIANCE, RETENTION, AND MOTIVATION FOR TREATMENT . Aaron Ashby Harris , Doctor of Philosophy , 200 6 Directed By: Dr. Kevin O’Grady , Department of Psychology Alcohol abuse and its treatment ha ve been an increasing focus of legal, social , and treatment research during recent decades . Motivational Interviewing (MI) is one treatment approach that has received considerable attention and increasing empirical support for treating individuals with al cohol use problems . DUI offender s represent a subgroup of the alcohol -abusing population who appear to face unique issues related to “coerced treatment”, low motivation for change, and a major treatment focus on decreasing recidivism. Success in treating this population been mixed. Given their unique treatment issues, DUI offenders may particularly benefit from MI’s focus on increasing motivation for change. However, only preliminary research examining the impact of MI on DUI offender s currently exists. The purpose of this study was to examine the factors that affect treatment participation, treatment engagement, and drinking behaviors by implementing a MI intervention with DUI offenders mandated to enroll in an outpatient treatment program. This stud y was the first to consider recidivist status and examine the efficacy of MI with DUI offenders with a reasonable sample size ( N = 98). A brief MI intervention was randomly administered to 48 of the DUI offenders enrolling in outpatient treatment and data was collected at baseline and 3 -month follow -up. Results of primary analyses revealed that only one outcome, self -confidence , was significantly affected by any predictor variables (i.e., treatment group, recidivist status, and motivation for treatment). Secondary analyses were conducted with two revised models. Offender compliance (i.e., number of positive urine tests) was predicted by recidivist status when the additional predictor variable of drug co -morbidity was included in the model. The second re vised model limited the sample size to 54 “recent” offenders (i.e., entered treatment within 180 days of their most recent DUI offense) and revealed several additional significant findings. Although few significant findings were found relating to the imp act of MI, results of this study nevertheless suggest that further examination of MI for treatment with DUI offenders is warranted. Moreover, the offender’s recidivist status and the amount of time lapse since offense appear to be important clinical and e mpirical considerations for this population. Study limitations and future directions are discussed. DUI: TREATMENT COMPLIANCE, RETENTION, AND MOTIVATION FOR TREATMENT . By Aaron Ashby Harris . Dissertation submitted to the Faculty of the Graduate School of the University of Maryland, College Park, in partial fulfillment of the requirements for the degree of Doctor of Philosophy 200 6 Advisory Committee: Dr. Kevin O’Grady , Chair Dr. Carl Lejuez Dr. Forrest Tyle r Dr. Amelia Arria Dr. Kenneth Beck , Dean’s Representative © Copyright by Aaron Ashby Harris 200 6 Dedication To Erin, the love of my life . Your patience and support through the years (and through this project) h ave inspired me to become a better person, while teaching me the most important lessons in life . My accomplishments are yours. Thank you for being right there beside me through this. ii Acknowledgements I would be remiss to not mention my gratitude for the following individual s and their support during my dissertation “years ”: Kevin O’Grady – for his patience and collaboration on this project Robert Brown – for all his help getting me started on my graduate career The clinical psychology faulty – for the ir mentoring and su pport My wife and children – for their patience during all the evenings that “daddy” was gone to Baltimore . iii Table of Contents Dedication ................................ ................................ ................................ ........................... ii Acknowledgements ................................ ................................ ................................ ............ iii Table of Contents ................................ ................................ ................................ ............... iv List of Tables ................................ ................................ ................................ .................... vii List of Figures ................................ ................................ ................................ .................... xi CHAPTER 1: INTRODUCTION ................................ ................................ ........................ 1 The Problem of Alcohol Abuse ................................ ................................ ....................... 1 Etiology and Treatment of Alcohol Abuse ................................ ................................ ...... 2 Motivational Interviewing ................................ ................................ ............................... 4 The Driving Un der the Influence (DUI) Offender ................................ ........................... 5 MI and the DUI Offender ................................ ................................ ................................ 7 Direction of the Present Study ................................ ................................ ......................... 9 CHAPTER 2: LITERATURE REVIEW ................................ ................................ ........... 11 Etiology of Alcohol Abuse ................................ ................................ ............................ 12 Moral and Temperance Models ................................ ................................ ................. 12 The American Disease Model ................................ ................................ .................... 13 Characterological Models ................................ ................................ .......................... 14 Biological Models ................................ ................................ ................................ ...... 14 Behavioral Models ................................ ................................ ................................ ..... 14 Social Learning and Educational Models ................................ ................................ .. 15 Socio -cultural and Systems Models ................................ ................................ ........... 15 Major Treatment Approaches to Alcohol Abuse ................................ ........................... 16 12 -Step Facilitation Approach ................................ ................................ ................... 16 Cognitive -Behavioral Coping Skills Therapy ................................ ............................ 17 Aversion Therapies ................................ ................................ ................................ .... 19 Relapse Prevention Strategies ................................ ................................ .................... 19 Marital and Family Approaches ................................ ................................ ................. 20 Outcome Research in Alcohol Abuse ................................ ................................ ............ 20 A Core Ingredient for Success: Motivation for Change ................................ ................ 21 Motivational Interviewing (MI) ................................ ................................ ..................... 23 Development of the MI Model ................................ ................................ ...................... 25 Description of the MI Intervention ................................ ................................ ................ 29 Motivational Enhancement Therapy (MET) ................................ .............................. 33 Summary of the MI Outcome Research ................................ ................................ ......... 34 DUI Offenders and Their Treatment ................................ ................................ .............. 39 Tre atment Issues with DUI Offenders ................................ ................................ ........... 43 Motivation for Change in DUI Offenders ................................ ................................ ...... 45 MI and DUI Offenders ................................ ................................ ................................ ... 46 CHAPTER 3: THE CURRENT STUDY ................................ ................................ .......... 48 Research Rationale ................................ ................................ ................................ ......... 48 iv Variables of Interest ................................ ................................ ................................ ....... 49 Primary Hypotheses ................................ ................................ ................................ ....... 50 CHAPTER 4: METHOD ................................ ................................ ................................ ... 52 The Participants ................................ ................................ ................................ ............. 52 The Treatment Sites ................................ ................................ ................................ ....... 54 The Assessment Process ................................ ................................ ................................ 55 The Treatment Model ................................ ................................ ...............................