Award Date

May 2015

Degree Type


First Committee Member

An-Pyung Sun

Second Committee Member

William M. Epstein

Third Committee Member

Kathleen Bergquist

Fourth Committee Member

Chih-Hsiang Ho

Fifth Committee Member

Kathryn Hausbeck Korgan

Number of Pages



Substance abuse persists as one of the most costly, prevalent, and damaging health problems in the United States. As of 2012, an estimated 22 million individuals, approximately 8.9 percent of the total population, were diagnosed with substance abuse or dependence disorder. Considering the significant number of clients served, successful national completion rates among individuals utilizing outpatient care remain markedly low. In the state of Nevada, where the present study is conducted, successful intensive outpatient treatment (IOP) completion rate remains at an alarmingly low 20.1 percent. Early dropout is a particular concern in that duration of participation in treatment has been a reliable clinical and statistical predictor of positive treatment outcome. A myriad of factors including erosion of the therapeutic alliance between client and clinician, heterogeneity of client characteristics, and inadequate assessment are among factors that contribute to noncompliance with established treatment goals and premature termination. The extent to which external factors that hasten ingress to substance abuse treatment are perceived as coercive and diminish motivation has not been fully realized in empirical discourse.

Informed by the theoretical underpinnings of the self-determination theory (SDT), the present study aims to examine perceptions of motivation, readiness, and external coercive circumstances that trigger substance use treatment entry among clients seeking substance use treatment under legal coercion (criminal), formal/informal coercion (non-criminal), those seeking substance use treatment voluntarily and their respective clinicians during the initial stages of treatment in outpatient treatment settings. The study will test the hypothesis: That a significant divergence exists between clinicians’ overall motivational ratings of clients who enter treatment under criminal legal coercion, non-criminal formal and informal coercion, and clients’ own ratings, as contrasted with ratings of voluntary groups. Utilizing convenience sampling, a total of 63 clients and 15 clinicians were recruited to participate in the study. One-way between subjects analysis of variance (ANOVA) were conducted to compare the effect of clients’ as well as clinicians’ perceptions of circumstances, motivation, and readiness in seeking treatment. Paired-samples t-tests were conducted to compare the clinicians’ and clients aggregate scores for the circumstance, motivation, and readiness scores. Key outcome of the study supports the hypothesis that a significant disparity, as measured by the aggregate scores on the CMR, appears to exist in levels of perceived motivation between client and clinician groups. The finding does not support the sub-hypothesis that clinicians perceive voluntary groups as being more motivated than those seeking treatment under various forms social or legal of coercion. Whereas analyses of sub dimensions of the scale suggest a significant effect in clinicians’ ratings of the readiness dimension between voluntary and (non-criminal) formal/informal coercion group, the clinicians and client groups did not differ in their appraisal of the circumstances dimensions.

The convergence of findings supports the major hypothesis and suggests that clinicians’ overall assessments are consistently incongruent with clients’ own perspectives. Outcomes are congruent with SDT, which proposes that external pressures are not necessarily antagonistic to internal motivation—rather, external controls can differ in the extent to which they are perceived as self-determined, vis-à-vis controlled, depending on the degree to which they may be internalized by the individual. Research in this field must evolve in order to facilitate empirical examinations of the reciprocity between internal and external pressures on treatment motivation, retention, and outcomes while making a concerted effort to withdraw from rendering generalizations strictly on the basis of referral source.


clients; clinicians; coercion; motivation; perception; substance use


Psychology | Social Work

File Format


Degree Grantor

University of Nevada, Las Vegas




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