Factors affecting motivation to treatment in severely dependent alcoholics.

OBJECTIVE: This article explores environmental, developmental and personality-related factors as predictors of motivation to treatment for alcoholism, using such concepts as: social situation on admission, treatment career, age, education and adventurous patterns of behavior.
METHOD: The original population consists of 603 severely dependent alcoholic patients (76% men, 42% compulsorily committed) with a mean age of 40 years. In structural equation model estimation, 85% of the original cases were used (N = 511), made up of compulsorily as well as voluntarily admitted patients. A reduced model was tried on voluntary patients alone.
RESULTS: In the main model, patterns of behavior and age were not related to the motivation to treatment, while treatment career had some negative impact. Social problems were related to less motivation to treatment. In turn, a worse social situation was related to more treatment experience. The reduced model on voluntary patients alone confirmed the main findings, although more previous treatment tended to be related to more motivation.
CONCLUSIONS: Motivation was mostly related to a better social situation (i.e., having "more to lose"). A collapse in the social situation was more of an obstacle than a promoter of motivation. There was no support for statements that "maturing out" would result in more motivation, and findings were inconclusive concerning the impact on motivation of having had many previous treatment experiences. The pattern of behavior was not directly related to the level of motivation. Based on these findings, the relevance of social work for motivation to treatment is discussed.