Internalization: A Process Related to Stages-of-Change among Participants in a Court-Mandated Substance Abuse Program
Type of Degreedissertation
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Substance-use disorders continue to be costly psychological conditions to the individuals who are afflicted, as well as to the society as a whole (NIDA, 1998). Unfortunately, the treatment of substance-use disorders has had limited long-term effectiveness (SAMHSA, 2004), which calls for further investigation of recovery-related variables. Although the relationship between the Transtheoretical Model of Change (Prochaska & DiClemente, 1983) and Self-Determination Theory (Deci & Ryan, 1985) has been studied in adult populations in the context of exercise behavior (Daley & Duda, 2006; Ingledew, Markland, & Medley, 1998; Landry & Solmon, 2004; Mullan and Markland, 1997; Wininger, 2007), it has not been investigated in populations suffering from clinical disorders. This dissertation study examined the relationship between the continuum of change stages proposed by the Transtheoretical Model and the continuum of internalization proposed by Self-Determination Theory. Using a sample of 237 adult male and female participants in court-ordered substance-abuse treatment programs, the relationship between stage-position and level of internalization was analyzed. The relationships between perceived coercion and stage position and between perceived coercion and level of internalization were also examined. Participants’ Stage-of-Change was measured with the University of Rhode Island Change Assessment (URICA; McConnaughy et al., 1983). The participants’ level of internalization was measured by the Treatment Entry Questionnaire (TEQ; Wild et al., 2006) and perception of coercion was measured by the Perceived Coercion Questionnaire (Klag, et al., 2006). Observers were also solicited to provide ratings of the participants’ stage-position and level of internalization. In support of the primary hypothesis, the results indicated that a significant (p <.01) relationship exists between position on the Stage-of-Change continuum and level of internalization. The results suggest that that as individuals move from use of alcohol and/or drugs to abstinence from alcohol and/or drugs, the transition may include the internalization of related values, attitudes, beliefs, and behaviors. However, the related hypotheses, such as the expected relationships between stages, internalization, and perceived coercion, were not supported. Difficulties associated with defining and measuring the construct of internalization are noted.