Dynamic effects among patients' treatment needs, beliefs, and utilization: a prospective study of adolescents in drug treatment.
OBJECTIVE
To document the prospective, reciprocal relationships among substance use problems, utilization of drug treatment, and predisposing beliefs thought to increase treatment utilization.


METHODS
Persistent Effects of Treatment Study-Adolescent (PETS-A), conducted by the Center on Substance Abuse Treatment. This was a longitudinal study of youths originally participating in one of two CSAT studies; one sample included 476 youths receiving residential drug treatment, and the other included 519 youths receiving outpatient treatment.


METHODS
This study uses five waves of data collected over a 12-month period to examine the temporal relationships among four variables: treatment dose, substance use problems, drug resistance self-efficacy, and perceived need for treatment (PNT). Data from this longitudinal study were analyzed using cross-lagged panel models, and structural equation modeling techniques were used to estimate the prospective, reciprocal relationships among these four variables in each of the two samples, while controlling for several covariates.


RESULTS
Both PNT and low drug resistance self-efficacy led to higher levels of subsequent treatment. However, low self-efficacy presaged increases in drug problems while PNT predicted decreases.


CONCLUSIONS
Understanding the role of psychological variables in the utilization of health services is complicated for psychological disorders because beliefs that affect treatment can also influence the disorder itself. Efforts to keep adolescents in drug treatment should focus on convincing youth that treatment can help them with their problems, rather than convincing them that they cannot resist drugs on their own. While both messages increase treatment utilization, the latter belief undermines the effects of treatment.
Schell
Terry L
TL
Drug Policy Research Center, RAND, Santa Monica, CA 90407, USA.
Orlando
Maria
M
Morral
Andrew R
AR
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000523:psychology / Q000534:rehabilitation; D008605:Mental Health Services / Q000706:statistics & numerical data*; D015233:Models, Statistical; D009042:Motivation; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D000297:Psychology, Adolescent; D020377:Self Efficacy; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D014481:United States