title: "Ready, willing, and (not) able" to change: young adults' response to residential treatment.
abstract: BACKGROUND
  Young adulthood represents a key developmental period for the onset of substance use disorder (SUD). While the number of young adults entering treatment has increased, little is known about the mechanisms of change and early recovery processes in this important clinical population. This study investigated during-treatment change in key therapeutic processes (psychological distress, motivation, self-efficacy, coping skills, and commitment to AA/NA), and tested their relation to outcome at 3 months post-treatment.
  
  
  METHODS
  Young adults undergoing residential treatment (N=303; age 18-24; 26% female; 95% Caucasian) were enrolled in a naturalistic prospective study and assessed at intake, mid-treatment, discharge, and 3 months following discharge. Repeated-measures and regression analyses modeled during-treatment change in process variables and impact on outcome.
  
  
  RESULTS
  Statistically significant medium to large effect sizes were observed for changes in most processes during treatment, with the exception of motivation, which was high at treatment intake and underwent smaller, but still significant, change. In turn, these during-treatment changes all individually predicted 3-month abstinence to varying degrees, with self-efficacy emerging as the sole predictor in a simultaneous regression.
  
  
  CONCLUSIONS
  Findings help to clarify the mechanisms through which treatment confers recovery-related benefit among young adults. At treatment intake, high levels of abstinence motivation but lower coping, self-efficacy, and commitment to AA/NA, suggests many entering treatment may be "ready and willing" to change, but "unable" to do so without help. Treatment appears to work, in part, by helping to maintain motivation while conferring greater ability and confidence to enact such change.
authors.affiliation: Center for Addiction Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA. jkelly11@partners.org
authors.forename: J F
authors.initials: JF
authors.lastname: Kelly
authors.forename: K A
authors.initials: KA
authors.lastname: Urbanoski
authors.forename: B B
authors.initials: BB
authors.lastname: Hoeppner
authors.forename: V
authors.initials: V
authors.lastname: Slaymaker
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011613:Psychotherapy; D012114:Residential Treatment; D020377:Self Efficacy; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult