Perceived coercion in substance abuse treatment: The eye of the beholder?

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Aims: To examine potential differences in subjective perceptions of coercion between substance abuse professionals and clients in how they view events that trigger entry to treatment. Such differences may influence both the clinician's approach and the client's response to treatment.Participants, measurement and findings: Seventy-four substance abuse treatment outpatients and 75 certified substance abuse clinicians rated 15 treatment entry-related events based on the degree of choice an individual would have in entering treatment. Clients perceived internal sources of coercion as more coercive, whereas the clinicians perceived external items as more coercive. Furthermore, clients' views of external coercive events appeared to be more uni-dimensional than for internal events, whereas clinicians perceived internal events as more cohesive relative to external events.Conclusions: Discrepant perceptions of treatment entry triggers may impact the development of a working alliance and the use of motivational strategies intended to enhance readiness to change. Further investigation into these divergent perceptions is needed to untangle the relationships among client and clinician assumptions, readiness for change, and treatment outcome.