الفهرس 
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Abstract
Substance use disorders (SUDs) is a major problem in Egypt that causes more deaths, illnesses and disabilities than any other preventable health condition. It cause damage to the physical, psychological, moral and intellectual growth among youth. It affects the formation of a strong self-identity, emotional and intellectual growth, establishment of a career, and the development of rewarding personal relationships.Individuals who are vulnerable for using substance are characterized by certain risk factors in their personalities, which trigger a spectrum of disorders when environmental factors interfere with those risk factors. These factors not only act as predictor of beginning of substance use but also have detrimental impact on motivation for treatment which lead to relapse after period of recovery.
The aim of the study:
The present study aimed to determine the psychosocial factors associated with motivation for treatment among patients with substance use disorders.
Research design:
A descriptive research design
Setting:
The study was conducted in the outpatient clinic for patients with SUDs at EL-Maamoura Hospital for Psychiatric Medicine in Alexandria.
Subjects:
The study covered 200 male patients with substance use disorder free from comorbid psychiatric disorders, attend the clinic without previous appointment and those with hotline services, willing to participate and cooperate in the study and not attending group therapy at the time of the study to avoid any interference.
Tools of data collection:
Tool I: A Socio-Demographic and Clinical Data Tool:
This tool was developed to collect data about the study subjects’ characteristics as age, marital status, education level, type of substance use, reasons of starting substance and age of onset of using substance.
Tool II: Psychosocial functioning and motivation scales:
Self-reported (TCU) psychosocial functioning and motivation scales was developed by Knight, Holcom, & Simpson (1992) and updated 1994, to assess psychosocial and motivational barriers identified as being closely related to drug-using behavioral change(Knight et al., 1994). It includes three scales a) Psychological functioning scale (28 items), b) Social functioning scale (31 items), and c) Motivation scale (24 items). The psychological functioning scale includes four subscales namely; self-esteem (SE), depression (DP), anxiety (AX), and decision-making confidence (DM) e.g. (You feel sad or depressed? / You have trouble sleeping? ). The social functioning scale includes four subscales namely; childhood problems (CP), hostility (HS), risk taking behavior (RT) and social conformity (SC) e.g. (You feel mistreated by other people? / You like to do things that are strange or exciting? ). The motivation scale includes three subscales namely; problem recognition (PR), desire for help (DH), and treatment readiness (TR) e.g. (Your life has gone out of control? / You want to be in a drug treatment program?). The total items of this scale consists of 83 items, each item rated on a 5-point Likert scale, where 0 = strongly disagree, 1 = disagree, 2 = undecided, 3 = agree, 4 = strongly. The scale was adapted from 1 to 5 rather than 0 to 4 as zero is not good for law, where 1 = strongly disagree, 2 = disagree, 3 = undecided, 4 = agree, 5 = strongly(Simpson et al., 2012). Each subscale divided into three groups, low, moderate and high. Higher scores in self-esteem (higher than 21), decision-making confidence (higher than 32), social conformity (higher than 29), and the three motivational subscales including problem recognition (higher than 32), desire for help (higher than 25) and treatment readiness (higher than 29) imply better functioning, while higher scores in depression (higher than 21), anxiety (higher than 25), childhood problems (higher than 29), hostility (higher than 29), and risk-taking (higher than 25) indicate poorer functioning.
Method of actual study:
A jury composed of seven experts of psychiatric and mental health nursing and medicine had examined the content validity of tools and modification were done accordingly and revealed that the tools are valid. A pilot study was carried out on 20 patients with substance use disorders (SUDs), to ascertain the clarity and applicability of the study tool and to identify the obstacles that may be faced during the actual study, after obtaining their witnessed oral consent (the majority of them refuse to sign written consent) to participate in the study. These patients were later excluded from the study. Cronbach’s alfa reliability test was done for tool. The α reliability of the total psychosocial functioning and motivation scales was 0.82, while α reliability for each of psychological scales was 0.70, social scales was 0.80 and motivation for treatment was 0.80. Patients fulfilling predetermined inclusion criteria were recruited in the study, interviewed individually. The duration of each patient interview ranged from 25-45 minutes according to the patients cooperation and ability from 9 AM to 3 PM three days weekly. Data were collected over period of three months starting at 22th of April 2019 and ending at the 25th of July 2019. All data were numerically coded and entered into Statistical Package for Social Science (SPSS) version 23.0 for statistical analysis.
Main finding of the present study were the following:
- Regarding to the socio-demographic characteristics, less than half of the studied patients (45.50%) were in the age group ranging from 30 to less than 40 year followed by 39.00% in the age group ranging from 20 to less than 30.
- More than one third (34.00%) of the studied subjects had secondary education, less than half (43.00%) of them had free business, 34.50%of them were handicrafts, nearly two thirds (62.00%) of them stated that they had enough financial income and 39.50% of them were middle sons.
- Regarding to the clinical characteristics, nearly quarter (24.95%) of studied subjects were using cannabis and more than half of them (57.80%) were using substance due to peer pressure and curiosity.
- Concerning to psychological functioning’s scale, the majority of studied subjects (90.50%) had low self-esteem, 89.00% of them had high depression, and 85.00% had high anxiety, while 87.50% of them had low decision making confidence.
- Regarding to social functioning’s scale, the majority of the studied subjects (93.00%) had high hostility, 79.00% of them had high risk taking, 74.50% of them had high childhood problems and 65.50% of them had low social conformity.
- In relation to motivation for treatment, the majority of the studied subjects (95.00%) had high problem recognition, 75.50% of them had high desire for help, whereas 59.50% of them had high readiness for treatment and 32.50% of them had low readiness for treatment.
- The study proved that there is a significant negative correlations between self-esteem and motivation for treatment.
- There was a significant negative correlations between decision making confidence and motivation for treatment(r=-.170, p=.016).
- There was a significant negative correlations between social conformity and motivation for treatment(r=-.202, p=.004).
- There was a significant negative correlation between problem recognition with self-esteem(r=-.295, p=.000), decision making confidence(r=-.212, p=.003) and social conformity(r=-.278, p=.000).
- There was a significant negative correlation between desire for help, self-esteem (r=-.171, p=.015) and social conformity(r=-.140, p=.048).
- There was a significant negative correlation between treatment readiness and self-esteem(r=-.207, p=.003).
- There was a significant positive correlations between depression and motivation for treatment(r=.200, p=.004).
- There was a significant positive correlations between anxiety and motivation for treatment(r=.198, p=.005).
- There was a significant positive correlation with childhood problem and motivation for treatment (r=155, p=.028).
- There was a significant positive correlations between problem recognition with depression(r=.266, p=.000), anxiety(r=.279, p=.000) and hostility(r=.191, p=.007).
- There was a significant positive correlations betweendesire for help desire for help with anxiety (r=.187, p=.008) and depression(r=.167, p=.018).
- There was a significant positive correlations between treatment readiness and childhood problem(r=.168, p=.017).
The following are the main recommendations from this study:
A. Recommendation geared toward the patients of SUDs and their families
1. Implementation of psychoeducational program which can help patients with SUDs to:
Increase self-awareness about psychosocial factors that can hamper their motivation for treatment.
Integrate self-esteem and decision making confidence training program as a part of group therapy to empower patients in their recovery process and decrease their relapse rate.
Motivation for treatment should be measured at different time for patients who are engaged to rehabilitation program
Integrate psychosocial factors and motivation for treatment assessment in to the hospital protocol.
2. Develop post discharge plan to follow up patients at different time for their level of motivation and psychosocial factors.
3. Caregivers should be taught about the psychosocial factors and motivation for treatment because they have significant role in treatment and relapse prevention.
B. Recommendation directed toward community:
1. Because of misconception about SUDs, it should be provided information for all population through mass media about psychosocial factors that precipitate people for using drugs.
2. Develop educational campaign for primary and secondary school students as target group about the most common psychosocial factors according to their age that egging them to using drugs and how to deal with it.
3. Planning and implementing public health program to increase awareness about nature of SUDs in order to decrease stigma.
4. Develop community services that help to provide support for substance user after recovery by find purpose, meaning and joy in life through positive habits and healthy lifestyles.
C. Recommendation directed toward psychiatric nursing staff:
1. Develop training program for psychiatric nurses to increase their awareness about the psychosocial factors that affect motivation for treatment among patients with SUDs.
2. Develop individualized nursing care plan for each patient considering his psychosocial factors and motivation for treatment.
3. Recovery program for patients with SUDs should be developed based on their psychosocial factors and motivation for treatment.
D. Recommendation directed toward further studies:
1. Investigate the effect of psychosocial factors on the relapse pattern among patients with SUDs.
2. Assess the level of motivation for treatment at different times during the rehabilitation phase.
3. Address the relationship between stress and motivation for treatment among patients with SUDs.
4. Replicate the study on female patients with SUDs.