(160) Motivation for Change and Treatment Among Transition-Age Adults With Substance Use Disorder

Background & Introduction: The transition from adolescence to adulthood is a period of instability marked by changes in identity, autonomy, roles and responsibilities. We term this period transition-age (TA) adulthood and note risk-taking, substance exposure, and reward sensitivity contributes to more severe substance use disorder (SUD) outcomes during this time. Despite this, TA adults face persistently lower SUD treatment initiation and retention rates than adolescents and older adult peers. Research suggests motivation for change plays an important role in how adults interprett a need for help, seek SUD treatment, and pursue recovery. However, the developmental instability of young adulthood may complicate how motivation interacts with, and is informed by, one’s treatment experience. This qualitative study explored how a) TA adults understand and experience motivation for change across help seeking, treatment, harm reduction, and recovery; and b) how TA adults’ motivation for change becomes intertwined with the organizational quality and delivery of care.

Methods: To better understand the motivational needs and treatment engagement experience of TA adults with substance use, we integrated Anderson’s behavioral model of health services use with Arnett’s developmental theory of emerging adulthood. We conducted virtual semi-structured 1:1 interviews across New York State. Participants were recruited via flyers posted in Office of Addiction Services and Supports (OASAS)-sponsored clinics and community spaces across the state, with QR codes which led participants to an eligibility survey, and they were contacted if eligible. The interviews were divided into four different sections, recounting the participants’ substance use history, treatment experience, substance use disorder needs and treatment preferences, and their personal and substance use related goals. Upon completion of the interview, participants were sent an electronic $50 gift card or mailed a physical copy, and the coordinator worked with clinic staff to facilitate communications for participants who did not have access to phones or computers to ensure a wide reach. For qualitative coding, the team conducted coding via Dedoose on de-identified transcripts (n=22). We used an iterative approach that blends top-down deductive and bottom-up inductive thematic coding to generate and refine analytical themes.

Results: Out of 22 interviews, 12 had received any sort of SUD treatment either past or present, and 10 had no treatment experience. Despite their motivation for change, TA adults with and without SUD treatment experience chronicled how past negative clinical encounters in late adolescence, such as psychiatric hospitalization, contributed to their hesitancy toward seeking SUD treatment in young adulthood. Second, for those who did engage in SUD treatment, lack of sustained support and aftercare presented a major barrier to maintaining motivation for change. Specifically, participants recounted being discharged into unsafe emergency housing, lacking follow-up appointments, or faced financial and transportation barriers to continued care. Many received short-term aftercare, if any, which resulted in rapid and repeated system re-entry. This cyclical process––what we call “churn”––indicates a broader pattern of being discharged, destabilized, and re-engaging in treatment with fewer resources and greater social and clinical vulnerability each time. Many TA adults re-entered the system; no longer in pursuit of recovery itself but out of survival and necessity.

Conclusion & Discussion: While some TA adults expressed strong initial desire for help, prior negative healthcare encounters undermined future help-seeking. For those who did enroll in treatment, program instability and inadequate discharge planning fostered disengagement, runaround, and repeated care cycling. The churn between treatment and re-entry—marked by unsafe housing, lack of aftercare, and other supports—reveals how structural and organizational shortcomings may inadvertently constrain the maintenance of motivation for change. For TA adults, sustaining motivational change requires more than crisis intervention; it demands stable, safe, and continuous clinical care that explicitly bridges the time-specific phase of treatment with broader community life. Taken together, our research helps inform "churn” as a potential quality indicator to identify and reduce. It also points to the need for clinicians and policymakers to augment case management and transitional supports following discharge to strengthen motivation and reduce revolving-door treatment patterns; doing so has the potential to improve long-term health outcomes.

References: DiClemente, C. C. (1999). Motivation for change: Implications for substance abuse treatment. Psychological Science, 10(3), 209-213.

Conner, B. T., Longshore, D., & Anglin, M. D. (2009). Modeling attitude towards drug treatment: the role of internal motivation, external pressure, and dramatic relief. The journal of behavioral health services & research, 36(2), 150-158.

Wilens, T. E., & Rosenbaum, J. F. (2013). Transitional aged youth: a new frontier in child and adolescent psychiatry. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 887-890.