The challenge of polysubstance users within Therapeutic Communities: a pilot study on patient profiling and motivation to change

Introduction: Motivation to change plays a key role in the treatment process of individuals with polysubstance addicted within Therapeutic Communities (TCs). However, motivation to change may vary according to several patients’ features that should be considered in the treatment planning, in order to avoid dropouts. Profiling patients addicted to multiple substances based on various sociodemographic and clinical features may contribute to identify more tailored and effective interventions. Therefore, this preliminary study aims to detect clusters of TCs polysubstance addicted and to determine how motivation to change varies among these subgroups. Methods: The study involved 35 polysubstance addicted (female n = 12), aged 22-59 years (mean = 36.9, SD = 10.7), in residential treatment within two therapeutic communities in Emilia-Romagna. Sociodemographic and clinical data were collected. All patients completed the Treatment Motivation Questionnaire (TMQ), aimed to assess Internalized Motivation (IM), External Motivation (EM), Help seeking (HS) and Confidence in treatment (C). A latent class analysis (LCA) was applied to variables related to demographics (sex, age), primary substance of abuse and legal situation to identify distinct profiles of patients. MANOVA was used to examine the relationship between the class membership and TMQ dimensions. Results: LCA identifies two profiles of patients. The first profile (P1) is composed by females, mainly aged from 21 to 30, without pending legal proceedings, whose primary substances are mainly heroin and cannabinoids. The second profile (P2) includes mainly higher aged men, showing pending legal proceedings and cocaine as primary substance. P1 and P2 differed based on sex, age, and primary substance of abuse, but not based on legal status. P1 show higher scores related to EM. Discussion: Despite had no pending legal proceedings, younger female polysubstance users, compared to older male polysubstance users, perceived greater lack of choice in seeking treatment and experienced more external pressure to remain in treatment rather than an inner motivation. These findings provide insights for CTs practitioners on the group more difficult to engage and on the sociodemographic and clinical features which may act as barriers to motivation to change.