Abstract: Motivational readiness to change is a key strength and success of drug addicts to remain drug free and prevent relapse. This study is provided to measure the motivational readiness to change among rehabilitees of national drug rehabilitation center (PUSPEN) in Malaysia. The rehabilitees’ motivation and stages of readiness to change was measured by the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). A total of 593 rehabilitees from 6 drug rehabilitation centers in Peninsular Malaysia were chosen using stratified random sampling. Data were analyzed using descriptive analyses. Results showed majority of respondents indicated high readiness which was demonstrated in the dimensions of recognition and taking steps to change and recover from drug addiction. On the other hand, results also demonstrated that majority of drug addicts were still feeling ambivalent and unsure whether they can control the problems associated with drug addiction. Results gave a positive indication to the Malaysian government in particular in seeking methods to rehabilitate drug addicts to remain free from the influence of drugs as majority of them showed high motivational and readiness to change. Likewise, ex-addicts should also be given moral and social support to ensure they maintain continuous recovery, live free from drugs and prevent future relapse.

INTRODUCTION

Motivational readiness for change is an important consideration in treatment planning (Finney, 2003). Measuring motivational readiness for change is viewed as important for interventions aimed at promoting health behaviors within substance abuse programs. Some researchers have found that the readiness for change is a concept that has been linked with successful treatment (Simpson and Joe, 1993; Friedman et al., 1994; De Leon and Jainchill, 1986). In substance abuse treatment, clients' motivation to change has often been the focus of clinical interest and frustration. Motivation has been described as a prerequisite for treatment, without which the clinician can do little. Similarly, lack of motivation has been used to explain the failure of individuals to begin, continue, comply with and succeed in treatment (Miller and Rollnick, 1991).

Like other countries in the world, Malaysia is no exception in facing the challenges of overcoming the problem of addiction among drug users. Over the decade, there has been a drastic increase in illegal drug use. Statistics released by the Malaysian National Anti-Drugs Agency showed a significant increase in drug abuse each year. In 2009, a total number of 15,736 people have been identified as drug addicts compared to the previous year’s statistic of 12,352 people. Reports indicated on average, a total of 594 new addicts and 718 relapse addicts were detected each month from January to December 2009.

The increase in the number of drug addicts especially among relapse cases have a negative impression on the effectiveness of drug treatment programs provided by the government. Habil (2001) contended that >70% of those attending drug rehabilitation centers would probably relapse. Various studies have shown that there have been many factors contributed towards relapse among drug addicts. These factors include psychological, self efficacy and lack of family and community support (Moos, 2007; Fauziah and Kumar, 2009; Allsop et al., 2000; Ellist et al., 2004; Salmon et al., 2000). Apart from these factors, the lack of motivation and readiness to change among drug addicts has also been found to be among the key factors that contributed toward drug relapse (Fauziah and Naresh, 2009; Greenfield et al., 2000).

The study conducted by Carey et al. (2002) showed that the main reason for the clients’ failure to change their drug behavior was due to lack of client motivation. The self-determination theory states that the formation of human behavior can be influenced by internal and external factors. The formation of behavior that is influenced by internal instinct factors will cause lasting behavioral changes compared with the changes in behavior caused by the external factors (Desi and Ryan, 2000). Research conducted by Frausto and Hejazi (2009) among emergency department patients aged 18 years and were using single drug found that 46% of these patients were not willing to change, 21% were unsure to change and only 33% stated their readiness to change. The results clearly showed the low awareness to change among patients with drug addiction problem. In other research conducted by Blanchard et al. (2003) was found that people in treatment are not always motivated to change. Those who were coerced to receive treatment by court’s ruling or employer’s suggestion tended to reject the treatment and described difficulties in changing their addictive behavior. In other words, those who were not internally motivated to change their addictions found it difficult to adopt the positive behavior.

Specifically, the objective of this research was to measure the motivational readiness for change that includes recognition, ambivalence taking steps among drug addicts in Malaysia. This study may help the government to overcome the problem of addiction and curb the high rate of relapse cases that may be due to lack of readiness for change among the drug addicts or rehabilitees in treatment.

MATERIALS AND METHODS

Sample and procedure: The primary data were obtained through a survey using self-administered questionnaire. An established instrument-The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), developed by Miller and Tonigan (1996) was employed to answer the objectives of the study. The SOCRATES is a 19 items instrument that was developed as a measure of motivation for change in drug use. It has three subscales, representing three stages of change: ambivalence, recognition taking steps (Table 1).

Respondents’ were required to rate their responses to each item on the scale using the rating criteria of: strongly disagree, disagree, undecided or unsure, agree and strongly agree. Reliability analyses demonstrated that Cronbach sign for all constructs have high reliability: ambivalence (0.82), recognition (0.88) and taking steps (0.91). Thus, the SOCRATES showed a good level of reliability. The respondents were recruited by a systematic sampling procedure.

Table 1:	Socrates subscales defined

A total of 593 questionnaires were personally distributed to the drug addicts who were undergoing treatment and rehabilitation in 6 drug rehabilitation centers in Peninsular Malaysia. The counselors from the respective centers assisted in disseminating and collecting the questionnaires. High response rate (100%) for this study was due to high degree of cooperation by the respondents and the centers’ counselors. In addition, the drop and pick method utilized in this survey was very effective. Data were analyzed using SPSS version 15.

RESULTS AND DISCUSSION

Majority of the respondents (89.5%) was Malays and Muslims with 81.8% were men and 63.4% of them were single. Demographic data on educational level revealed that 37.4 and 34.6% of the respondents were holding malaysian certificate of education (SPM) (equivalent to O’ Level) and lower certificate education of malaysia (SRP), respectively.

Readiness to change (Recognition): Recognition refers to acknowledgement of problem and desire for change among drug addicts. Results of readiness to change for recognition subscale demonstrated that 82.8% of the drug addicts admitted to wanting to make changes in their addictive behavior. Recognition subscale is recorded as the highest response with the mean of 4.30 (Table 2).

This situation reflected that respondents who were currently enrolled in treatment at the rehabilitation centers showed changes towards a positive awareness of the effects of drugs. Majority (82.8%) of respondents were aware that their involvement with drug activity has resulted in difficulties in their lives. About 87% of them also realized that adverse effects will occur if they did not take steps to change. While a total of 72.3% of the respondents also acknowledged that they were drug addicts and have problems with drug addiction (78.5%). High level of readiness to change among drug addicts gave a positive indication towards drug addicts’ recovery.

Table 2:	Descriptive analysis result of motivational and readiness to change in terms of recognition, ambivalence and taking steps among drug addicts

This situation can facilitate the task being carried out by drug counselors in Malaysian drug rehabilitation centers. High level of readiness to change may also prevent the drug addicts from repeating activities that can damage their lives and futures.

Readiness to change (Ambivalence): The effectiveness of drug treatment should come from self-determination of an individual to change. The study conducted showed that the majority of respondents, 78.4% of them still have doubts that their involvement with drug addiction can cause harm. This is reflected in a high mean of 4.04 for the ambivalence subscale (Table 2). A total of 65.1% drug addicts showed that they were still not sure whether they were in control over their drug activities and did not know whether they were really drug addicts and ready to change. Results of this study indicated that most of drug users surveyed still have the attitude of uncertainty and unsure whether they were ready to change and recover from using drugs.

This situation gave a negative implication on Malaysian government’s effort to rehabilitate drug addicts. High ambivalence gave the impression that majority of drug addicts did not have high confidence to really recover from the grip of drugs. If this situation is not addressed it may lead to higher tendency of relapse among the addicts. Thus, drug counselors must take immediate action to address this uncertainty.

Readiness to change (taking steps): Taking steps refers to actions and efforts taken by the addicts to change and free themselves from the influence of drugs. The study showed that 89.4% of the respondents admitted that they had made few changes in their addictive behavior and needed help to avoid being trapped again (Table 2). Meanwhile, 82.7% of the respondents indicated high effort to recover by taking steps to seek the best method to keep away from drugs. These 2 items recorded the highest mean of 4.25. This situation has a positive indication that majority of respondents were willing to take steps to change and have desire to be free of drugs.

Maintaining the level of recovery from addiction and remaining drug free is not an easy task as the rehabilitees may face unexpected challenges and obstacles in their life. Thus, they may need continuous support in order to liberate themselves from drug addiction.

Results of the study found that 84.6% of respondents admitted that they really needed help to avoid being drawn into drug addiction problem. Majority (80.8%) of them demonstrated high effort to change and was actively doing something to stop their drug use. All the efforts and positive steps reported by the drug addicts could ease the task of drug counselors and consequently free themselves from drug addiction. Without motivation and readiness to change the government certainly faces huge challenges to restore most of the drug addicts to normal individuals.

CONCLUSION

This study showed the level of readiness for change among addicts in Malaysia. Overall, the results showed that majority of Malaysian drug addicts reported high percentage of motivational and readiness to change. They also reported their initiatives in taking steps toward positive changes. However, one worrying aspect is majority of them still showed high ambivalence to control their addictions. If this situation is not addressed promptly it may lead to relapse among the addicts. Therefore, it is suggested that counselors dealing with drug addiction take immediate steps to identify individuals who are still highly ambivalence about their addictive behavior.

RECOMMENDATIONS

It is recommended that counselors employ motivational interviewing method, a therapeutic approach intended to help clinicians work with clients to address their ambivalence. With this effort, drug addicts should be more motivated to change and this will directly help Malaysia to successfully achieve the goal of a drug free nation by 2015.

ACKNOWLEDGEMENTS

This research has been generously supported by National Anti-Drugs Agency and the Faculty of Social Sciences and Humanities, University Kebangsaan Malaysia. The researchers would like to express their sincere appreciations and gratitude for all the supports provided.