Development of a positive psychology intervention to improve intrinsic motivation for the treatment of substance use disorders

Abstract

Background - People with substance use disorders (SUD) often drop out of treatment. A lack of motivation is one of the most recurrent reasons for treatment dropout, including failure to abide by treatment, relapse, and other negative treatment outcomes. This study aimed to better understand what should be included in a positive psychology intervention (PPI) to increase intrinsic motivation to treat substance use disorders. The development was informed by the self-determination theory (SDT) with a specific focus on using the basic psychological needs as the core of the PPI. Methods - This was an exploratory, qualitative study consisting of two parts, before and after intervention development. The first part, developing the initial version of the positive psychology intervention, was informed by inputs from 70 participants from four focus groups. Of those, 37 were people with substance use disorders, and 33 were experts (also future implementers of the intervention) from two in-patient treatment centres in Gauteng, South Africa. The second part, namely the modification of the first draft of the PPI, was also informed by the inputs of these participants from another four focus groups. For the selection of the target group, a homogeneous sampling method was used. The experts were selected using an expert sampling method. Audio recordings of the focus groups discussed were transcribed verbatim by the researcher and an assistant to ensure that the transcriptions could be analysed in detail, linked to analytic notes, and coded. Once the data was captured, thematic analysis was used to examine the findings. Results - It was found that people receiving treatment for substance use disorders need support from others (family, staff, people in recovery, other people in treatment, higher power) to feel more engaged. They need to have a life purpose, participate in more structured activities and skills development and have more opportunities to become more competent. They also need to make their own good choices, feel in control of their own lives, and participate in their own treatment to develop autonomy. Furthermore, people with SUD and experts indicated that the first version of the PPI could inspire people to change and motivate people with SUD to continue their treatment. They found it relevant for the target group and appreciated the involvement of the target group in the development thereof. They also identified some suggested additions to include in the PPI to improve it. Discussion The development of the PPI was thoroughly informed by theory (SDT) and research on SUD treatment in South Africa. Basing this PPI development on SDT was valuable in understanding the needs of people with SUD, subsequently enhancing their intrinsic motivation for treatment. The findings indicated that SDT is ideal to use in the development of an intervention for such a vulnerable group. The involvement of people with SUD and future implementers of the intervention in developing this PPI through a participatory approach provided a useful alternative to the conventional research-led approaches. While research-led approaches are inadequately matched to the needs of target users, this study specifically focused on the needs of target users. If participants are asked what would be good for their needs, they knew and expressed specific ideas on improvement. The feedback from people with SUD in active treatment and people working with them (experts) was substantial and led to the intervention's development being based on it, although in combination with the theory. The suggested additions to the first version of the intervention by people with SUD reflected their accountability for their own recovery. They were included in the final intervention to improve it. Recommendations include that treatment centres consider allowing people with SUD to play a more active role during treatment and connect people with SUD with opportunities to enhance their need-fulfilment. It seems that the currently available treatment of people with SUD does insufficiently address the basic psychological needs and intrinsic motivation for people with SUD. This shows the need for the newly developed Sunflower PPI, which is likely to increase well-being and motivation because all three needs of people with SUD are addressed in concrete ways. Implementing this intervention in support of a current treatment programme may improve intrinsic motivation. Conclusion - This study led to the development of a positive psychology intervention based on theory, namely the self-determination theory, and on the expertise of people with SUD and practitioners working with them. It is, therefore, a promising way to improve the much needed motivation to support the prevention of treatment dropout and the recovery from SUD.