1997) showed that the ASI psychiatric scale was a significant general predictor of posttreatment drinking and posttreatment social adjustment in a sample of more than 1200 alcohol dependent patients in three types of outpatient treatment.

Note: While there are a number of studies relating severity of psychopathology to posttreatment outcome, it should be noted that Schuckit and his colleagues have argued cogently against "over diagnosing" psychiatric symptoms, especially among alcohol dependent patients (Brown et al., 1991; Schuckit and Monteiro, 1988). These authors have shown that much of the serious psychopathology seen among alcohol dependent patients at treatment admission is reduced following even four weeks of abstinence. There is also evidence for rapid dissipation of psychiatric symptoms following abstinence from cocaine (Satel et al., 1991; Weddington, 1992). This proviso suggests that care should be taken to distinguish acute alcohol and/or drug related psychopathology from more enduring and chronic psychiatric symptoms.

Patient Motivation and Stage of Change—Evidence for patient "motivation for treatment" has traditionally been measured as the extent to which patients have freely entered into treatment. Conversely, patients who have been coerced into treatment based on pressure from legal, family, or employment sources, have been considered "treatment resistant." While this is a face valid measure of motivation—and presumably a good predictor of patient performance during and following treatment—the large literature on coerced treatment indicates the opposite of what would be expected. That is, patients who have been forced to enter a substance abuse treatment have shown during and posttreatment results that are quite similar to those shown by supposedly "internally motivated" patients (Inciardi, 1988; Lawental et al., 1996; Roman, 1988). This rather broad literature has led to the conclusion that when "motivation" is conceptualized and measured in terms of the degree to which the patient has been coerced into treatment, it is not an important predictor of treatment response.

However, there is rapidly growing body of research indicating that when motivation is defined as "readiness for change" and is conceptualized and measured in stages as suggested by Prochaska, DiClemente and their associates (e.g., Prochaska and DiClemente, 1984; Prochaska et al., 1992), "stage of change" motivation can be a very important predictor of treatment response and treatment outcome. According to the stage of change model, the process of behavior change occurs in a progression of five distinct stages, each characterized by a different constellation of attitudes and behaviors. An individual in the "precontemplation stage" has no awareness of a problem and no desire to change. A patient in the "preparation stage" has made the decision to change and is already taking steps to do so. A