Understanding motivation for substance use treatment: The role of social pressure during the transition to adulthood Ilana Goodman a, ⁎, Michele Peterson-Badali a , Joanna Henderson b a Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, ON, Canada M5S 1V6 b Centre for Addiction and Mental Health, Toronto, Canada abstract article info Keywords: Treatment motivation Social pressure Emerging adulthood Substance use Research has shown that social pressure is related to treatment motivation and plays an important role in treatment engagement in adults with problematic substance use. Despite the shifts in autonomy and decision- making in emerging adulthood, the factors affecting treatment motivation (e.g., readiness to comply with treatment) during this period have been largely ignored. In this cross sectional study, 134 youth (83 males and 51 females) presenting to an outpatient substance abuse program completed questionnaires regarding substance use history, mental health, social pressure to reduce use and enter treatment, and treatment motivation. Age was positively related to identification of internal reasons for seeking treatment and negatively related to external coercive social pressures as a motivator for treatment. Peer pressure accounted for significant variance in Identified (e.g., personal choice and commitment to the program) and Introjected (e.g., guilt about continued substance use) treatment motivation. Family pressure was related only to External treatment motivation when peer pressure was considered in the regression model. These results highlight the importance of emerging adult peers as motivators of youths' treatment seeking. Limitations, directions for future research and treatment implications are discussed. Crown Copyright © 2011 Published by Elsevier Ltd. All rights reserved. 1. Introduction Problematic substance use in youth is associated with continued substance abuse in adulthood, adverse health effects, academic/ vocational difficulties, unemployment, increased risk taking behavior, criminality, suicidality, and later psychiatric disorders (Merline, O'Malley, Schulenberg, Bachman, & Johnston 2004; Rohde, Lewinsohn, Kahler, Seeley, & Brown, 2001; Spirito, Jelalian, Rasile, Rohrbeck, & Vinnick, 2000; Valdez, Kaplan, & Curtis, 2001). Recent research has begun to focus on identifying the developmental trajectories associated with substance use initiation and maintenance. An at-risk subgroup that is beginning to receive empirical attention are those youth who have delayed initiation or experimented moderately in early adolescence but commence or increase their substance use to significantly higher levels as they transition into adulthood (Tucker, Ellickson, Orlando, Martino, & Klein, 2005). This period, known as emerging adulthood, occurs from roughly 18–25 years of age and has been clearly differentiated from adolescence and adulthood (Arnett, 2005). Emerging adults begin to make independent decisions concerning vocational and/or educational status, residential arrangements and interpersonal relationships (Arnett, 2001,2004; Martin & White, 2005). Although for most this transition is accompanied by positive change and growth it is also a time of great instability in many domains. Most illustrative of this instability is the dramatic increase in psychopathology from late adolescence to early adulthood (Khatzian, 1997). A significant number of emerging adults develop mental health issues such as depression or anxiety, and these issues are often accompanied by drug and alcohol abuse and/or dependence (Arnett, 2005). For example, The National Survey on Drug Use and Health for the United States reported that approximately 10% of males aged 18 to 25 reported serious psychological distress in the past year and were more likely to have engaged in heavy alcohol use (21%), binge alcohol use (51%) and illicit drug use (24%) than older respondents (Substance Abuse and Mental Health Services Administra- tion (Office of Applied Studies), 2008). Of college aged-youth in Canada, approximately 32% reported hazardous or harmful drinking patterns and 29% reported four or more symptoms indicating elevated distress (Adlaf, Demers, & Gliksman, 2005). Similarly, the Canadian Alcohol and Drug Use Monitoring Survey reported that rates of drug use by youth aged 15 – 24 years are significantly higher than adults 25 years and older (Health Canada, 2009). Recently, studies have begun to investigate trends related to drug use during emerging adulthood. Changes in substance consumption have been linked to significant transitions that often occur during this developmental stage (e.g., increased use after moving away from one's parental home, decreased use after entering romantic partner- ship/establishing a family) (Hammer & Vaglum, 1990). For many young people, college offers a lifestyle of increased freedom in which Addictive Behaviors 36 (2011) 660–668 ⁎ Corresponding author at: Department of Human Development and Applied Psychology, OISE, University of Toronto, 252 Bloor Street West, 9th Floor, Toronto, Ontario, Canada M5S 1V6. Tel.: +1 416 535 8501x6126; fax: +1 416 979 4996. E-mail address: ilana.goodman@utoronto.ca (I. Goodman). 0306-4603/$ – see front matter. Crown Copyright © 2011 Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2011.01.011 Contents lists available at ScienceDirect Addictive Behaviors