Patient motivation is a necessary ingredient in substance abuse treatment and recovery. Because of the reinforcing nature of addictive substances and the physiological and psychological reliance they engender, individuals with problematic and dependent patterns of substance use often refuse to acknowledge problems or seek treatment. Even when substance abusers arrive at a treatment program, many are ambivalent about the need to modify their substance use and resist any notion that they need to reduce their use or abstain completely. Going to treatment is not a panacea that turns ambivalence and lack of readiness into commitment to change—a significant number of individuals who enter a treatment facility fail to complete the treatment and many drop out after intake or a single session (Simpson and Joe 1993; Wickizer et al. 1994). Engagement in substance and alcohol abuse treatment is sporadic. Even those who comply and complete treatment do not always achieve stated goals. Reluctance to seek help, attrition, and relapse are significant problems facing treatment providers as they try to help individuals who abuse drugs and alcohol along the path to recovery. All of these barriers are connected in some way to patient motivation.