______________________________________________________________ Alcohol and Alcohol Use Disorder
MOTIVATIONS FOR CHANGE
Patients are more likely to seek treatment if: • There are few actual or perceived barriers to treatment. • The expectation is that treatment will work and that it is a positive change. • They think they need help. • They “hit bottom.” • They no longer feel in control. • They cannot change on their own. • They want to change their behavior. • They perceive that treatment will suit their needs. • There is social pressure to stop drinking or get treatment. • They experience notable or multiple problems (e.g., black-outs, DUI arrest, etc.). Patients are less likely to seek treatment if: • There are numerous real or perceived barriers to treatment. • They fear being unable to cope without alcohol. • There are negative perceptions of treatment or changing behavior. • They think that treatment will not work. • There is fear of withdrawal. • They think they will be stigmatized. • They believe that they will be unable to stop. • They fear failure. • They perceive continued use as positive.
Source: [305]
Table 2
necessary. For those with more severe alcohol problems in a treatment setting, brief intervention may be appropriate as an initial treatment with nonresponders receiving more extensive/ intensive treatment [301]. In summary, brief intervention can help patients without disordered alcohol consumption reduce or stop drinking, can help motivate patients with alcohol use disorder to enter treatment, and can be used to treat some patients with alcohol use disorder. One study reported that brief intervention is associated with decreased alcohol consumption and decreased healthcare utilization, motor vehicle events, and other related costs [302]. The study also reported that the cost-benefit analysis suggests that for every $10,000 invested in early intervention, there will be a $43,000 decrease in future healthcare costs [302]. A meta-analysis of brief alcohol interventions for adolescents and young adults found that the interventions yielded modest, but clinically significant positive effects on problematic alcohol use trajectories among youth [303]. READINESS TO CHANGE Readiness to Change was Dimension 4 of the third edition of the American Society of Addiction Medicine’s (ASAM’s) Six Dimensions of Multidimensional Assessment (also known as the ASAM Criteria) that is the standard for placement, continued stay, transfer, or discharge of patients with substance
use disorder and co-occurring conditions [304]. Readiness to Change is now considered within each of the six dimensions in the fourth edition of the ASAM Criteria. The six dimensions of the fourth edition include: intoxication, withdrawal, and addiction medications; biomedical conditions; psychiatric and cognitive conditions; substance use-related risks; recovery environment interactions; and person-centered considerations (new). This new sixth dimension considers barriers to care, patient preferences, and need for motivational enhancement [304]. Several factors influence a person’s readiness and ability to change behaviors. It is useful to help patients to weigh the risks of continued alcohol consumption and benefits of decreasing or eliminating alcohol consumption. Physicians can help motivate the patient to become ready for treatment if the patient appears ready to change. Is the patient ready to change? The role of motivation is an important part of changing behavior. Table 2 summarizes the “pros” and “cons” of changing [305]. The Stages of Change Model is also useful in determining where a patient is in the process of change [306]. The stages of change include: • Precontemplation • Contemplation • Preparation
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