Recovery and URICA stage-of-change scores in three marijuana treatment studies

Feasibility of a remotely monitored blood alcohol concentration device to facilitate treatment motivation

BACKGROUND

Consistent monitoring of blood alcohol concentration through breathalyzers is critical for identifying reoccurrence. Little research has effectively utilized convenient wireless enabled breathalyzers that can measure blood alcohol concentration while enhancing treatment motivation for outpatient care. The current study attempted to understand the impact of wireless breathalyzers on treatment motivation and self-efficacy in remaining sober for individuals diagnosed with alcohol use disorder in an outpatient treatment facility.

METHODS

Participants were assigned to one of two conditions: the experimental breathalyzer and the treatment as usual group. The groups were assessed by the University of Rhode Island Change Assessment (URICA), and on self-efficacy, measured by the Alcohol Abstinence Self-Efficacy Scale (AASE). The evaluation period took place over three months with a six-week follow-up evaluation. During the entirety of the evaluation period and post-study follow up, interviews occurred.

RESULTS

As a secondary analysis, the URICA's motivational scores were higher for participants receiving the experimental intervention at a two-month evaluation and at the six-week follow-up. The AASE's temptation to reoccurrence scores significantly reduced over time for both groups. The confidence to resist temptation was not significant. Three major themes emerged from the interviews, including the benefit of the breathalyzer facilitating their treatment, ease of device use, and technical issues.

CONCLUSIONS

The insights gained from this study will be important to develop cost-effective ancillary interventions for comprehensive alcohol dependence treatment. On-going monitoring enabled by new technology allows treatment providers to take an individualized disease-management approach as well as facilitating timely interventions by the treatment provider.

Predictive validity of the R-URICA

OBJECTIVES

Measuring client motivation to change, and then using information from that assessment to plan and conduct treatment, has been of great interest to therapists. Researchers have modified a measure of motivation to change to develop the R-URICA (Tambling & Johnson, 2012, Fam. J., 20, 59).

DESIGN

This manuscript presents the results of an exploration of the validity of the R-URICA in a sample of individuals in couple therapy. Sample included 581 couples from a treatment-as-usual sample of counselling clinic clients. This study presents the results of inquiry into the ways in which scores on the R-URICA are modified over time in therapy, an indicator of the predictive validity of the instrument.

MEASURES

R-URICA, RDAS.

RESULTS

Results indicated that scores on the Action Subscale of the R-URICA change over time, indicating that therapy positively impacts this aspect of motivation to change. Results also suggested that the aspects of the R-URICA are related to where couples present for couple therapy and changes in dyadic adjustment in couple therapy.

PRACTITIONER POINTS

Practitioners should inquire about motivation to change at the outset of therapy. Further, practitioners should be sensitive to differences in motivation to change among families or couples as not all clients may be equally motivated. Practitioners may wish to devote time to engagement of male partners in therapy as males are more variable in their motivation to change and seem to impact outcomes. Practitioners may wish to consider the use of the R-URICA as an alternative measure of motivation to change in therapy.

Staging of mental disorders: systematic review

BACKGROUND

The staging method, whereby a disorder is characterized according to its seriousness, extension, development and features, is attracting increasing attention in clinical psychology and psychiatry. The aim of this systematic review was to critically summarize the tools that are available for reproducing and standardizing the clinical intuitions that are involved in a staging formulation.

METHODS

A comprehensive research was conducted on the MEDLINE, PsycINFO, EMBASE and Cochrane databases from inception to May 2012. The following search terms were used: 'stage/staging' AND 'psychiatric disorder/mental disorder/schizophrenia/mood disorder/anxiety disorder/substance use disorder/eating disorder'.

RESULTS

A total of 78 studies were identified for inclusion in the review. We discussed studies addressing or related to the issue of staging in a number of mental disorders (schizophrenia, unipolar depression, bipolar disorder, panic disorder, substance use disorders, anorexia and bulimia nervosa). The literature indicates that disorders have a longitudinal development or a treatment history that can be categorized according to stages. We proposed staging formulations for the above-mentioned psychiatric disorders.

CONCLUSION

Staging models offer innovative assessment tools for clinical psychologists and psychiatrists. Characterizing each stage of an illness demarcates major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis. A stage 0 to denote an at-risk condition does not appear to be warranted at the current state of research.

Reasons for quitting among emerging adults and adolescents in substance-use-disorder treatment

OBJECTIVE

Understanding developmental differences in reasons for quitting substance use may assist clinicians in tailoring treatments to different clinical populations. This study investigates whether alcohol-disordered and problem-drinking emerging adults (i.e., ages 18-25 years) have different reasons for quitting than younger adolescents (i.e., ages 13-17 years).

METHOD

Using a large clinical sample of emerging adults and adolescents, we compared endorsement rates for 26 separate reasons for quitting between emerging adults and adolescents who were matched on clinical severity. Then age group was regressed on total, interpersonal, and personal reasons for quitting, and mediation tests were conducted with variables proposed to be developmentally salient to emerging adults.

RESULTS

Among both age groups, self-control reasons were the most highly endorsed. Emerging adults had significantly fewer interpersonal reasons for quitting (Cohen's d = 0.20), and this association was partially mediated by days of being in trouble with one's family. There were no differences in personal reasons or total number of reasons for quitting.

CONCLUSIONS

Our findings are consistent with developmental theory suggesting that emerging adults experience less social control, which here leads to less interpersonal motivation to refrain from alcohol and drug use. As emerging adults in clinical samples may indicate few interpersonal reasons for quitting, one challenge to tailoring treatments for them will be identifying innovative ways of leveraging social supports and altering existing social networks.

Single-session motivational interviewing for drug detoxification inpatients: effects on self-efficacy, stages of change and substance use

Thirty-five inpatients at a Stockholm hospital drug user detoxification unit received single-session Motivational Interviewing (MI) between 2006 and 2008. At baseline and after 3 months, they were compared to a semi-randomized control group of 52 patients with treatment as usual. In the MI group, self-efficacy increased regarding abstention in connection with positive feelings, appreciation of positive drug effects increased, and participants tended to transition toward preparation/action stages of change. Despite implementation challenges, the study demonstrates the feasibility and effectiveness of single-session MI delivery in the inpatient drug detoxification setting and suggests paths for future research on delivery of single-session MI.

The transtheoretical model and substance dependence: theoretical and practical aspects

OBJECTIVE: This paper aims to present and discuss the Transtheoretical Model and its importance for the treatment of substance abuse disorders. METHOD: A literature review was made based on articles from the last 10 years in substance use with human subjects found in PubMed (Medline) and the Scientific Electronic Library Online, as well as on the main books written by the creators of the model. From the initial collection of articles related to the Transtheoretical Model, the University of Rhode Island Assessment and substance abuse, those related to other health conditions were excluded. Although articles related to hospitalization were also excluded, as were those related to the Minnesota Model, treatment proposals were included. RESULTS: Although the TTM has been studied for over 20 years, new concerns regarding the initial idea continue to arise. Such concerns include the cross-sectional design of studies employing the model, as well as the prescriptive versus descriptive point of view. DISCUSSION: The review of the Transtheoretical Model brought intentional behavior change to light, which could broaden the understanding of addictive behaviors. Together with its concepts of processes and stages of change, the Transtheoretical Model provides professionals with the idea that the effectiveness of therapy is dependent upon the capability of the therapist to match the technique to the current motivational stage of the patient in the process of change. This demonstrates the importance of identifying the stage of change of the patient when they present for treatment. Here, we describe the principal elements of the Transtheoretical Model, as well as the instruments currently used to identify the stage of change. Finally, criticisms and limitations of the model are discussed.

Progressive stage transition does mean getting better: a further test of the Transtheoretical Model in recovery from alcohol problems

AIMS

To test two central assumptions of the Transtheoretical Model (TTM) regarding recovery from alcohol problems: (i) individuals making a forward transition from pre-action to action stages will show greater drinking improvements than those remaining in pre-action stages; and (ii) individuals remaining in pre-action stages will not demonstrate improvements in drinking outcomes.

DESIGN AND SETTING

Large, multi-centre, randomized controlled trial of treatment for alcohol problems [United Kingdom Alcohol Treatment Trial (UKATT)].

MEASUREMENTS

Stage of change, drinks per drinking day and percentage days abstinent at baseline, 3- and 12-month follow-ups.

FINDINGS

In support of TTM assumption 1, improvements in drinking outcomes were consistently greater among clients who showed a forward stage transition (Cohen's d = 0.68) than among those who did not (d = 0.10). Two tests of assumption 2 showed a significant improvement in drinking outcomes in non-transition groups, inconsistent with the TTM; one test showed a significant deterioration and the other showed equivalent drinking outcomes across time. An explanation is offered as to why, under the relevant assumption of the TTM, clients in non-transition groups showed small changes in drinking outcomes.

CONCLUSIONS

In contrast to a previous study by Callaghan and colleagues, our findings largely support the TTM account of recovery from alcohol problems in treatment. The discrepancy can be explained by the use in our study of a more reliable and valid method for assigning stage of change.