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Robinson L, Flynn M, Cooper M. Individual differences in motivation to change in individuals with eating disorders: A systematic review. Int J Eat Disord 2024; 57:1069-1087. [PMID: 38436481 DOI: 10.1002/eat.24178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Motivation to change has been suggested to significantly impact treatment outcomes in eating disorders (EDs). This review will investigate factors associated with motivation to change in EDs with the aim of supporting clinicians to be aware and sensitive to factors that might obstruct recovery and to inform motivation-based interventions. METHOD Using PRISMA guidelines, this article identified 24 studies through database searches meeting eligibility criteria. Only correlates of motivation were identified, limiting the ability of this review to identify causal relationships. Factors that changed alongside changes in motivation were identified from longitudinal studies. RESULTS This review identified factors such as individual characteristics, co-morbid psychopathology, lack of treatment autonomy and relationships with others to be associated with motivation to change in individuals with EDs. In addition, motivation to change significantly increased alongside self-esteem and identity re-negotiation when measured longitudinally. DISCUSSION Motivational interviewing can typically focus on exploring ambivalence to treatment, identifying goals and values, and increasing self-efficacy. However, this review identifies individual and relational factors to be particularly significant and may obstruct recovery from an ED. As such, evidence-based targets have been identified to inform clinicians and motivation-based interventions. PUBLIC SIGNIFICANCE Knowledge of factors associated with motivation to change in EDs is important to understand those who may have poorer treatment outcomes. Motivation may be improved by supporting individuals' relationship with others and tailoring interventions according to temperament and personality traits. Utilizing an individual's social support as they enter ED treatment may be effective in maximizing motivation to recover.
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Affiliation(s)
- Lauren Robinson
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Myra Cooper
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
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2
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Kaufman A, Nemeroff R. Motivation to change predicts college students' utilization of self-help resources. J Am Coll Health 2024:1-9. [PMID: 38592799 DOI: 10.1080/07448481.2024.2334082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
Background: Stress and mental health difficulties are common burdens on college students. College counseling centers have been overrun by demand. Thus, self-help interventions may offer a promising alternative to traditional college counseling services. Methods: The current study examined the influence of perceived stress, motivation to change, and self-efficacy beliefs on college students' use of self-help resources, to determine whether these factors would predict follow-up with self-help recommendations. Results: Results of stepwise linear regression models suggest that perceived stress and self-efficacy did not predict self-help resource utilization. Different types of self-help recommendations did not predict different levels of follow-up. However, motivation to change was a significant predictor college students' self-help resource use, and this variable was particularly important when self-help recommendations were less structured. Conclusions: These findings can help to predict which college students are likely to make use of self-help resources, and inform targeted individual treatment.
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Affiliation(s)
- Alyson Kaufman
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
| | - Robin Nemeroff
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
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3
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Schager JA, Stout KG, Steinkamp M. Measuring motivation to change in community mental health: A Program Evaluation. J Prev Interv Community 2023; 51:130-140. [PMID: 31349767 DOI: 10.1080/10852352.2019.1643581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A program evaluation of a community outpatient mental health program was conducted as part of a required course in Spalding University's School of Professional Psychology. Specifically, the program evaluation examined how the client-specific factors of motivation to change were related to attendance and participation in services. Motivation to change was assessed by surveying program participants utilizing the University of Rhode Island Change Assessment (URICA). Students hypothesized stage of change would be significantly correlated with attendance rates. Results indicate stage of change was related to attendance, with pre-contemplation scores negatively associated with attendance although most of the specific analyses were not statistically significant. Students' experiences and feedback regarding conducting the program evaluation are discussed.
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Affiliation(s)
- Jennifer A Schager
- School of Professional Psychology, Spalding University, Louisville, Kentucky, USA
| | - Kelsey G Stout
- School of Professional Psychology, Spalding University, Louisville, Kentucky, USA
| | - Melissa Steinkamp
- School of Professional Psychology, Spalding University, Louisville, Kentucky, USA
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Zale EL, Williams CM, Reynolds LR, Mastroleo NR. Examining Sex Differences in Associations between Pain and Alcohol Use among College Student-Athletes. Subst Use Misuse 2022; 57:539-547. [PMID: 34957907 DOI: 10.1080/10826084.2021.2019784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: College student-athletes are a high-risk population for both pain and alcohol use. Although a growing literature indicates that pain motivates alcohol consumption, no studies have tested associations between pain and alcohol in college student-athletes. Methods and Results: Among National Collegiate Athletic Association Division I student-athletes at a large public university (N = 65; 48% Female), nearly all student-athletes (97%) reported alcohol use and 65% reported pain due to an athletic injury. Pain intensity was positively associated with greater motivation to reduce drinking prior to receiving a brief alcohol intervention. Among females, pain intensity was associated with lower self-reported alcohol consumption. Among male athletes, pain-related interference was associated with greater alcohol-related problems and lower perceived ability to deal with alcohol-related situations. Conclusion: Results provide initial evidence that pain may be important to consider when addressing alcohol use among student-athletes.
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Affiliation(s)
- Emily L Zale
- Department of Psychology, Harpur College of Arts & Sciences, Binghamton University, Binghamton, New York, USA
| | - Callon M Williams
- Department of Psychology, Harpur College of Arts & Sciences, Binghamton University, Binghamton, New York, USA
| | - Linda R Reynolds
- Health Promotion and Prevention Services Department, Binghamton University, Binghamton, New York, USA
| | - Nadine R Mastroleo
- Department of Psychology, Harpur College of Arts & Sciences, Binghamton University, Binghamton, New York, USA
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Schreiner AM, Livingston NA, Heilman M, Lynch T, Vittorio L, Brief DJ, Rubin A, Enggasser JL, Roy M, Solhan M, Helmuth E, Rosenbloom D, Keane TM. Understanding motives for and against hazardous drinking and change among returning veterans. Psychol Serv 2021; 18:523-532. [PMID: 32378932 PMCID: PMC9036940 DOI: 10.1037/ser0000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The prevalence of hazardous drinking is elevated among returning veterans of Iraq and Afghanistan wars, particularly among returning veterans and those with co-occurring posttraumatic stress disorder (PTSD) symptoms. Understanding the reasons for drinking as well as motivations for change can tremendously improve intervention efforts. Unfortunately, little is currently known regarding the motivations that might facilitate or hinder change among returning veterans. In the current study, we examined returning veterans' reasons to change or not change drinking through analysis of responses to an open-ended decisional balance exercise. We included 366 returning veterans selected from a larger sample of returning veterans enrolled in a web-based randomized-controlled trial of an online intervention for alcohol use and PTSD. We used qualitative content analysis to systematically classify responses into categories through identification of common themes. Top reasons to change/reduce drinking included reducing negative physical effects, improve finances, and expected social/interpersonal benefits of reduction or abstaining. Top reasons to continue drinking/not change included facilitation of social interaction, promote sleep, and reduce tension. The current study adds to our phenomenological understanding of motivations for and against changing drinking among returning veterans. Whereas many motives were consistent with those of nonveteran samples, others appear to distinguish, and are uniquely salient among, returning veterans (e.g., to manage sleep and PTSD symptoms). These results provide insight into key assessment and intervention points regarding hazardous drinking among returning veterans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Amy M. Schreiner
- VA Boston Healthcare System, Boston, Massachusetts, and National Center on Addiction and Substance Abuse, New York, New York
| | - Nicholas A. Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Meagan Heilman
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, and University of Alabama
| | - Toby Lynch
- Massachusetts General Hospital, Boston, Massachusetts, and VA Boston Healthcare System, Boston, Massachusetts
| | - Lisa Vittorio
- Ohio State University and National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts
| | - Deborah J. Brief
- VA Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Amy Rubin
- VA Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Justin L. Enggasser
- VA Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Monica Roy
- VA Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Marika Solhan
- VA Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Eric Helmuth
- Education Development Center, Boston, Massachusetts, and VA Boston Healthcare System, Boston, Massachusetts
| | | | - Terence M. Keane
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
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Lillie KM, Jansen KJ, Dirks LG, Lyons AJ, Alcover KC, Avey JP, Hirchak K, Herron J, Buchwald D, Donovan DM, McDonell MG, Shaw JL. Assessing the Predictive Validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) in Alaska Native and American Indian People. J Addict Med 2021; 14:e241-e246. [PMID: 32371661 PMCID: PMC7541407 DOI: 10.1097/adm.0000000000000661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of this study was to examine the predictive validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) among Alaska Native and American Indian (ANAI) people with an alcohol use disorder. METHODS The sample was 170 ANAI adults with an alcohol use disorder living in Anchorage, Alaska who were part of a larger alcohol intervention study. The primary outcome of this study was alcohol use as measured by mean urinary ethyl glucuronide (EtG). EtG urine tests were collected at baseline and then up to twice a week for four weeks. We conducted bivariate linear regression analyses to evaluate associations between mean EtG value and each of the three SOCRATES subscales (Recognition, Ambivalence, and Taking Steps) and other covariates such as demographic characteristics, alcohol use history, and chemical dependency service utilization. We then performed multivariable linear regression modeling to examine these associations after adjusting for covariates. RESULTS After adjusting for covariates, mean EtG values were negatively associated with the Taking Steps (P = 0.017) and Recognition (P = 0.005) subscales of the SOCRATES among ANAI people living in Alaska. We did not find an association between mean EtG values and the Ambivalence subscale (P = 0.129) of the SOCRATES after adjusting for covariates. CONCLUSIONS Higher scores on the Taking Steps and Recognition subscales of the SOCRATES at baseline among ANAI people predicted lower mean EtG values. This study has important implications for communities and clinicians who need tools to assist ANAI clients in initiating behavior changes related to alcohol use.
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Affiliation(s)
- Kate M Lillie
- Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK (KML, KJJ, JPA, JLS); Information School, University of Washington, Box 352840, Mary Gates Hall, Seattle, WA (LGD); Elson S. Floyd College of Medicine, Washington State University, 412 E. Riverpoint BLVD, Spokane, WA (AJL, KCA, MGMD); Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM (KH); Department of Psychology, University of New Mexico, Albuquerque, NM (JH); Institute for Research and Education to Advance Community Health and Partnerships for Native Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA (DB); Department of Psychiatry and Behavioral Sciences and Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Suite 120, Seattle, WA (DMD)
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Moon TJ, Mathias CW, Mullen J, Karns-Wright TE, Hill-Kapturczak N, Roache JD, Dougherty DM. Social Support and the Rehabilitation of Alcohol-Impaired Drivers: Drinking Motives as Moderators. Health Commun 2021; 36:540-550. [PMID: 32091242 PMCID: PMC7483183 DOI: 10.1080/10410236.2020.1731914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Alcohol-impaired driving is a common and costly public health problem associated with alcohol misuse. This investigation aims to understand the role of social support and drinking motives in motivating alcohol-impaired drivers to reduce alcohol use. One hundred nineteen participants with a history of driving-while-intoxicated arrest were recruited from either a correctional treatment facility (n = 59) or the community (n = 60) and asked about their motivation to change alcohol use. Motivation to change was tested in relationships with two types of social support (i.e. Abstinence-Specific Social Support and General Social Support) and drinking motives (Coping, Enhancement, and Social Motives). The results showed: (1) only Abstinence-Specific Social Support was positively associated with motivation to change; (2) Coping and Social Motives had a negative association with motivation to change; (3) the impact of Abstinence-Specific Social Support on motivation to change was greater among those with a stronger Enhancement Motives. In other words, those who drink primarily for pleasure showed a greater increase in motivation to change when more Abstinence-Specific Social Support is available, compared to those with lower Enhancement Motives. The findings of this investigation contribute to our knowledge of the roles of communication in the rehabilitation of alcohol-impaired drivers.
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Affiliation(s)
- Tae-Joon Moon
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | - Charles W. Mathias
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | - Jillian Mullen
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | - Tara E. Karns-Wright
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | | | - John D. Roache
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | - Donald M. Dougherty
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
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Heider KS, Dempfle A, Altdorf S, Herpertz-Dahlmann B, Dahmen B. Motivation to Change in the Course of a Pilot Study of a Step-Down Treatment Approach of Inpatient and Anorexia Nervosa-Specific Home Treatment and Its Effects on Treatment Outcome. Front Psychiatry 2021; 12:693103. [PMID: 34690825 PMCID: PMC8529001 DOI: 10.3389/fpsyt.2021.693103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/23/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction: Anorexia nervosa (AN) is a serious mental disorder that typically manifests in adolescence. Motivation to change is an important predictor for treatment outcome in adolescent AN, even though its development over the often long therapeutic process, with transitions between treatment settings, has not yet been studied. In this pilot study, the course of motivation to change and its effect on treatment outcome were investigated over the course of a step-down treatment approach during a 12-month observation period. Methods: Twenty-one adolescents admitted to inpatient treatment because of AN received multidisciplinary home treatment (HoT) with several weekly visits after short inpatient stabilization. Eating disorder (ED-)specific cognitive [Eating Disorder Inventory 2 (EDI-2) subscales] and physical [% expected body weight (%EBW)] illness severity and motivation to change [Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ)] were assessed at the time of admission, discharge from hospital, at the end of HoT, and at a 12-month follow-up. Changes in motivation over time and its relationship with treatment outcome were investigated. Results: Mean motivation to change improved significantly over the course of treatment from the contemplation stage [2nd stage, mean ANSOCQ sum score 47.26 (SD 17.60)] at admission to the action stage [4th stage, mean ANSOCQ sum score 77.64 (SD 18.97)] at the end of HoT (p < 0.001) and remained stable during the follow-up period. At each assessment, higher motivation to change was significantly correlated with lower ED-specific cognitive illness severity (Spearman ρs: -0.53 to -0.77, all p < 0.05). Only pretreatment motivation to change significantly predicted ED-specific cognitive illness severity after the first inpatient treatment phase when taking prior illness severity into account. Conclusions: Motivation to change is an important aspect of treatment success in adolescent AN, especially in the early phase of treatment. In addition, home treatment contributed significantly to a higher motivation. Further longitudinal research into how motivation to change in adolescent patients with AN is related to outcome in this often severe and enduring disease and into targeted therapeutic strategies and interventions that reliably enhance the motivation to change in adolescent patients with AN seems promising.
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Affiliation(s)
- Kathrin Sophie Heider
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sophie Altdorf
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen University, Aachen, Germany
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Moise C, Varma M, Stewart D. Interpersonal Consequences Predicting Adolescent Substance Use: Examining the Role of Temptation Coping, Motivation, and Impulsivity. Subst Use Misuse 2020; 55:1640-1649. [PMID: 32460576 DOI: 10.1080/10826084.2020.1756848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Adolescent substance use is highly prevalent and problematic; it has been reported as one of the most pertinent leading health concerns in the United States. The current longitudinal study examined the presence of peer and parental interpersonal relationship consequences (IP) as a motivating factor in activating coping skills to decrease the frequency of adolescent substance use, while further evaluating the role of impulsivity within that process. Objectives: Two main hypotheses were proposed: (1) IP will decrease substance use frequency mediated by increases in motivation and temptation coping; and (2) impulsivity will moderate the link between coping and substance use frequency. Participants included 343 adolescents between the ages of 13-19 (M = 16.23) referred to Project READY, a school-based substance use intervention. Assessments were completed during Sessions 1 and 4 of the intervention. Results: Serial mediation analyses indicated temptation coping, baseline alcohol use, and Time 2 marijuana use were the only statistically significant predictors of Time 2 alcohol use. Temptation coping and baseline marijuana use were the only statistically significant predictors of Time 2 marijuana use. Conclusions: Once adolescents' baseline and concurrent substance use were incorporated into the model, there was no statistical significance of the indirect effects. Results provided a stronger examination of the factors related to long-term substance use among adolescents. Knowing that temptation coping and baseline substance use levels were significant predictors of time 2 substance use independent of interpersonal consequences and motivation to change provides a structural frame and highlights need for early intervention.
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Affiliation(s)
- Claudine Moise
- Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts, USA
| | - Malini Varma
- School of Psychology Family and Community, Clinical Psychology, Seattle Pacific University, Seattle, Washington, USA
| | - David Stewart
- Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts, USA
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McLean SA, Caldwell B, Roberton M. Reach Out and Recover: Intentions to seek treatment in individuals using online support for eating disorders. Int J Eat Disord 2019; 52:1137-1149. [PMID: 31298791 DOI: 10.1002/eat.23133] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to explore characteristics and treatment-seeking intentions of consumers accessing an online resource for eating disorders support, Reach Out and Recover (ROAR). Factors associated with treatment-seeking intent among visitors to ROAR were also examined. METHOD Participants were 200 visitors to the website aged 18 to 60 plus. The majority of participants (93.5%) identified as women. Responses to self-report questions assessing treatment-seeking intention, eating disorder symptoms and their impact on health, and attitudes to treatment were collected. RESULTS Participants experienced a range of eating disorder symptoms, yet the majority (86.0%) was not receiving treatment. Importantly, of those not in treatment, the majority (82.6%) indicated that they planned to get treatment. In addition, more than half of participants (52.9%) downloaded a report to present to their health practitioner to facilitate communication with a health professional. Intention to seek treatment and download of the report were positively associated with motivation to change, confidence to achieve change, greater frequency of binge eating, and greater recognition of the impact of eating disorder symptoms on relationships and well-being but not with stigma or ambivalence. DISCUSSION Study findings indicated that the ROAR website was accessed by individuals for whom it was designed, namely those experiencing eating disorder symptoms who are not receiving treatment. Encouragingly, participants had strong intentions to seek treatment, and the majority downloaded a report that could be used to facilitate the first step toward treatment. Greater focus on enhancing motivation and confidence to change may further promote treatment-seeking.
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Affiliation(s)
- Siân A McLean
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Victorian Centre of Excellence in Eating Disorders, Melbourne Health, Melbourne, Victoria, Australia
| | - Belinda Caldwell
- Victorian Centre of Excellence in Eating Disorders, Melbourne Health, Melbourne, Victoria, Australia
| | - Michelle Roberton
- Victorian Centre of Excellence in Eating Disorders, Melbourne Health, Melbourne, Victoria, Australia
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11
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Surratt HL, Otachi JK, Williams T, Gulley J, Lockard AS, Rains R. Motivation to Change and Treatment Participation Among Syringe Service Program Utilizers in Rural Kentucky. J Rural Health 2019; 36:224-233. [PMID: 31415716 DOI: 10.1111/jrh.12388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/21/2019] [Accepted: 07/16/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Kentucky experiences a disproportionate burden of substance use disorder (SUD), particularly in rural areas of the state. Multiple factors increase vulnerability to SUD and limit access to services in rural communities. However, the recent implementation and expansion of syringe service programs (SSPs) in rural Kentucky may provide a leverage point to reach at-risk people who inject drugs (PWID). METHODS Data were collected as part of an ongoing NIDA-funded study designed to examine uptake of SSPs among PWID in Appalachian Kentucky. Using Respondent Driven Sampling (RDS), the study enrolled a sample of 186 PWID SSP attenders across 3 rural Appalachian Kentucky counties and conducted face-to-face interviews regarding health behaviors, injecting practices, SSP utilization, and treatment services. Using logistic regression analyses, we examined consistent SSP use, as well as importance and confidence to reduce substance use as predictors of current treatment participation. FINDINGS For the prior 6 months, 44.6% of the sample reported consistent SSP use. Consistent use of SSPs was associated with treatment participation in the unadjusted logistic regression models. Significant predictors of treatment participation in the adjusted model included high confidence to reduce substance use, and not reporting primary methamphetamine injection. CONCLUSIONS Rurally located SSPs may play an important role in supporting confidence and motivation to change substance use behaviors among PWID impacted by SUD. SSPs may be critical venues for integration and expansion of prevention, health promotion, and treatment linkage services for this underserved population.
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Affiliation(s)
- Hilary L Surratt
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Janet K Otachi
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Timothy Williams
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, Kentucky
| | | | | | - Rebecca Rains
- Knox County Health Department, Barbourville, Kentucky
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12
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Grodin EN, Lim AC, MacKillop J, Karno MP, Ray LA. An Examination of Motivation to Change and Neural Alcohol Cue Reactivity Following a Brief Intervention. Front Psychiatry 2019; 10:408. [PMID: 31244697 PMCID: PMC6580427 DOI: 10.3389/fpsyt.2019.00408] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Brief interventions represent a promising psychological intervention targeting individuals with heavy alcohol use. Motivation to change represents an individual's openness to engage in a behavior change strategy and is thought to be a crucial component of brief interventions. Neuroimaging techniques provide a translational tool to investigate the neurobiological mechanisms underlying potential mediators of treatment response, including motivation to change. Therefore, this study aimed to examine the effect of a brief intervention on motivation to change drinking behavior and neural alcohol taste cue reactivity. Methods: Non-treatment-seeking heavy drinkers were randomized to receive a brief drinking intervention (n = 22) or an attention-matched control (n = 24). Three indices of motivation to change were assessed at baseline and after the intervention or control session: importance, confidence, and readiness. Immediately following the intervention or control session, participants also underwent an functional magnetic resonance imaging (fMRI) during which they completed an alcohol taste cues paradigm. Results: There was a significant effect of the brief intervention on increasing ratings of importance of changing drinking behavior, but not on ratings of confidence or readiness to change. Ratings of importance after the intervention or control session were associated with neural alcohol taste cue reactivity, but notably, this effect was only significant for participants who received the intervention. Individuals in the intervention condition showed a positive association between ratings of importance and activation in the precuneus, posterior cingulate, and insula. Conclusions: The brief drinking intervention was successful at improving one dimension of motivation to change among non-treatment-seeking heavy drinkers. The brief intervention moderated the relationship between ratings of importance and brain activation in circuitry associated with interoceptive awareness and self-reflection. Together, findings represent an initial step toward understanding the neurobiological mechanisms through which a brief intervention may improve motivation to change.
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Affiliation(s)
- Erica N. Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Aaron C. Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mitchell P. Karno
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Wagner V, Acier D, Dietlin JE. Mediation of time perspectives on inclinations to use alcohol and motivation to change relationship. J Clin Psychol 2018; 74:1854-1866. [PMID: 29756291 DOI: 10.1002/jclp.22637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/07/2018] [Accepted: 04/13/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Trajectories of change accompanying alcohol-specialized care can be affected by numerous variables. Massive urges to drink can substantially hamper personal motivation to change. However, time perspective could also play an indirect role in this association. This research explores whether time perspectives mediates the relationship between inclinations to use or not to use alcohol and patients' motivation to change. DESIGN The sample included 150 outpatients in care for their problematic alcohol use. Models of mediation were planned. RESULTS At the entry in care, three specific time perspectives, Past Negative, Present Fatalistic, and Future, acted as discrete mediators. CONCLUSIONS These findings highlight underlying mechanisms connecting inclinations to use or to avoid the substance and the patient's motivation to change. Time perspective could also be an interesting intervention target in existing alcohol-specialized treatment programs.
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Affiliation(s)
- Vincent Wagner
- University of Nantes.,Beausejour Addiction Care, Support, and Prevention Center
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14
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Abstract
CONTEXT Motivation plays an important role in the treatment of alcohol dependence syndrome (ADS) by influencing the patient to seek and comply with treatment as well as make successful long term changes. AIM The aim of this study is to study the motivation for change in inpatients with ADS. SETTINGS AND DESIGN One hundred consecutive patients admitted for the treatment of ADS in a medical college hospital were evaluated. MATERIALS AND METHODS The International Classification of Disease 10th Revision - AM symptom checklist for mental disorders screener and appropriate modules were used to establish ADS. The assessment of motivation was done using the University of Rhode Island Change Assessment scale at baseline and after 2 weeks of admission. The Severity of Alcohol Dependence Questionnaire and Kuppuswamy's scale for socioeconomic status were used. STATISTICAL ANALYSIS Paired and unpaired t-test, Fisher's exact test, and Wilcoxon signed-rank test were used to analyze data. RESULTS The assessment of motivation showed 60% of patients in precontemplation (PC) stage at baseline, compared to 34% of the patients in PC, 57% in contemplation, and 9% in action stage after 2 weeks of inpatient stay. A highly significant change was seen in the levels of motivation toward contemplation and action stage after 2 weeks of inpatient stay (Z = 5.745, P < 0.001). Motivation to change had a significant association with complications of alcohol use, medical comorbidity, onset and severity of alcohol dependence, socioeconomic status, religion, and mode of referral. CONCLUSIONS The study concludes that certain patients with ADS may have low pretreatment levels of motivation, with significant improvement in the motivation levels after a short duration of inpatient treatment.
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Affiliation(s)
- Prima Cheryl D'Souza
- Department of Psychiatry, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - P John Mathai
- Department of Psychiatry, Father Muller Medical College, Rajiv Gandhi University of Health Sciences, Mangalore, Karnataka, India
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15
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Fiabane E, Ottonello M, Zavan V, Pistarini C, Giorgi I. Motivation to change and posttreatment temptation to drink: a multicenter study among alcohol-dependent patients. Neuropsychiatr Dis Treat 2017; 13:2497-2504. [PMID: 29042778 PMCID: PMC5633278 DOI: 10.2147/ndt.s137766] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An inpatient 28-day rehabilitation program for alcohol dependence is focused on detoxification, enhancing motivation to change, and coping strategies for the management of emotional distress and temptation to drink. The aims of the present study were to investigate 1) changes over time in motivation to change, anxiety, and depression in individuals undergoing residential rehabilitation treatment for alcohol addiction, and 2) which pretreatment factors are associated with posttreatment temptation to drink. METHODS We assessed 432 patients diagnosed with alcohol dependence based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) consecutively recruited from seven residential rehabilitation centers in Northern Italy. Patients were assessed by means of self-report questionnaires at the beginning of rehabilitation (pretreatment) and before their hospital discharge (posttreatment) regarding motivation to change and self-efficacy (motivation assessment of change - alcoholism version), readiness to change and temptation to drink (visual analog scales), and depression and anxiety (cognitive behavioral assessment - outcome evaluation). RESULTS Results showed an overall improvement in motivation to change and a significant reduction over time in depression and anxiety levels for the total sample, particularly patients with low baseline level of temptation to drink. Multivariate linear regression analysis revealed that significant predictors of posttreatment temptation to drink were polysubstance dependence (p<0.001), readiness to change (p=0.01), and self-efficacy (p=0.05). CONCLUSION Inpatients' rehabilitation for alcohol dependence is associated with an overall improvement in motivation to change and a significant reduction of psychological distress. Treatments for alcohol-dependent patients should focus on motivation to change, negative moods, and relapse prevention strategies for the management of craving.
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Affiliation(s)
- Elena Fiabane
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia
| | - Marcella Ottonello
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa.,Department of Medicine, PhD Program in Advance Sciences and Technologies in Rehabilitation Medicine and Sport, Università di Tor Vergata, Rome
| | | | - Caterina Pistarini
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa
| | - Ines Giorgi
- Psychology Unit, ICS Maugeri Spa SB, Scientific Institute of Pavia, Pavia, Italy
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Chie QT, Tam CL, Bonn G, Dang HM, Khairuddin R. Substance Abuse, Relapse, and Treatment Program Evaluation in Malaysia: Perspective of Rehab Patients and Staff Using the Mixed Method Approach. Front Psychiatry 2016; 7:90. [PMID: 27303313 PMCID: PMC4881619 DOI: 10.3389/fpsyt.2016.00090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 05/12/2016] [Indexed: 11/20/2022] Open
Abstract
This study examined reasons for substance abuse and evaluated the effectiveness of substance treatment programs in Malaysia through interviews with rehab patients and staff. Substance rehab patients (aged 18-69 years; n = 30) and staff (ages 30-72 years; n = 10) participated in semi-structured interviews covering a range of topics, including family and peer relationships, substance use and treatment history, factors for substance use and relapse, motivation for entering treatment, work experience, job satisfaction, treatment evaluation, and patient satisfaction. Most patients did not demonstrate the substance progression trend and had normal family relationships. Most patients reported having peers from normal family backgrounds as well. Various environmental and personal factors was cited as contributing to substance abuse and relapse. There was no significant difference between patient and staff program evaluation scores although the mean score for patients was lower. A holistic treatment approach with a combination of cognitive-behavioral, medical, social, and spiritual components was favored by patients. Suggestions for improving existing programs include better tailoring treatment to individual needs, and providing more post-treatment group support.
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Affiliation(s)
- Qiu Ting Chie
- Jeffery Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Cai Lian Tam
- Jeffery Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Gregory Bonn
- International Research Fellow of the Japan Society for the Promotion of Science, Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
| | - Hoang Minh Dang
- Centre for Research, Information and Service in Psychology (CRISP), Vietnam National University, Hanoi, Vietnam
| | - Rozainee Khairuddin
- Faculty of Social Science and Humanities, Psychology and Human Development, National University of Malaysia (UKM), Bangi, Malaysia
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17
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Hillen S, Dempfle A, Seitz J, Herpertz-Dahlmann B, Bühren K. Motivation to change and perceptions of the admission process with respect to outcome in adolescent anorexia nervosa. BMC Psychiatry 2015; 15:140. [PMID: 26134628 PMCID: PMC4488048 DOI: 10.1186/s12888-015-0516-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 06/02/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In patients with anorexia nervosa (AN), there is evidence that readiness to change is an important predictor of outcome with respect to weight gain and improvement in eating disorder psychopathology. In particular, young patients are characterized by a low level of motivation for recovery and perceive more coercion at hospitalization. Thus, a better understanding of the variables that influence readiness to change and perception of the admission process in adolescent AN may help to support patients in initiating change and staying motivated for treatment. METHODS In 40 adolescent patients diagnosed with AN according to DSM-IV criteria, we assessed in a prospective clinical cohort study the motivation to change using the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) at admission to inpatient treatment, in week 9 after admission and at discharge. Additional variables were assessed, including depressive symptoms (Beck Depression Inventory, BDI), eating disorder-specific psychopathology (Eating Disorder Inventory, EDI-2), body mass index (BMI) and the percentage of expected body weight (%EBW). The patients' perceptions of the admission process and their perceived need for hospitalization were assessed using a self-report scale developed by Guarda et al. (2007). RESULTS Younger patients perceived more coercion than older patients did. Low %EBW and more severe eating disorder-specific psychopathology were associated with a greater perceived need for hospitalization. Moreover, low %EBW at admission and a longer duration of illness were accompanied by a greater motivation to change at admission, whereas more severe eating disorder psychopathology was associated with a low motivation to change. The motivation to change increased significantly between admission and discharge. Patients with a greater motivation to change at admission exhibited a higher weekly weight gain during treatment but did not show better outcome in eating disorder-specific psychopathology and depression. CONCLUSIONS Motivation to change is an important predictor of short-term outcome with respect to weight gain trajectory during treatment of adolescent AN. As patients with a higher BMI at admission and those with more severe eating disorder-specific symptoms seem to be less motivated to change, the crucial issue of motivation to change should be addressed with these patients during the therapeutic process.
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Affiliation(s)
- Simona Hillen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany.
| | - Astrid Dempfle
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany. .,Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany.
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany.
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany.
| | - Katharina Bühren
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany.
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18
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von Brachel R, Hötzel K, Hirschfeld G, Rieger E, Schmidt U, Kosfelder J, Hechler T, Schulte D, Vocks S. Internet-based motivation program for women with eating disorders: eating disorder pathology and depressive mood predict dropout. J Med Internet Res 2014; 16:e92. [PMID: 24686856 PMCID: PMC4004149 DOI: 10.2196/jmir.3104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/15/2014] [Accepted: 01/19/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology. OBJECTIVE The aim of the present study was to identify predictors of dropout from this Web program. METHODS A total of 179 women took part in the study. We used survival analyses (Cox regression) to investigate the predictive effect of eating disorder pathology (assessed by the Eating Disorders Examination-Questionnaire; EDE-Q), depressive mood (Hopkins Symptom Checklist), motivation to change (University of Rhode Island Change Assessment Scale; URICA), and participants' age at dropout. To identify predictors, we used the least absolute shrinkage and selection operator (LASSO) method. RESULTS The dropout rate was 50.8% (91/179) and was equally distributed across the 6 treatment sessions. The LASSO analysis revealed that higher scores on the Shape Concerns subscale of the EDE-Q, a higher frequency of binge eating episodes and vomiting, as well as higher depression scores significantly increased the probability of dropout. However, we did not find any effect of the URICA or age on dropout. CONCLUSIONS Women with more severe eating disorder pathology and depressive mood had a higher likelihood of dropping out from a Web-based motivational enhancement program. Interventions such as ours need to address the specific needs of women with more severe eating disorder pathology and depressive mood and offer them additional support to prevent them from prematurely discontinuing treatment.
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Affiliation(s)
- Ruth von Brachel
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany.
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19
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Abstract
Motivation to change is believed to be a key factor in therapeutic success in substance use disorders; however, the neurobiological mechanisms through which motivation to change impacts decreased substance use remain unclear. Existing research is conflicting, with some investigations supporting decreased and others reporting increased frontal activation to drug cues in individuals seeking treatment for substance use disorders. The present study investigated the relationship between motivation to change cocaine use and cue-elicited brain activity in cocaine-dependent individuals using two conceptualizations of 'motivation to change': (1) current treatment status (i.e. currently receiving versus not receiving outpatient treatment for cocaine dependence) and (2) self-reported motivation to change substance use, using the Stages of Change Readiness and Treatment Eagerness Scale. Thirty-eight cocaine-dependent individuals (14 currently in treatment) completed a diagnostic assessment and an fMRI cocaine cue-reactivity task. Whole-brain analyses demonstrated that both treatment-seeking and motivated participants had lower activation to cocaine cues in a wide variety of brain regions in the frontal, occipital, temporal and cingulate cortices relative to non-treatment-seeking and less motivated participants. Future research is needed to explain the mechanism by which treatment and/or motivation impacts neural cue reactivity, as such work could potentially aid in the development of more effective therapeutic techniques for substance-dependent patients.
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Affiliation(s)
- James J Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC, USA
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20
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Abstract
OBJECTIVE The aim of the study was to review the eating disorder literature in order to examine the effect of pretreatment autonomous/level of motivation to change on treatment outcome as measured by change in eating disorder pathology. METHOD Relevant databases were systematically searched for studies in which motivation to change prior to treatment was examined in relation to treatment outcome. RESULTS Pretreatment autonomous/level of motivation were associated with change in restrictive eating behaviors, bingeing behaviors, and cognitive/affective measures of eating disorder pathology. There was mixed support for the effect of motivation to change on global measures of eating disorder symptoms and virtually no support for the effect of motivation to change on purging behavior. DISCUSSION The level of pretreatment motivation the person exhibits prior to commencement of treatment appears to be helpful in predicting treatment outcome.
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Affiliation(s)
- Loa Clausen
- Regional Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
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21
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Moallem NR, Courtney KE, Bacio GA, Ray LA. Modeling alcohol use disorder severity: an integrative structural equation modeling approach. Front Psychiatry 2013; 4:75. [PMID: 23908635 PMCID: PMC3725454 DOI: 10.3389/fpsyt.2013.00075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 07/13/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Alcohol dependence is a complex psychological disorder whose phenomenology changes as the disorder progresses. Neuroscience has provided a variety of theories and evidence for the development, maintenance, and severity of addiction; however, clinically, it has been difficult to evaluate alcohol use disorder (AUD) severity. OBJECTIVE This study seeks to evaluate and validate a data-driven approach to capturing alcohol severity in a community sample. METHOD Participants were non-treatment seeking problem drinkers (n = 283). A structural equation modeling approach was used to (a) verify the latent factor structure of the indices of AUD severity; and (b) test the relationship between the AUD severity factor and measures of alcohol use, affective symptoms, and motivation to change drinking. RESULTS The model was found to fit well, with all chosen indices of AUD severity loading significantly and positively onto the severity factor. In addition, the paths from the alcohol use, motivation, and affective factors accounted for 68% of the variance in AUD severity. Greater AUD severity was associated with greater alcohol use, increased affective symptoms, and higher motivation to change. CONCLUSION Unlike the categorical diagnostic criteria, the AUD severity factor is comprised of multiple quantitative dimensions of impairment observed across the progression of the disorder. The AUD severity factor was validated by testing it in relation to other outcomes such as alcohol use, affective symptoms, and motivation for change. Clinically, this approach to AUD severity can be used to inform treatment planning and ultimately to improve outcomes.
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Affiliation(s)
- Nathasha R. Moallem
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Kelly E. Courtney
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Guadalupe A. Bacio
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lara A. Ray
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
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22
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Collins J, Slesnick N. Factors Associated with Motivation to Change HIV Risk and Substance Use Behaviors among Homeless Youth. J Soc Work Pract Addict 2011; 11:163-180. [PMID: 21765800 PMCID: PMC3136194 DOI: 10.1080/1533256x.2011.570219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study sought to identify and compare variables associated with motivation to change alcohol, drug use, and HIV risk behaviors among a sample of homeless youths. More frequent alcohol use, older age, and childhood sexual abuse was associated with greater motivation to change alcohol use; higher reported negative consequences of substance use was associated with higher motivation to reduce illicit drug use. Shorter periods of current homelessness predicted higher motivation to change HIV risk behaviors. Findings suggest these areas might be fruitful targets of intervention efforts to enhance motivation to reduce alcohol and illicit drug use and HIV risk behaviors.
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Affiliation(s)
- Jennifer Collins
- The Ohio State University, Human Development and Family Science, Columbus, OH, USA
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23
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Stein MD, Hagerty CE, Herman DS, Phipps MG, Anderson BJ. A brief marijuana intervention for non-treatment-seeking young adult women. J Subst Abuse Treat 2011; 40:189-98. [PMID: 21185685 PMCID: PMC2996851 DOI: 10.1016/j.jsat.2010.11.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/12/2010] [Accepted: 11/08/2010] [Indexed: 11/28/2022]
Abstract
We randomized 332 women, 18-24 years old, who were not explicitly seeking treatment for their marijuana use to either a two-session motivationally focused intervention or an assessment-only condition. Assessed by timeline follow-back methodology, participants reported using marijuana 57% of days in the 3 months prior to study entry. Intervention effects on the likelihood of marijuana use were not statistically significant at 1 month (odds ratio [OR] = 0.77, p = .17), significant at 3 months (OR = 0.53, p = .01), and no longer significant at 6 months (OR = 0.74, p = .20). Among the 61% of participants endorsing any desire to quit using marijuana at baseline, significant intervention effects on the likelihood of marijuana use days were observed at 1 month (OR = 0.42, p = .03), 3 months (OR = 0.31, p = .02), and 6 months (OR = 0.35, p = .03). A two-session brief motivational intervention reduced marijuana use among young women not seeking treatment. Women with a desire to quit showed a greater and more durable response.
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Affiliation(s)
- Michael D Stein
- Department of Medicine, Butler Hospital, Providence, RI 02906, USA.
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Abstract
Gender differences in patterns and consequences of substance use, treatment-seeking, and motivation to change were examined in two samples of people with serious mental illness (SMI) and comorbid substance use disorders (SUDs): a community sample not currently seeking substance abuse treatment (N = 175) and a treatment-seeking sample (N = 137). In both groups, women and men demonstrated more similarities in the pattern and severity of their substance use than differences. However, treatment-seeking women showed greater readiness to change their substance use. Mental health problems and traumatic experiences may prompt people with SMI and SUD to enter substance abuse treatment, regardless of gender.
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Affiliation(s)
- Amy Drapalski
- VISN 5 Mental Illness Research, Education, and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland 21201, USA.
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Buscemi J, Murphy JG, Martens MP, McDevitt-Murphy ME, Dennhardt AA, Skidmore JR. Help-seeking for alcohol-related problems in college students: correlates and preferred resources. Psychol Addict Behav 2010; 24:571-80. [PMID: 21198220 PMCID: PMC4912043 DOI: 10.1037/a0021122] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the development of a variety of efficacious alcohol intervention approaches for college students, few student drinkers seek help. The present study assessed students' history of help-seeking for alcohol problems, as well as their estimates of how likely they would be to use various help-seeking resources, should they wish to change their drinking. Participants were 197 college students who reported recent heavy drinking (46% male, 68.5% White, 27.4% African-American). Participants completed measures related to their drinking and their use (both past use and likelihood of future use) of 14 different alcohol help-seeking options. Repeated-measures analyses of variance revealed that students preferred informal help-seeking (e.g., talking to friends and family) over formal (e.g., talking with a counselor or medical provider) and anonymous resources (e.g., internet- or computer-based programs). Higher self-ideal discrepancy, greater depressive symptoms, and more alcohol-related consequences were positively associated with actual past help-seeking. Alcohol-related problems and normative discrepancy were negatively associated with hypothetical likelihood of utilizing all three help-seeking resources. These results suggest that heavy drinking college students prefer low-threshold intervention options including peer, family, computerized, and brief motivational interventions. Only 36 participants (18.3% of the sample) reported that they had utilized any of the help-seeking options queried, suggesting that campus prevention efforts should include both promoting low-threshold interventions and attempting to increase the salience of alcohol-related risk and the potential utility of changing drinking patterns.
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Affiliation(s)
- Joanna Buscemi
- Department of Psychology, University of Memphis, Memphis, TN 38152, USA.
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26
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Abstract
AIMS The current study was designed to re-examine the motivation matching hypothesis from Project MATCH using growth mixture modeling, an analytical technique that models variation in individual drinking patterns. DESIGN, SETTING AND PARTICIPANTS Secondary data analyses of data from Project MATCH (n = 1726), a large multi-site alcoholism treatment-matching study. MEASUREMENTS Percentage of drinking days was the primary outcome measure, assessed from 1 month to 12 months following treatment. Treatment assignment, alcohol dependence symptoms and baseline percentage of drinking days were included as covariates. FINDINGS The results provided support for the motivation matching hypothesis in the out-patient sample and among females in the aftercare sample: the majority of individuals with lower baseline motivation had better outcomes if assigned to motivation enhancement treatment (MET) compared to those assigned to cognitive behavioral treatment (CBT). In the aftercare sample there was a moderating effect of gender and alcohol dependence severity, whereby males with lower baseline motivation and greater alcohol dependence drank more frequently if assigned to MET compared to those assigned to CBT. CONCLUSIONS Results from the current study lend partial support to the motivation-matching hypothesis and also demonstrated the importance of moderating influences on treatment matching effectiveness. Based upon these findings, individuals with low baseline motivation in out-patient settings and males with low levels of alcohol dependence or females in aftercare settings may benefit more from motivational enhancement techniques than from cognitive-behavioral techniques.
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Affiliation(s)
- Katie Witkiewitz
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Seattle,WA 98105-4631, USA.
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Field CA, Adinoff B, Harris TR, Ball SA, Carroll KM. Construct, concurrent and predictive validity of the URICA: data from two multi-site clinical trials. Drug Alcohol Depend 2009; 101:115-23. [PMID: 19157723 PMCID: PMC3097110 DOI: 10.1016/j.drugalcdep.2008.12.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 12/01/2008] [Accepted: 12/02/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND A better understanding of how to measure motivation to change and how it relates to behavior change in patients with drug and alcohol dependence would broaden our understanding of the role of motivation in addiction treatment. METHODS Two multi-site, randomized clinical trials comparing brief motivational interventions with standard care were conducted in the National Institute on Drug Abuse Clinical Trials Network. Patients with primary drug dependence and alcohol dependence entering outpatient treatment participated in a study of either Motivational Enhancement Therapy (n=431) or Motivational Interviewing (n=423). The construct, concurrent, and predictive validity of two composite measures of motivation to change derived from the University of Rhode Island Change Assessment (URICA): Readiness to Change (RTC) and Committed Action (CA) were evaluated. RESULTS Confirmatory factor analysis confirmed the a priori factor structure of the URICA. RTC was significantly associated with measures of addiction severity at baseline (r=.12-.52, p<.05). Although statistically significant (p<.01), the correlations between treatment outcomes and RTC were low (r=-.15 and -18). Additional analyses did not support a moderating or mediating effect of motivation on treatment retention or substance use. CONCLUSIONS The construct validity of the URICA was confirmed separately in a large sample of drug- and alcohol-dependent patients. However, evidence for the predictive validity of composite scores was very limited and there were no moderating or mediating effects of either measure on treatment outcome. Thus, increased motivation to change, as measured by the composite scores of motivation derived from the URICA, does not appear to influence treatment outcome.
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Affiliation(s)
- Craig A Field
- School of Social Work, Center for Social Work Research, University of Texas at Austin, Health Behavior Research and Training Institute, 1717 West 6th Street Ste 295, Austin, TX 78703, USA.
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Slavet JD, Stein LAR, Colby SM, Barnett NP, Monti PM, Golembeske C, Lebeau-Craven R. The Marijuana Ladder: measuring motivation to change marijuana use in incarcerated adolescents. Drug Alcohol Depend 2006; 83:42-8. [PMID: 16289930 PMCID: PMC2754131 DOI: 10.1016/j.drugalcdep.2005.10.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Revised: 10/06/2005] [Accepted: 10/18/2005] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to determine if a modified version of the Contemplation Ladder, a measure of motivation to change marijuana use among incarcerated adolescents (Marijuana Ladder; ML), was related to marijuana use and treatment engagement. Participants (N=122) in this study were all incarcerated at a state juvenile correctional facility in the Northeast. Adolescents were assessed at the beginning of their incarceration, 2 months into their incarceration, and 3 months after their release. There was a significant negative relationship between ML scores and marijuana use and a significant positive relationship between ML scores and treatment engagement. When controlling for prior marijuana use and age, ML scores at baseline significantly added to the prediction of marijuana use and treatment engagement among incarcerated adolescents. Results support the concurrent validity and the predictive validity of the ML. This measure has the potential to provide important information for Juvenile Justice Facilities that might aid in treatment planning and discharge planning for incarcerated adolescents. In addition, researchers may find a quick visual analog measure of motivation to change marijuana use with good psychometric properties useful.
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Affiliation(s)
- James D Slavet
- Center for Alcohol and Addiction Studies, Brown University, The Rhode Island Training School, USA
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