Models of change should be broadened so that treatment is seen as a complex system of parts, facilitating a nexus of cognitive, social and behavioural changes, embedded within a broader system of events and processes catalysing change. Such a model helps explain the relative absence of between-treatments outcome differences in UKATT and in the alcohol problems treatment and more general psychotherapy research literatures.

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Aim: To develop a model of why people seek professional treatment for drinking problems, grounded in what clients say about the process at treatment entry. Participants: Three sets of consecutive entrants to the UK Alcohol Treatment Trial, sets commencing at intervals during trial recruitment (total n598). Location: Statutory and non-statutory alcohol problem treatment agencies in three areas of England and Wales. Data: Open-ended interviews according to a brief interview guide, leading to 400-800-word postinterview reports used for analysis (tape recordings used for auditing the interview and analysis process). Analysis: Reports analysed by a team according to grounded theory principles, involving an iterative process with successive refinement of interviewing and analysis with each successive set of data. Findings: A model of professional treatment entry was developed, refined and ''tested'' with the last set of data. The process of seeking professional treatment was depicted in the model as involving a realization of worsening, accumulating and multiple problems related to drinking, especially in health and family domains; in conjunction with, in most cases (but not all), a trigger event and/or family or professional influence; combined with rejection of the possibility of unaided change or nonprofessional help; leading to the seeking or accepting of professional help. Conclusions: The findings support conclusions already in the literature about the process of seeking professional help for a drinking problem, but provide further refinement of existing ideas: for example regarding the accumulation of drinking-related problems, the ways in which a realization of those

Adding a psychological intervention to a home detoxification programme was successful and cost-effective.

backgroundThis study explored the direct experience of anabolic androgenic steroid (AAS) use by young men, with an emphasis on how motivations progressed from adolescent initiation to more entrenched usage. participants and procedureNine semi-structured interviews were conducted with individuals ranging in experience of AAS use, from novice to experienced users. resultsThe results indicated that the young adult men progressed through a clear transition whereby their motives for using these substances changed from a mere desire to compete with other men to more internalised body image problems. conclusionsThe findings presented suggest a more complex relationship between AAS use and body image pathology than previously suggested.