Dropout among patients in qualified alcohol detoxification treatment: the effect of treatment motivation is moderated by Trauma Load

Abstract

BackgroundMotivation to change has been proposed as a prerequisite for behavioral change, although empirical results are contradictory. Traumatic experiences are frequently found amongst patients in alcohol treatment, but this has not been systematically studied in terms of effects on treatment outcomes. This study aimed to clarify whether individual Trauma Load explains some of the inconsistencies between motivation to change and behavioral change.MethodsOver the course of two months in 2009, 55 patients admitted to an alcohol detoxification unit of a psychiatric hospital were enrolled in this study. At treatment entry, we assessed lifetime Trauma Load and motivation to change. Mode of discharge was taken from patient files following therapy. We tested whether Trauma Load moderates the effect of motivation to change on dropout from alcohol detoxification using multivariate methods.Results55.4% dropped out of detoxification treatment, while 44.6% completed the treatment. Age, gender and days in treatment did not differ between completers and dropouts. Patients who dropped out reported more traumatic event types on average than completers. Treatment completers had higher scores in the URICA subscale Maintenance. Multivariate methods confirmed the moderator effect of Trauma Load: among participants with high Trauma Load, treatment completion was related to higher Maintenance scores at treatment entry; this was not true among patients with low Trauma Load.ConclusionsWe found evidence that the effect of motivation to change on detoxification treatment completion is moderated by Trauma Load: among patients with low Trauma Load, motivation to change is not relevant for treatment completion; among highly burdened patients, however, who a priori have a greater risk of dropping out, a high motivation to change might make the difference. This finding justifies targeted and specific interventions for highly burdened alcohol patients to increase their motivation to change.

The Mediating Influence of Treatment Participation Rate on Post-Treatment Employment

“…As in previous studies by Biegel et al (2010) and Rogers, Anthony, Cohen, and Davies (1997), we found the direct effect of psychiatric issue severity for people with SUDs to be a significant predictor of treatment participation and employment. Second, we found support for prior findings that treatment participation rate is associated with baseline alcohol use severity (Lopez-Goni et al, 2011;Odenwald & Semrau, 2013), drug use severity (Evans et al, 2009;Hser et al, 2004), and psychiatric issue severity (Angelo et al, 2013;Tsang et al, 2010). Third, our findings mirror those of previous studies showing that a lower treatment participation rate (i.e., frequent appointment cancellations and a high no-show rate) directly influenced post-treatment employment (Evans et al, 2009;McKay, 2009).…”

Drinking to ease the burden: a cross-sectional study on trauma, alcohol abuse and psychopathology in a post-conflict context

“…Likewise civilians with a PTSD and substance use disorder comorbidity reported more relapses or unfavorable treatment results [ 31 , 86 ]. Individuals reporting more traumatic experiences dropped out of inpatient detoxification treatment more readily [ 87 , 88 ]. All these findings have been interpreted such that traumatized individuals depend more on consumption in order to self-medicate trauma-related negative emotional, physical and cognitive states than non-traumatized patients.…”

Externalizing psychopathology and cognitive functions in patients with early- and late-onset alcohol dependence

“…Previous studies show that the dropout rate from the treatment of AUD ranges from 17.4% to 74% in the inpatient population, whereas in the outpatient population, it even reaches as high as 70%. [ 19 20 ] Various benzodiazepines prescribed in the study population were chlordiazepoxide, oxazepam, and lorazepam. They were converted to chlordiazepoxide equivalent dosage as per the Maudsley prescriber's guidelines[ 21 ] and on comparing the two groups, no significant difference was found.…”