Readiness to change is a predictor of reduced substance use involvement: findings from a randomized controlled trial of patients attending South African emergency departments

Abstract

BackgroundThis study examines whether readiness to change is a predictor of substance use outcomes and explores factors associated with RTC substance use among patients at South African emergency departments.MethodsWe use data from participants enrolled into a randomized controlled trial of a brief substance use intervention conducted in three emergency departments in Cape Town, South Africa.ResultsIn adjusted analyses, the SOCRATES “Recognition” (B = 11.6; 95 % CI = 6.2–17.0) and “Taking Steps” score (B = -9.5; 95 % CI = -15.5- -3.5) as well as alcohol problems (B = 4.4; 95 % CI = 0.9–7.9) predicted change in substance use involvement at 3 month follow-up. Severity of depression (B = 0.2; 95 % CI = 0.1–0.3), methamphetamine use (B = 3.4; 95 % CI = 0.5- 6.3) and substance-related injury (B = 1.9; 95 % CI = 0.6–3.2) were associated with greater recognition of the need for change. Depression (B = 0.1; 95 % CI = 0.04 -0.1) and methamphetamine use (B = 2.3; 95 % CI = 0.1 -4.2) were also associated with more ambivalence about whether to change. Participants who presented with an injury that was preceded by substance use were less likely to be taking steps to reduce their substance use compared to individuals who did not (B = -1.7; 95 % CI = -5.0- -0.6).ConclusionFindings suggest that brief interventions for this population should include a strong focus on building readiness to change substance use through motivational enhancement strategies. Findings also suggest that providing additional support to individuals with depression may enhance intervention outcomes.Trial registrationThis trial registered with the Pan African Clinical Trial Registry (PACTR201308000591418) on 14/07/2013.

Effectiveness of a psychoeducational programme in enhancing motivation to change alcohol‐addictive behaviour

“…Recognition and understanding of alcohol‐dependent patients' alcohol problems could increase their motivation to change the unhealthy drinking behaviour (Myers et al . ).…”

“…, Myers et al . ). The results demonstrated that the psychoeducational programme increased participants' ambivalence towards their drinking behaviour to some extent and prompts helped patients consider uncertainties about drinking, and thereafter resolve their problem drinking.…”

“…, Myers et al . ). Psychoeducational programmes are commonly used to resolve ambivalence and enhance motivation for change in alcohol‐dependent inpatients during detoxification (Lee & Lee ).…”

Substance Dependence Treatment Endpoint and Intermediate Outcomes

“…This can be achieved with Screening Brief Intervention and Referral for Treatment 4 and can be assessed with instruments such as Readiness Ruler 5 or the Stages of Change, Readiness, and Treatment Eagerness Scale. 6 For individuals receiving or who have received treatment, stopping or reducing substance use is often taken as the primary treatment outcome and is assessed with self-report and/or biological testing (SRBT). [7][8][9] Having stopped or reduced substance use, the outcome of treatment becomes maintenance or relapse prevention, 6 which is also measured with SRBT.…”

“…6 For individuals receiving or who have received treatment, stopping or reducing substance use is often taken as the primary treatment outcome and is assessed with self-report and/or biological testing (SRBT). [7][8][9] Having stopped or reduced substance use, the outcome of treatment becomes maintenance or relapse prevention, 6 which is also measured with SRBT. Stopping, reducing or relapse prevention is recommended as primary outcome of treatment.…”