Assessing and Strengthening Motivation during Alcoholism Treatment to Prevent Relapse

Abstract

This dissertation investigates the role of motivational factors during inpatient alcohol therapy. The focus lies on measuring (Research Paper I) and strengthening (Research Paper III) their motivation to abstain from alcohol. In this context, the risk of relapse during treatment (Research Paper II) is also examined in more detail. Research Paper I examines the predictive power of motivation for alcohol abstinence during inpatient alcohol treatment. For this purpose, the transtheoretical model of behavior change served as the framework for assessing motivation. In addition, other substance-related and sociodemographic variables were examined to predict the dependent variable. The results of this observational study show that the risk of relapse decreased with higher treatment motivation and with occupational employment. The results of the Research Paper I therefore highlight that assessing treatment motivation is important for predicting treatment success, and the underlying mechanisms of motivation should be further researched. Research Paper II investigates the risk of relapse during inpatient alcohol treatment, how the risk changes during treatment, and how a first relapse can affect the risk of subsequent relapses. The results of this observational study show that the risk of experiencing a first relapse during treatment decreased from one day to the next in abstinent patients. In the event of a first relapse, the risk of drinking alcohol again remained stable throughout treatment. The second important factor influencing relapse was the severity of the alcohol use disorder: the greater the severity, the higher the risk of experiencing one or more relapses. The results emphasize the importance of individually tailored treatment for abstinent patients on the one hand and patients who have experienced a relapse on the other. For abstinent patients, strengthening self- efficacy should reduce the risk of a first relapse. For those who have experienced a relapse and thus have an increased risk of further relapses, treatment should focus on relapse-prevention strategies. Finally, Research Paper III examines the possibility of improving treatment outcomes in people with alcohol use disorder through mental contrasting with implementation intentions (MCII). As an effective and efficient self-regulation strategy, MCII should reduce craving and the risk of relapse during inpatient cessation treatment. The randomized controlled trial consisted of two groups: a group receiving MCII as an intervention and an active control group receiving a module from a relapse prevention model. The results show that at the beginning of treatment, craving decreased more in the MCII group compared to the active control group. In further measurements during the course of treatment, there was not any difference between the groups and there also was not any difference in the number of relapses between the MCII group and the active control group. These results suggest that the disappearance of the initial difference in craving is probably due to the establishment of a normative context during the course of treatment. As a relapse prevention technique for alcohol use disorders, MCII should next be investigated in an outpatient context where there is no normative context. In summary, the studies found that it is important to assess the motivation of patients with an alcohol use disorder during inpatient therapy in order to adapt the therapy accordingly and to improve the therapy results. The use of MCII as a self- regulation strategy also exhibited initial success with a positive influence on experiencing craving. Together, the present thesis points to the importance of motivational factors and provides specific suggestions for future research, for example, in the continued development of concepts for reducing relapses and improving treatment outcomes.