A new study looks at the extent to which motivation and resisting temptation change during alcohol addiction treatment, and the degree to which these variables affected drinking behaviors.The researchers found that differences in motivation seem to make a significant difference in seeking, complying with, and completing alcohol addiction treatment. This suggests that treatments tailored to specific subgroups may be more effective.
J. Kim Penberthy, corresponding author of the study and associate professor of psychiatry and neurobehavioral sciences at the University of Virginia School of Medicine, said that the researchers decided to focus on motivation in the form of stages of change and self-efficacy, such as resisting temptation and abstaining from alcohol.
For example, people who are preparing to enter treatment have completed early tasks such as overcoming ambivalence, decision making, and committing to a plan, and are therefore more motivated to change their behavior by reducing their drinking before starting treatment.
People who have a strong belief in their ability to resist temptation to drinking are more confident and think about tempting situations differently, which increases their motivation to complete treatment and prevent relapse.
Penberthy added that patient motivation and self-efficacy are important in terms of which patients respond to treatment and when. For the study, the researchers looked at changes in motivation, temptation to drink, confidence to abstain, and drinking behaviors during the treatment phase of a study of 321 alcohol-dependent individuals.
Participants were given cognitive behavioral therapy (CBT) and either the anti-craving medication ondansetron or a placebo. The researchers also looked at the ways in which individual variables such as drinking severity, age of onset of alcohol dependence, and medication status influenced changes in motivation, drinking behaviors, and self-efficacy.
Penberthy said that increased motivation to change, reduced temptation to drink, and increased confidence to abstain predicted reductions in drinking regardless of the treatment provided, which indicates that tailoring treatment plans to target certain subgroups may be most effective.
The study found that ondansetron was more effective in early-onset drinkers in reducing drinking behaviors, compared to late-onset drinkers. It also helped increase the percentage of days abstinent and decreased the temptation to drink in early-onset drinkers. The drug did not have a different impact on early-onset versus late-onset drinkers in terms of increased motivation or confidence to abstain.
Reductions in drinking behavior in early-onset drinkers may be helped along by a reduced temptation to drink, Penberthy said. This supports the idea that early-onset alcohol dependence is a biologically based disease and is more responsive to selective serotonergic agents to reduce the temptation to drink, which leads to decreased drinking behavior.
The authors added that they need to focus their research and clinical work on tailoring treatment methods based on the stage of the disease, as well as the patient’s level of motivation, self-efficacy, and biological response to medications.
Penberthy added that this current study is the first step in understanding more about which patients respond to treatment and the mechanisms that may be involved in the changes in drinking behavior, and that this knowledge is necessary to tailor treatments to alcohol-dependent individuals.
Source: Science Daily, Motivation to Change, Confidence to Resist Temptation, Should Tailor Alcohol-Dependence Treatment, June 15, 2011
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