PURPOSE: Previous studies have established an association between pre-treatment drinking goals (abstinence vs. non-abstinence) and alcohol treatment outcome. The purpose of this study is to better understand that characteristics of individuals who choose abstinence compared to non-abstinence as a drinking goal prior to treatment. This study explores the characteristics as predictor variables of drinking goal choice prior to entering a Phase II research study in Boston, Massachusetts. METHODS: The participant population consisted ot individuals who called about entry into a Phase II alcohol dependence research study and completes a telephone screening questionnaire (n=608). Desired drinking goal was measured in the telephone screening form and categorized as either abstinence (n=206) or non-abstinence (n=308). Differences between the 2 goal groups were explored by univariate calculations. In the final stage of the analysis potential predictor variables were entered into a backwards elimination logistic regression model to determine significant relationships between predictor variables and drinking goal choice. RESULTS: A total of 206 (40.1%) participants selected abstinence and 308 (59.9%) selected non-abstinence as a pre-treatment drinking goal. In the univariate analysis, participants' selecting a goal of abstinence were significantly more likely to have had previous alcohol treatment (including rehabilitation, outpatient counseling, detoxification, and Alcoholics Anonymous), have had alcohol related seizures, were currently on probation or parole, had higher average of drinks per drinking day, and more heavy drinking days as compared to the non-abstinence group. In the logistic regression model the strongest predictors of a participant choosing a goal of abstinence are previous alcohol treatment, previous detoxification, current probation or parole, and absence of recreational drug use. CONCLUSIONS: Several predictor variables were found to be associated with an individual choosing a drinking goal of abstinence prior to entry into an alcohol research study. These results can be helpful for researchers conducting future clinical trials. Based on the strongest predictors, those variables can be used in stratification to prevent confounding in future research studies.

yes / Alcohol treatment requirements (ATRs) were introduced under section 212 of the criminal justice act (2003) and offers treatment for those whose offending behaviour has been found to be linked to either hazardous or harmful drinking patterns. This current report aims to provide information around the characteristics of individuals who have participated in the ATR. The report is based on quantitative data collected from probation records and treatment files and is part of a wider study of the ATR in Wakefield. The impact of this treatment approach, based on 'coercion' is explored and this report presents outcome data in relation to offenders' participation, retention and rehabilitation. / NHS Wakefield District

Syftet med den här studien är att genom en kvalitativ intervjustudie undersöka vilken typ av motivation samt, i den mån de existerar, vändpunkter som lett till att individer har tagit sig ur ett alkoholmissbruk. Studien har utförts genom sex intervjuer med privatpersoner som har levt med alkoholmissbruk och via behandling fått hjälp att ta sig ur sagda missbruk. Intervjuerna bokades med hjälp av socialtjänsten i en mellansvensk kommun där samtliga respondenter har utfört sin behandling. Vi har tolkat vår empiri genom stämplingsteori och defining moments. Resultatet presenterar teman som belyser likheter i respondenternas upplevelser. Resultatet påvisar att individer behöver få en insikt om sitt missbruk för att behandling ska kunna ha en positiv påverkan. Denna insikt införskaffas genom olika processer eller fysiska skador som påverkat respondenterna liv. Även motivation från individen själv och det privata nätverket påverkar möjligheterna att ta sig ur ett alkoholmissbruk. Respondenterna ansåg att behovet av behandling är nyckeln för att bli fri från alkoholmissbruk då de ansåg att de inte hade kunskap eller möjlighet för att göra det själva. Detta är något som stärks av tidigare forskning inom området. / The purpose of this study is that through a qualitative interview study investigating what kind of motivation and, to the extent they exist, turning points that led individuals to emerged from an alcohol addiction. The study was conducted through six interviews with individuals who have been living with alcohol abuse and through the treatment received help to get out of said abuse. The interviews was booked with the help of the social services in a Swedish municipality where all respondents have completed their treatment. We have interpreted our empiricism by labeling theory and defining moments. The result presents themes that highlight the similarities in the respondents' experiences. The result demonstrates that individuals need to get an insight into his addiction to treatment will have a positive impact. This insight is acquired through various processes or physical damage that affected respondents lives. The motivation of the individual and the private network allso affects the ability to get out of an alcohol abuse. Respondents felt that the need for treatment is the key to freedom from alcohol abuse when they felt that they did not have the knowledge or the ability to do it themselves. This is something that is supported by previous research in the area.

Using 12-month post treatment Timeline Followback drinking reports, data extrapolated from shorter time windows (e.g., 1 month, 6 months) were used to estimate total annual drinking. The objective was to determine whether data from a shorter time window would provide an estimate of annual drinking sufficiently consistent with the full year report such that it can be used in place of the full report. Data for this study were obtained from problem drinkers who voluntarily participated in a randomized controlled trial of a mail-based intervention. Complete follow-up data were obtained for 467 of the 825 participants who completed a 12-month Timeline Followback of their post intervention drinking. The results of this study suggest that 3 months is the necessary minimum time window to best represent annual posttreatment drinking with alcohol abusers. The major implication of this finding is that alcohol treatment outcome studies can use a shorter posttreatment time window, which is more time and resource efficient, over which to obtain follow-up data with little to no loss in the representativeness of that data.

Motivational Interviewing (MI) is an evidence-based, directive, client-centered therapy designed to develop discrepancy and resolve ambivalence by eliciting and reinforcing client Change Talk. However, the exact link between the process engaged in during MI and outcome is only starting to be uncovered. The present thesis has replicated and expanded on the current knowledge of the relationship between Therapist and Client Behaviours during a MI-based intervention (Motivational Enhancement Therapy; MET) and outcome, and has provided support for the emergent theory of the inner workings of MI. This was achieved by coding 106 audiotaped MET sessions primarily by the methods outlined in the Motivational Interviewing Skill Code Version 2.0. Data was drawn from 28 participants who received 3-4 sessions of MET within the context of a randomised controlled trial for mild-moderate alcohol dependence at the Community Alcohol and Drug Service of Christchurch. Therapist and Client Behaviours were analysed within sessions (categorised into Early, Mid, or End Intervals) and across sessions, and compared with whether the client had drank within national drinking guidelines during the 6-months after MET (Controlled Drinkers). In terms of Client Behaviours during MET it was found that Uncontrolled Drinkers (compared with Controlled Drinkers) uttered a significantly higher frequency of Sustain Talk, lower Ability Language strength (over all MET and during End Intervals), and lower Commitment Language strength (during Session 2 and 4, and change over MET). Giving Information was the only Therapist Behaviour where significant differences were observed over all MET, with a higher frequency given to the Uncontrolled Drinkers. However, during End Intervals within MET Sessions, Controlled Drinkers received a significantly higher frequency of Advise without Permission and a lower frequency of Emphasise Control statements. In most instances MI-Consistent Therapist Behaviours were associated with higher strength of Ability and Commitment Language, and a lower frequency of Sustain Talk. MI-Inconsistent Therapist Behaviour, Direct, was associated with lower Client Language strength. Limitations to these results include small sample, limited ability to make inferences about causality, coder biases, and uneven reliability. However, this exploratory study was unique in investigating the relationship between Therapist Behaviours and the strength of Client Language, and in examining these factors within and across multiple sessions, and has produced a number of potentially valuable findings that warrant further investigation.

This research addresses the question ‘How does transformative change occur in rehabilitation programmes, and how is it facilitated or constrained by contextual factors?’ The study, carried out in three community-based intensive rehabilitation projects for alcohol and drug dependent people, is designed to specify and explain change mechanisms, understood as the processes through which programme resources influence the intentional actions of participants. A critical realist theoretical frame is used, drawing on the work of Margaret Archer and John Greenwood. The study consisted of two phases: in Phase 1, fourteen client interviews and eight counsellor interviews were carried out in two treatment programmes, and these were analysed abductively to produce a set of tentative contexts, mechanisms and outcomes. Phase 2 consisted of ten theory-driven interviews (Pawson 1996) with clients in a third programme, designed to elaborate the emerging theory. An explanatory model was produced, in contexts-mechanisms-outcomes form. This showed that the institutional context of active warmth and acceptance, combined with a clear, predictable and transparent structure, allowed participants to build trust, bond with the peer group and become ready to accept and process respectful challenges to their perspective or their interpersonal behaviour. This facilitated a change in the clients’ internal conversation (Archer 2000), permitting new emotional responses and the formation of new attachments, values and commitments. The programme was seen as a place which facilitated the development of a revised personal and social identity. The study contributes to the understanding of these programmes by clarifying how participants change or fail to change. It responds to recent calls for more useful forms of evidence, to complement the sparse and equivocal experimental evidence base. The study findings have the potential to improve counsellor training and programme development.

This thesis takes Discursive Psychology as its main theoretical influence. Drawing on the resources of Discursive Psychology and utilising analytic tools provided by Conversation Analysis, these principles are applied to the study of addiction, and specifically alcohol problems. The data explored are telephone calls to an alcohol helpline. Four analytic chapters are presented. The first focuses on the concept of loss of control over drinking, identifying features of how this concept is constructed in talk and suggests possible functions of control talk for both callers and Advice Workers. The second analytic chapter examines how Advice Workers respond to callers' professed impaired control over their drinking and I demonstrate that embedded in discursive sequences of problem formulation and advice giving are issues of agency, accountability and responsibility. The thesis moves on to explore the role of knowledge in calls to an alcohol helpline and the analysis reveals that both the expert status of the Advice Worker and the speciality of the topic are co-constructed between the speakers on the helpline. The final analytic chapter features just one telephone call and demonstrates the application of such an analysis for alcohol service providers. The thesis ends with a discussion of the main overall findings and the implications of the research for clinical practice. I close by arguing that initial agency contact is a very important site of study and recommend that this should be explored utilising naturally-occurring talk.

Motivational Interviewing (MI) is an evidence-based, directive, client-centered therapy designed to develop discrepancy and resolve ambivalence by eliciting and reinforcing client Change Talk. However, the exact link between the process engaged in during MI and outcome is only starting to be uncovered. The present thesis has replicated and expanded on the current knowledge of the relationship between Therapist and Client Behaviours during a MI-based intervention (Motivational Enhancement Therapy; MET) and outcome, and has provided support for the emergent theory of the inner workings of MI. This was achieved by coding 106 audiotaped MET sessions primarily by the methods outlined in the Motivational Interviewing Skill Code Version 2.0. Data was drawn from 28 participants who received 3-4 sessions of MET within the context of a randomised controlled trial for mild-moderate alcohol dependence at the Community Alcohol and Drug Service of Christchurch. Therapist and Client Behaviours were analysed within sessions (categorised into Early, Mid, or End Intervals) and across sessions, and compared with whether the client had drank within national drinking guidelines during the 6-months after MET (Controlled Drinkers). In terms of Client Behaviours during MET it was found that Uncontrolled Drinkers (compared with Controlled Drinkers) uttered a significantly higher frequency of Sustain Talk, lower Ability Language strength (over all MET and during End Intervals), and lower Commitment Language strength (during Session 2 and 4, and change over MET). Giving Information was the only Therapist Behaviour where significant differences were observed over all MET, with a higher frequency given to the Uncontrolled Drinkers. However, during End Intervals within MET Sessions, Controlled Drinkers received a significantly higher frequency of Advise without Permission and a lower frequency of Emphasise Control statements. In most instances MI-Consistent Therapist Behaviours were associated with higher strength of Ability and Commitment Language, and a lower frequency of Sustain Talk. MI-Inconsistent Therapist Behaviour, Direct, was associated with lower Client Language strength. Limitations to these results include small sample, limited ability to make inferences about causality, coder biases, and uneven reliability. However, this exploratory study was unique in investigating the relationship between Therapist Behaviours and the strength of Client Language, and in examining these factors within and across multiple sessions, and has produced a number of potentially valuable findings that warrant further investigation.

of the thesis Introduction: Evaluation of the effectiveness of treatment methods, programmes and services is often something that people and journalists, or reporters, who do not work in health care and in social services ask and are not always easy to answer and give a simple and "measurable" answer. What is the percentage success rate of treatment? What percent of patients abstain? What does it mean? How does their somato-psycho-social condition improve? What do we mostly watch? In general, qualitative and quantitative outputs (number of contacts and treated clients, interventions, issued material, etc.) are also assessed, as well as their volume with previous periods, etc. Efficiency indicators often identified and determined by individual facilities; the standards have not yet assumed a unified form forspecific types of services. Claim: The aim of this work, which is focused retrospective on evaluating the effectiveness of the Apolinář treatment, its effective elements and methods of measurement, is to contribute to the effectiveness of the clinic's activities in future, to offer possible stimuli to set up interventions in the context of improving and streamlining the reported therapeutic care and provide possible argumentation also for insurance companies to contract further and in the long...

In the UK there has been growing concern about the relationship between levels of alcohol consumption and offending behaviour. The Alcohol Treatment Requirement (ATR) was introduced to the UK in 2007 and was piloted in a District in the north of England in July 2007. The ATR is a coercive form of treatment delivered jointly by the probation service and the National Health Service (NHS) and was funded by the NHS. The ATR centres on supporting offenders to cease their offending behaviour and reduce or end their alcohol misuse. Two female alcohol treatment workers have been appointed to specifically deliver the ATR. Therefore this study aimed to investigate the delivery of the ATR, and more specifically, aimed to explore what impact the ATR might have in relation to positive behaviour change and rehabilitation for offenders with alcohol problems. In order to meet the expectations of producing 'outcome' data for the NHS funders, and indepth theoretical data worthy of an academic PhD, this research took a pragmatic methodological approach which enabled different social realities of the ATR to be explored. To this end, a mixed methods design was employed involving quantitative and qualitative data collection methods. The data for this research was generated in three phases with Phase One aiming to explore quantitatively the characteristics, impacts and outcomes of those sentenced to the ATR. This phase revealed that the ATR is being delivered to predominantly young, male, alcohol dependent, violent, persistent offenders. This analysis further revealed that the ATR was effective in bringing about positive treatment outcomes and in reducing reoffending. In order to explore further how this positive change was occurring, Phase Two consisted of qualitative participant observations of the treatment interaction involving the female alcohol treatment workers and the male offenders. By drawing on positioning theory, the analysis considered the complexity of the gendered interactions that occurred during these encounters. It was found that the two female alcohol treatment workers resisted positions of 'feminine carer' offered up by these young men in order to occupy positions of control. Indeed this analysis provided great insight into the constant flow of negotiations and manoeuvring of positions that occurred between the alcohol treatment worker and the offender, argued to be vitally important in working towards positive behaviour change. During Phase Three ten offenders were interviewed in order to explore through a dialogical lens (Bakhtin, 1982) how they constructed and experienced treatment on the ATR. In exploring the offenders' stories dialogically, the analysis highlighted how the ATR was enabling, in that it offered a 'space' for these offenders to engage and internalise a dialogue that draws on the authoritative voice of therapy. Therefore it was revealed that through dialogue with the 'other', offenders were able to re-author a more 'moral' and 'worthy' self. Moreover, the ATR has been found to be successful in enabling the offenders' hegemonic masculine identities to be both challenged and protected as a result of the multilayered interactions that occurred during these treatment encounters. This research therefore concludes that coercive treatment, rather than being a concern, should be embraced as a way of enabling change for offenders with alcohol problems. Furthermore, this research has highlighted the value of the relational aspect of treatment in bringing about positive behaviour changes. Finally this research has shown that community sentences offer a more constructive way of engaging with offenders than those who receive a custodial sentence.