Motivation and adherence to psychosocial treatment for alcohol and drug use-related problems

LEITE, Jose Carlos de Carvalho; LUZ, Maria Fernanda Duarte da; WALZ, Júlio Cézar; FILIPPIN, Lidiane Isabel; SALDANHA, Ricardo Pedrozo; DRACHLER, Maria de Lourdes

doi:10.1590/1982-02752018000400006

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Estudos de Psicologia (Campinas)

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HEALTH PSYCHOLOGY • Estud. psicol. 35 (04) • Oct-Dec 2018 • https://doi.org/10.1590/1982-02752018000400006 copy

Motivation and adherence to psychosocial treatment for alcohol and drug use-related problems

Motivação e adesão ao tratamento psicossocial entre usuários de substâncias químicas

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This is a prospective cohort study of 150 individuals attending a specialized health service for substance-related disorders. The study investigated the association between motivation to remain in treatment and treatment adherence. All service users were interviewed soon after admission to the treatment program and were followed-up during the first two months of treatment. A Cox Regression Model was used to estimate the hazard ratios for dropout during the two months following the admission interview. The results indicated that individuals with a primary-school education, lack of income, and low motivation toward treatment at the admission interview presented a higher risk of treatment dropout. This study showed the importance of motivation in changing addictive behavior and in adherence to treatment as essential factors for recovery.

Keywords
Motivation; Substance-related disorders; Treatment outcome

Programa de Pós-Graduação em Psicologia, Pontifícia Universidade Católica de Campinas Núcleo de Editoração SBI - Campus II, Av. John Boyd Dunlop, s/n. Prédio de Odontologia, 13060-900 Campinas - São Paulo Brasil, Tel./Fax: +55 19 3343-7223 - Campinas - SP - Brazil
E-mail: psychologicalstudies@puc-campinas.edu.br

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[1] Correspondência para/Correspondence to: J.C.C. LEITE. E-mail: <jcdc.leite@gmail.com>.

Variables	Participants		Discontinuation		p
Variables	n	%	n	%	p
Gender			<0.454^a a Fisher’s exact test;
Male	131	087.3	117	89.3
Female	19	012.7	16	84.2
Age (years)			<0.301^b b Pearson’s chi-squared test;
1930	52	034.7	44	84.6
31–40	61	040.6	57	93.4
41–68	37	024.7	32	86.5
Education level			<0.001^b b Pearson’s chi-squared test;
Up to primary	83	055.4	80	96.4
Secondary	53	035.3	43	81.1
Higher	14	009.3	10	71.4
Source of income			<0.009^b b Pearson’s chi-squared test;
Yes	40	026.7	31	77.5
No	110	073.3	102	92.7
Social support outside the clinical setting			<0.475^b b Pearson’s chi-squared test;
High^c c High ≥ median;	76	050.7	66	86.8
Low^d d Low < median.	74	049.3	67	90.5
Living situation			<0.580^b b Pearson’s chi-squared test;
Alone	71	047.3	64	90.1
With other people	79	052.7	69	87.3
Previous treatment			<0.297^b b Pearson’s chi-squared test;
No	53	035.3	45	84.9
Yes	97	064.7	88	90.7
Severity of alcohol dependence			<0.305^a a Fisher’s exact test;
Mild to moderate	3	002.0	2	66.7
Severe	147	098.0	131	89.1
Illicit drug use (last month)			<0.696^a a Fisher’s exact test;
No	16	010.7	15	93.8
Yes	134	089.3	118	88.1
Total	150	100.0	133	86.7

	Participants (n)	Self-efficacy
	Participants (n)	Mean	SD
Self-efficacy expectations of changing addictive behaviors ¹ 1 Total score for the scale of self-efficacy expectations of changing addictive behaviors;
Treatment adherence	17	63.60	22.19
Treatment dropout	133	39.96	22.40
Total	150	42.64	23.53
Self-efficacy expectations of treatment adherence ² 2 Single question about self-efficacy expectations of treatment adherence; SD: Standard Deviation.
Treatment adherence	17	04.82	00.53
Treatment dropout	133	03.56	01.81
Total	150	03.71	01.76

Type of self-efficacy expectations	Unadjusted HR¹ 1 Unadjusted HR: Ratio between risk rates (hazard ratio) estimated using the Cox Regression Model that includes the outcome variable and the exposure variable of interest; (95% CI)³ 3 95% CI: 95% Confidence Interval.	Adjusted HR² 2 Adjusted HR: For the other self-efficacy expectations in this table, education level, and source of income; (95% CI)³ 3 95% CI: 95% Confidence Interval.
Self-efficacy expectations of changing addictive behaviors
	1.03 (1.01−1.04)	1.03 (1.004−1.05)
	p = 0.006	p = 0.021
Self-efficacy expectations of treatment adherence
	2.21 (1.08−4.51)	2.04 (1.06−3.92)
	p = 0.03	p = 0.034