The current study aimed to investigate the range of influences on people's decisions to seek alcohol treatment and develop a model of treatment-seeking based on participants' accounts. Understanding these influences could inform clinical practice and aid development of effective motivational interventions for the majority of people with alcohol problems who avoid or delay seeking treatment. Individual, semi-structured interviews were conducted with 30 participants who had been referred to an NHS alcohol treatment unit. To ensure, a broad range of treatment-seekers was investigated; participants were recruited according to the principles of maximum variation sampling whereby we interviewed participants at varying stages of engagement. Verbatim transcripts of the interviews were analysed within a thematic analytic framework. Contrary to expectations participants had not worked up gradually to seek help. Rather, participants described the decision to seek treatment as sudden and prompted by events that mirrored the extent of their drinking. Participants described their response to these mirroring events as both passive and autonomous. Furthermore, a window of opportunity was initiated by these events, during which participants were responsive to suggestions to make changes to their drinking and practitioners could influence the treatment-seeking process. This evidence is inconsistent with influential models of treatment-seeking behaviour. It suggests an alternative view that treatment-seeking is externally influenced and the result of a step-wise rather than gradual process. The findings indicate how practitioners might encourage treatment-seeking, particularly for participants who may not appear ready to change.

Background & Aims: Models of relapse have usually focused on the antecedents to a drinking session. This qualitative study examined themes within the whole process of relapse in alcohol use (including four phases: before, during, ending and following a drinking session).Methods: Fifteen clients from a UK alcohol treatment clinic received a semi-structured interview, and in-depth accounts of their most recent relapse experiences were obtained. Interview transcripts were analysed using thematic analysis.Results: Participants made sense of their relapse as being caused by circumstantial and compelling triggers, over which they perceived having little control. However, less readily identified, the whole process of relapse was underpinned by a sequence of ordinary decisions. Participants selected options in beverage choice, purchasing and drinking behaviour, which minimised anticipated negative outcomes of a relapse. Their continued drinking was reinforced by primary and secondary gains, and beliefs of uncontrollability. Participants were able to stop drinking, without assistance, when they had enough. Negative consequences of relapse were delayed and less serious than drinkers anticipated. Sharing their accounts with supportive others gave them a sense of consolation.Conclusions: Reflecting on the whole process of relapse and building up drinkers' sense of control may be important components of relapse prevention.

Previous research has suggested that alcohol dependency may be associated with particular cognitive schemas. The objective of this study was to examine the severity of reported maladaptive schemas, and of anxiety and depression levels of an alcohol dependent group prior to and following a period of abstinence, and in comparison with a non-clinical sample. A total of 100 participants, comprising an alcohol dependent clinical (ADC) group ( n = 50) and a non-clinical group ( n = 50), were recruited. Data were collected on demographic characteristics, drinking patterns, severity of alcohol dependence, depression, anxiety, and maladaptive schemas. ADC participants reported higher levels of depression and anxiety than did the non-clinical group immediately before a period of abstinence. The groups differed significantly on 6 of 15 schema beliefs. Following a brief (3-week) period of abstinence and participation in a psycho-educational program, the ADC group demonstrated significant improvements in relation to depression, anxiety, and 13 out of 15 maladaptive schema beliefs. Further research is required to understand the association and potential relevance of particular schemas to alcohol dependency.

Objective. To examine the effects of telephone prompting on attendance for the start of treatment and retention in treatment in a specialist alcohol clinic.Method. The study setting was a specialist alcohol treatment clinic. Participants were 172 clients attending as out-patients. An ABABAB design was used with planned alternating conditions, respectively, with or without a telephone prompt the day before the client was due to attend, over a succession of six consecutive 4-week periods.Results. Clients who were prompted were more likely to start treatment and attend further treatment sessions than clients who were not prompted.Conclusions. Telephone prompting is a simple and effective way to improve attendance for the start of treatment and retention in alcohol treatment.

The study aimed to examine representations of alcohol problems in patients and their significant others and investigate the impact of divergent beliefs on relationship quality, significant other distress and treatment attendance. Representations of alcohol problems in patients (n = 49) admitted to an alcohol treatment clinic and their significant others (n = 49) were examined using revised versions of the Illness Perception Questionnaire (IPQ). Dissimilarity scores were calculated. Relationship quality was measured using expressed and perceived negative feelings scales and significant other distress was measured using a shortened version of the General Health Questionnaire (GHQ-12). Significant other representations of alcohol problems were found to be associated with patient - significant other relationship quality. Dissimilar beliefs in patients and significant others were important for both (a) entry into aftercare and (b) subsequent number of aftercare groups attended, after age and severity of dependency had been controlled for. These results demonstrate the importance of the role of significant other and divergent beliefs, and highlight the need for more emphasis on the social environment in the treatment of alcohol problems.

A historical summary is given of the clinical application of assessment and treatment procedures emanating from the new model of problem drinking that was emerging in the 1970s contemporaneously with the opening of the Windsor Clinic in Liverpool. Learning from the sometimes unexpected long-term outcomes of treated clients has provided invaluable feedback for this service. Controlled drinking is a goal choice selected by most clients at treatment entry but is a long-term successful drinking status found less commonly than abstinence. A sample of 10 clients who have been successful in maintaining controlled drinking after treatment for an average of 5 years is described. Common strategies that these individuals have adopted – including an initial period of abstinence, maintaining regular attendance at the agency, alcohol consumption levels considerably less than recommended limits and avoiding distilled spirits and solitary drinking – appear to be important.

Aims: To identify factors that predict attendance for the start of treatment following assessment, and factors that predict retention in treatment, at a specialist alcohol treatment clinic.Participants: The sample consisted of 419 consecutive clients (272 male and 147 female) who had attended for assessment over a two‐year period and had chosen out‐patient care. These included 141 who did not attend treatment (non‐starters), 106 who attended only once (starters), and 172 who attended more than one session (retainers).Design: We recorded factors that previous research or clinical experience suggested might influence attendance, including: demographic factors, clients' support and mental state, substance use and aspects of clinical practice.Analysis: Univariate analyses and multiple logistic regression analyses were conducted to identify factors predicting whether clients attended the first treatment session and whether they continued to remain in treatment.Findings: Clients most likely to start treatment following assessment were those who were older, lived with others, drank fewer units of alcohol daily, did not use illegal drugs, had waited a shorter time between assessment and the start of treatment, lived nearer the clinic and made contact with the clinic before the start of treatment. Clients who were most likely to be retained in treatment were also older, had waited a shorter time between assessment and the start of treatment, and had chosen to attend the 6‐week structured day programme rather than the open support sessions.Conclusions: Clients who were most likely to start treatment were the “less complex” of those who access the clinic.Strategies to promote engagement of and retention in treatment might include: incorporating more motivational work with clients during initial assessment; telephoning each client before the start of treatment to remind them to attend; and providing more satellite clinics for those clients who have further to travel.

OBJECTIVE:To investigate the use of a minimal intervention as a preparation for treatment of alcohol dependency.METHOD:A randomized-controlled trial with 361 treatment seekers in an alcohol treatment unit in Northwest England. Study variables included recent alcohol intake, participants' views of their drinking problem, and several self-report scale scores. Experimental group participants received an advance leaflet containing advice on reducing alcohol intake.RESULTS:At follow-up participants in the leaflet group were more likely to view their drinking problem as a learnt behaviour. There was a non-significant tendency for more of the leaflet group to attend for assessment by comparison with controls. Significant improvements occurred over time in readiness to change (recognition subscale), self efficacy and dependency, independent of group allocation.CONCLUSIONS:The tendency toward increased attendance rates should be confirmed in a larger sample. Findings have potential implications for the usage of treatment preparatory material.

Background Longitudinal research has many strengths, but is often compromised by attrition of participants. This is a particular problem in studies with ‘difficult‐to‐reach’ populations. Recommended techniques for maximizing retention are often impractical for routine clinical services.Aims To examine whether methods that are available in routine practice can achieve satisfactory follow‐up of a cohort of patients, 11 months after assessment for alcohol treatment.Methods Using a longitudinal cohort design, we tested the incremental effect of a simple three‐step approach with 124 consecutive patients seeking treatment for alcohol problems: first an interview appointment, then postal questionnaires and, finally, a reminder by telephone or letter. Data on treatment compliance and self‐reports of drinking behaviour during the 11‐month follow‐up period were obtained.Results Stage of contact was significantly associated with treatment compliance and treatment outcome. The final telephone reminder proved to be an important step in obtaining a sample that more accurately reflected both the treatment attendance and outcome of the original cohort.Conclusions Intensive resources, contact with multiple agencies and financial incentives were not necessary to achieve a contact rate of 75% and successful follow‐up of 67%. Alcohol treatment outcome research is feasible within services with limited time and resources.

Aims: To identify variables associated with response to first appointments at a specialist alcohol treatment clinic, and to determine the effect on patients' attendance of a brief telephone prompt prior to the appointment.Design, participants and intervention: Multivariate analysis of patient characteristics from referral letters and aspects of the quality of the referral process was carried out. Consecutive non‐repliers (n=100), non‐attenders (n=100) and attenders (n=100) were studied. A further 100 patients were matched and allocated to two groups, one of which received a telephone prompt prior to their appointment. Clinic attendance was noted.Findings: Results showed that patients' older age, shorter travelling distance to the clinic, shorter waiting time and administrative delay, faster response by the patient to the appointment invitation, and morning appointments were associated with positive responses. Patients not receiving a telephone prompt were less likely to attend.Conclusions: Reductions in waiting time for first appointment, locally based services and prompting patients by telephone would appear to hold promise as strategies for reducing non‐attendance in alcohol dependency. Planning would need to take account of whether services could adequately cope with additional demand. Further research to assess the influence of patients' readiness to change prior to appointments is warranted.KeywordsNon‐attendancetelephonealcohol clinic

Because of the need to maximise treatment adherence and minimise costs, the duration of treatment for alcohol problems should not be longer than is necessary to achieve clinical benefit. The present authors have previously demonstrated the effectiveness of a 10-week outpatient treatment programme. In this paper, they evaluate the effects of reducing the length of the programme to 6 weeks by comparing the outcomes to those of the original programme. One hundred and twenty-four patients were followed up 11 months after choosing the revised 6-week programme. Eighty-eight patients (71%) were successfully contacted. Data collected included alcohol-related problems, use of other services, drinking patterns throughout the follow-up period and details of alcohol intake for the week prior to interview. Reducing the programme length significantly increased the number of patients completing the programme at no cost to clinical effectiveness.

When empowered to select either a residential or a day care treatment programme for problem drinking, more patients favour the latter option. Those completing the full programme, which was similar in content in both settings, were followed up at approximately 9 months after initial engagement in treatment. Attrition was a major problem, particularly in the day-patient sample. Of the 103 patients who began each programme, 91 completed the residential option but only 23 completed all sessions in the day-patient course. Day-care completers tended to have less severe alcohol-related problems than in-patient completers. They were also older, had experienced fewer episodes of alcohol-related admissions in the past and were less likely to show biochemical evidence of alcohol-related physical damage. Both groups showed positive changes in drinking intake, drink-related problems, the use of adjunct services and the self-ratings of improvement throughout the follow-up period. Outcome in the day programme completers group was, however, generally better than that shown by the in-patients. The results should be interpreted with caution owing to the significant inter-group differences at the start of treatment and the considerably higher non-attendance and attrition rates for the day-care programme. A cognitive-behavioural in-patient programme for alcohol dependent patients can be provided in a day-care setting. For some patients, this option is both attractive and effective.

The ubiquity of alcohol abuse problems encountered by practising health care workers is not reflected by the scale of training input into professional qualification courses. The present survey found this to be the case within occupational therapy education and training. Practising occupational therapists were aware of basic health information about alcohol. However, they were reluctant and lacked confidence to engage in screening assessment or basic treatment with the problem drinkers, whom they perceived as a significant proportion of their caseload. Enhanced training in alcohol and substance misuse would reinforce both the inevitable involvement with these clients and the legitimate role of the occupational therapist in their management.

Thirty-seven problem drinkers, who had completed a 6-week residential programme which emphasises self-control and education, were classified into three groups. The patients leaving treatment with no measurable physical damage were classed as either controlled drinking choosers or abstinence choosers depending on their goal choice. The third group of patients, who showed physical damage, were strongly advised to remain abstinent after discharge. Follow-up for 1 year produced no significant outcome differences between the controlled drinking choosers and abstinence choosers, with patients in each group most likely to achieve their goal choice. The worst outcome, measured on several indices, was shown by patients strongly advised to abstain.