Elsevier

General Hospital Psychiatry

Volume 32, Issue 1, January–February 2010, Pages 86-93
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
Motivation to change risky drinking and motivation to seek help for alcohol risk drinking among general hospital inpatients with problem drinking and alcohol-related diseases

https://doi.org/10.1016/j.genhosppsych.2009.10.002Get rights and content

Abstract

Objective

The objective of this study was to analyze motivation to change drinking behavior and motivation to seek help in general hospital inpatients with problem drinking and alcohol-related diseases.

Method

The sample consisted of 294 general hospital inpatients aged 18–64 years. Inpatients with alcohol-attributable disease were classified according to its alcohol-attributable fraction (AAF; AAF=1, AAF<1 and AAF=0). Baseline differences in alcohol-related variables, demographics and motivation between the AAF groups were analyzed. Furthermore, differences in motivation to change, in motivation to seek help and in the amount of alcohol consumed from baseline to follow-up between the AAF groups were evaluated.

Results

During hospital stay, motivation to change was higher among inpatients with alcohol-attributable diseases than among inpatients who had no alcohol-attributable diseases [F(2)=18.40, P<.001]. Motivation to seek help was higher among inpatients with AAF=1 than among inpatients with AAF<1 and AAF=0 [F(2)=21.66, P<.001]. While motivation to change drinking behavior remained stable within 12 months of hospitalization, motivation to seek help decreased. The amount of alcohol consumed decreased in all three AAF groups.

Conclusions

Data suggest that hospital stay seems to be a “teachable moment.” Screening for problem drinking and motivation differentiated by AAFs might be a tool for early intervention.

Introduction

In general hospitals, inpatients with problem drinking are frequently found to have alcohol-related diseases. A study conducted in Germany showed that 21% of the inpatients of one general hospital were treated for alcohol-related diseases [1]. Data of a study conducted by Jarque-Lopez et al. [2] revealed that 24% of the inpatients of a general hospital unit for internal medicine in Spain were admitted due to alcohol-related disorders. In a study in Canada, 33.8% of malignant neoplasms and 57.9% of neuropsychiatric conditions in the male adult population were attributable to alcohol [3].

Due to the high proportion of general hospital inpatients with alcohol-attributable diseases, there is a need for appropriate treatment for three reasons. First, alcohol problem drinking may be expected to be practiced again after discharge. Second, alcohol problem drinking may lead to hospital readmission due to accompanying health problems. Third, being hospitalized due to alcohol-attributable disease may be a motivator to change problem drinking. Therefore, the hospital stay may be used for providing a brief intervention based on the inpatients' alcohol problem and motivational level.

From the point of view of hospital care and public health, it is important to find ways to screen for problem drinking in a time-saving manner. One opportunity to add to screening and early intervention according to alcohol problems might be to use routine treatment diagnoses classified by alcohol-attributable fractions (AAFs). Diseases may be classified according to their AAFs into two groups [4]: (a) diseases totally attributable to alcohol by definition (AAF=1; e.g., alcoholic neuropathy or alcoholic gastritis) and (b) diseases partially attributable to alcohol (AAF<1; e.g., esophageal cancer or hypertension). AAFs have been defined as the proportion by which disease cases, injury events or deaths would be reduced if alcohol use and misuse were eliminated among the population [5]. Specific AAFs have been found by analyzing survey data on per-capita alcohol consumption and relative risks for chronic diseases and injuries [6]. AAFs may be used for screening and counseling purposes.

Data on alcohol-related diseases provided so far by general hospitals have been largely limited to inpatients with alcohol dependence or alcohol abuse according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria [7]. However, the majority of general hospital inpatients with alcohol-attributable diseases are drinking an amount that is a risk for their health, but without fulfilling the criteria for alcohol dependence or abuse. Several definitions have been suggested for risky drinking. According to the definition of the British Medical Association (BMA) [8], an average daily alcohol consumption of more than 20 g for women and more than 30 g for men is regarded as risky drinking. Problem drinking may be defined as including risky drinking, as well as alcohol use disorders, according to DSM-IV criteria.

When screening for alcohol problem drinking and providing advice, inpatients' motivation to change drinking behavior and motivation to seek help for alcohol problems are important to consider. However, little is known about that among inpatients with problem drinking [9], [10].

According to the Transtheoretical Model of Behavior Change (TTM), motivation to change drinking behavior may be conceptualized as a process differentiating the precontemplation, contemplation, action, preparation and maintenance stages [11]. Individuals in the precontemplation stage are either ignorant of their drinking problem or unwilling to change drinking. In the contemplation stage, individuals think seriously about change and evaluate the pros and cons both of the problem behavior and the change. Individuals in the preparation stage intend to take action in the immediate future, while individuals in the action stage modify their behavior or environment in order to overcome their problem. The maintenance stage is characterized by stabilizing behavior change and avoiding relapse.

From motivation to change, motivation to seek formal help for alcohol problems is distinguished. Motivation to seek help can also be described using the stage model of behavior change. Freyer et al. [12] demonstrated that motivation to change drinking behavior and motivation to seek help were distinct, albeit positively correlated, measurement constructs among high-risk drinkers. Although several criticisms of the TTM's theoretical aspects have been published, it has been proven particularly practicable in medical settings where its advantage of saving time is of particular note (cf., meta-analysis by Noar et al. [13]).

Previous studies on motivation and alcohol-related diseases contain several limitations. First, only specific diseases or injuries were considered as trauma [14]. Second, data were limited to alcohol-dependent individuals [15] or to special wards as emergency departments [16]. Third, the study design was cross-sectional and used small samples [9].

To our knowledge, there has been no study providing data on motivation and alcohol-related diseases that encompasses the following criteria: (a) focusing on any alcohol-related diseases; (b) providing data from general hospitals, including a variety of clinical wards; (c) including individuals with alcohol dependence, alcohol abuse and risky drinking; and (d) using longitudinal data. The aims of the present study were to investigate, first, whether having an alcohol-attributable disease may have an impact on the motivation to change problem drinking and on the motivation to seek help for alcohol problems and, second, whether the degree to which diseases are attributable to alcohol may have an impact on the motivation to change problem drinking and on the motivation to seek help for alcohol problems. To achieve these aims, we utilized data from general hospital inpatients with problem drinking and alcohol-related diseases.

Section snippets

Sample recruitment

Data for this study were collected as part of the study ‘Early Intervention in General Hospitals’ (NCT 00423904, Research Collaboration on Early Substance Use Intervention, EARLINT) between April 28, 2002 and June 30, 2004 at four general hospitals in Mecklenburg-Western Pomerania, Germany. These four hospitals provide medical care for 198,745 inhabitants in the comprised geographical region [17]. A total of 29 wards, including internal medicine, surgical medicine, dermatology and orthopedic

Description of the total sample

Ninety-one percent (n=268) of the inpatients were male, and the mean age was 40.59 years (S.D.=11.97). Thirty-one percent of the inpatients suffered from a disease with AAF=1, and 19% had a disease with AAF<1. Among the sample, 50% were alcohol dependents, 12% were alcohol abusers and 38% were risky drinkers.

The frequent diseases of inpatients according to ICD-10[25] are displayed in Table 1. Regarding the principal diagnosis and the secondary diagnosis, the most common disease groups were

Discussion

The main findings of our study are as follows. First, the three AAF groups differed significantly in motivation to change and in motivation to seek help while hospitalized, indicating that motivation and the degree to which diseases are attributable to alcohol are positively associated. Second, motivation to change remained at the same levels after 12 months in the three AAF groups, while motivation to seek help decreased. Third, inpatients in all three AAF groups decreased their alcohol

Acknowledgment

This study, as part of the Research Collaboration in Early Substance Use Intervention (EARLINT), has been funded by the German Federal Ministry of Education and Research (grants 01EB0120 and 01EB0420) and the Social Ministry of the State of Mecklenburg-Western Pomerania (IX 311a 406.68.43.05).

The authors wish to thank Karin Paatsch, Dr. Barbara Wedler, Christine Fehlhaber, Birgit Hartmann and Katrin Stegemann for implementing the study; the medical and nursing staff of the University Hospital

References (33)

  • RehmJ. et al.

    Alcohol-attributable mortality and potential years of life lost in Canada 2001: implications for prevention and policy

    Addiction

    (2006)
  • BMA

    Guidelines on sensible drinking

    (1995)
  • ApodacaT.R. et al.

    Readiness to change alcohol use after trauma

    J Trauma

    (2003)
  • LongabaughR. et al.

    Injury as a motivator to reduce drinking

    Acad Emerg Med

    (1995)
  • DiClementeC.C. et al.

    Toward a comprehensive, transtheoretical model of change: stages of change and addictive behaviors

  • Cited by (0)

    View full text