الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 192 |  |  |
| | | from | 192 | | |
Abstract
Substance use disorders are chronic conditions characterized by repeated
cycles of abstinence and relapse. Relapse is a significant barrier to sustained
abstinence for clients with SUDs, estimated at 40 and 60% in the first weeks to
six months of recovery. The relapse is triggered by significant difficulties, such
as high desire thinking, craving, and low self-efficacy. Some clients begin to
experience these barriers, during detoxification, leading to premature discharge
before completion of detoxification. It is essential to target those specific barriers
that prevent clients from successfully completing treatment and reaching full
recovery and causing relapse. Therefore, psychological interventions that
reducing the probability of relapse and its risk factors, e.g., craving and desirethinking,
as well as enhancing its protective factors, e.g., motivation and selfefficacy
could provide valuable support during detoxification and enhance
recovery outcomes. Motivational Enhancement Therapy is a client-centered
approach designed to provide tailored interventions to increase intrinsic
motivation, resolve ambivalence, and empower clients with SUDs.
The present study aimed at determining the effect of implementing
Motivational Enhancement Therapy on desire thinking, craving, probability of
relapse, and self-efficacy among clients with Substance Use Disorders.
Materials & Method
The study followed a quasi-experimental research design. It was conducted
at the inpatient detoxification unit of the addiction center at Al-Maamoura
Hospital for Psychiatric Medicine in Alexandria. The study subjects comprised
70 clients, assigned to two equal groups. The control group was subjected to unit
routine care, and the study group was subjected to the Motivational Enhancement
Therapy.
Tools used for data collection:
Tool I: A Socio-Demographic and Clinical Data Structured Interview Schedule
for clients with SUDs.
Tool II: General Craving Scale (GCS): GCS developed by Flannery et al.,1999
to measure the duration, frequency, and intensity of craving for both alcohol and
other drugs.
Tool III: Desire Thinking Questionnaire (DTQ): DTQ is a self-report
instrument developed by Caselli & Spada, (2011) to assess the cognitive process
of desire thinking. The questionnaire adapted to specify the substance. It consists
of 10 items with two subscales: verbal perseveration and imaginal prefiguration.
Tool IV: Advance Warning of Relapse Questionnaire (AWARE): AWARE
Questionnaire was designed by Gorski and Miller (1982) to assess the probability
of relapse for alcohol or drug dependence. The scale is 28-item (version 3.0).
Tool V: Drug Abstinence Self-Efficacy Scale (DASES): The DASES is a
modified version of the Alcohol Abstinence Self-Efficacy Scale (AASES) by
Hiller et al. (2000) to assesses an individual’s efficacy in abstaining from drugs
in specific situations. It consists of 20 typical drug-taking situations with four subscales
that measure types of relapse precipitants.
Methods
- The study tools were translated into Arabic and retranslated into English. The
content validity was examined by a jury of five experts in the field of
Psychiatric Nursing.
- A pilot study using 30 clients with SUDs was conducted to assess and ensure
the clarity, consistency, and applicability of the study tools and to identify any
obstacles and problems that might hinder data collection and adjustment
accordingly. The results of the pilot study showed that the study tools were
clear, understandable, and applicable. Study tools were tested for reliability and internal consistency. They proved to be reliable with high internal
consistency.
- The researcher completed an online training program on Motivational
Interviewing for Addiction under the supervision of Dr William Miller & Dr
Theresa Moyers. The researcher also completed an online training on
Motivational Enhancement Techniques: Working with Patients with Opioid &
Substance Use Disorders or High-Risk Use conducted by the University of
Virginia.
- The MET was conducted in six sessions, each lasting one hour, three times per
week for two weeks, utilizing clipboards, audio-visual materials, and
handouts, tailored to the client and researcher’s schedule. The sessions began
with a relaxation exercise, a discussion on the cycle of change, and a discussion
on substance use impact. MET sessions begin with an orientation session,
discussing group norms and goals. Clients explore substance use’s impact, pros
and cons, and discrepancies between values and behavior. Strategies for
coping with cravings and high-risk situations are learned. Relapse prevention
strategies are discussed, emphasizing rewarding successes and setting goals.
Clients review progress and future goals, reassessing commitment, confidence,
and motivation to change.
The field work in the present study was implemented in three phases:
Phase I: selection of the subjects:
• Newly admitted detoxification unit clients who met the criteria were recruited
as studied clients, who were individually met to establish rapport, explain the
study purpose, and obtain consent.
• Data was collected from the control group first, followed by the study group
to prevent double contamination, which could affect the study results.
• The baseline tests of tools I and II were conducted individually for the studied
groups. Then, both control and study groups had received routine hospital
care, including meditation and pharmacotherapy in detoxification unit.
Phase II: Implementation of Motivational Enhancement Therapy (MET) sessions:
• The study group’s clients were divided into small groups and the first five
clients of them received six one-hour MET sessions three times a week for
two weeks.
• The researcher and recruited clients were working together to practice MET
skills to achieve the sessions’ objective throughout therapy, different audiovisual
materials.
• After completion of MET sessions, another group was selected until the
required number of study subjects was achieved.
•
Phase III: Evaluation of the effectiveness of MET
• The post-test was administered using study tools for control group before the
clients were transferred to the rehabilitation unit and administered to the study
group after completion of the MET sessions.
• Both groups were transferred to rehabilitation and received NA program and
group therapy. Follow-up post-test was repeated in both the study group and
the control group in the rehabilitation unit after the completion of the hospital
program (before the patients were discharged).
The following is a list of the most significant findings from this investigation:
• The age of the study group ranged from 20 to 48 years old, with a mean age of
34.2 ± 6.72 years, while the age of the control group ranged from 21 to 47, with
a mean age of 32.8 ± 6.15 years. The majority of both the study and control
groups were craft workers or laborers (40% and 45.7%, respectively).
• Concerning substance use, 82.9% of the study group and 85.7% of the control
group were using heroin. Additionally, tramadol was mentioned to be used by
more than 70% of either the study or control groups.
• The craving mean score among the study group significantly decreased from
26.37 ± 2.47 to 5.0 ± 2.33 after implementation of MET, and to 2.40 ± 1.95
after three months follow-up. This difference was statistically significant
(P=0.001 for both), with a large effect size of 98 %.
• The desire thinking mean score significantly decreased from 36.68 ± 1.89 to
13.91 ± 3.50 immediately after MET and then 11.60 ± 2.17 after three months
of follow-up, with a statistically significant change over time (F = 59.138,
p<0.001) and a large effect size of 97%.
• The drug abstinence self-efficacy of the study group showed significantly
improving from 11.34 ± 3.17 to 67.85 ± 2.52 after implementation of MET.
Furthermore, after 3 months of follow-up, it was noticed that this mean score
was increased to 74.77 ± 3.04 with a statistically significant change (F =
7945.518, p<0.001) and a large effect size of 96%.
• The probability of relapse of the study group significant decreased from
174.0±8.37 to 58.0±5.09 immediately after implementation of MET.
Furthermore, after 3 months of follow-up, it was noticed that this mean score
was decreased to 43.45 ± 5.35 with a statistically significant change (F =
7945.518, p<0.001) and a large effect size of 99%.
• There are no drop-out clients in the study group overall treatment in hospital.
In contrast, the number of clients in the control group decreased from 35 at preintervention
to 27 at post-intervention and further to 23 at follow-up, with a
total of 12 clients dropping out. This indicates a substantial improvement in the
treatment adherence and continuity of care of the study group.
• There is a significant negative correlation between self-efficacy and the
probability of relapse and its risk factors as desire thinking and craving.
Based on the results of the present study, the following recommendations can
be suggested:
13. Educate clients with SUDs about protective factors such as motivation and
self-efficacy, to overcome probability of relapse by providing from time to
time with opportunities and means to participate in at least one MET session
to enhance clients’ intrinsic motivation to initiate treatment.
14. Family psychoeducation should be developed to increase family awareness
of the benefits of MET in order to encourage and support their clients to
seek MET at an early treatment stage.
15. Include MET into psychiatric hospital treatment protocols for clients with
SUDs during outpatient care and in the detoxification unit. This could
potentially increase treatment engagement and commitment to abstinence.
16. Introduce the concept and principles of MET in theoretical and practical
educational programs for psychiatric nurses to help them improve their
skills in empowering clients to continue care and decrease probability of
relapse.
17. Further studies are needed to assess the effect of MET on relapse risk
factors in other areas of addiction, such as eating disorders, internet
addiction, and gambling.