The clients’ perspective on change during treatment for an alcohol problem: qualitative analysis of follow‐up interviews in the UK Alcohol Treatment Trial
Abstract
Aim To develop a model of change during and following professional treatment for drinking problems, grounded in clients’ accounts. Participants Subsets of consecutively selected clients of the UK Alcohol Treatment Trial (UKATT), followed‐up at 3 months (n = 211) and 12 months (n = 198) after randomization. Location Five statutory and non‐statutory alcohol problems treatment agencies in three areas of England and Wales. Data Open‐ended interviews conducted according to a brief interview guide, leading to 400–800‐word post‐interview reports used for analysis (tape‐recordings used for auditing purposes). Analysis Reports analysed by a team according to grounded theory principles, involving an iterative process with successive refinement of interviewing and analysis with each successive batch of data. Findings A model of change from the clients’ perspective was developed. Treatment was seen by clients as facilitating various changes in ways of thinking and/or increased support of various kinds from family and friends, along with new ways of acting in relation to drinking or more generally. For many those changes had led to an appreciation of the benefits accruing to them. Treatment was seen as part of a broader treatment system which included pretreatment assessment, forms of help additional to the trial treatment, plus an element of self‐directed change during and following treatment. Taken with awareness of worsening alcohol‐related harms, triggering events and external influence to seek treatment (the catalyst system), to which clients continued to refer following treatment, the change process is depicted as a complex, ongoing set of systems in which a trial treatment is embedded. Conclusions Models of change should be broadened so that treatment is seen as a complex system of parts, facilitating a nexus of cognitive, social and behavioural changes, embedded within a broader system of events and processes catalysing change. Such a model helps explain the relative absence of between‐treatments outcome differences in UKATT and in the alcohol problems treatment and more general psychotherapy research literatures.
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Addiction research has been criticized for excluding the patient's view and focusing on intervention techniques rather than intervention mechanisms.
“Addiction research has been criticized for excluding the patient's view and focussing on intervention techniques rather than intervention mechanisms. 15”
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BackgroundMethodInfluentialPretreatment Changes in Drinking: Relationship to Treatment Outcomes
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BackgroundInfluentialPost-treatment Stage of Change Predicts 12-month Outcome of Treatment for Alcohol Problems
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“This is likely to be the case and qualitative investigation of UKATT client accounts of their change processes supports this proposition (Orford et al., 2006).”
ResultClient experiences of motivational interviewing: An interpersonal process recall study
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“…is needed to confirm this, our findings suggest that being hospitalized for an alcohol-attributable illness may serve as a catalyst of change (Orford et al., 2006) for someone whose drinking or perception of drinking is more malleable to begin with (i.e., patients without dependence or who…”
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“It has long been acknowledged that the effectiveness of treatment relies heavily on service user motivation, expectations, autonomy, and ability as regards lifestyle change (Gifford & Humphreys, 2007; Orford et al., 2006; Simpson, 2001).”
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“…are similar to those identified in prior qualitative work among persons receiving alcohol treatment, in which participants described the importance of behavior change coming “down to me” or the idea that changes in alcohol use need to be self-directed to be effective (Orford et al., 2006).”
ResultTrocchio, S., Chassler, D., Storbjörk, J., Delucchi, K., Witbrodt, J., & Lundgren, L. M. (2013) · Journal of Addictive Diseases · doi:10.1080/10550887.2013.795468 · Cited by 20 · see citing works
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Identifying the Main Components of Substance-Related Addiction Recovery Groups
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“Research exploring service users’ perspectives often provides new insights that objective measures cannot capture (Laudet, 2007; Orford et al., 2006).”
BackgroundOrford, J., HODGSON, R. J., Copello, A. G., Krishnan, M., de Madariaga, M., & Coulton, S. (2009) · Alcohol and Alcoholism · doi:10.1093/alcalc/agn112 · Cited by 19 · see citing works
“This result fits well with the analysis of videotapes of therapists during sessions (Tober et al., 2008) and qualitative and content analysis of reports of 3- and 12-month follow-up semistructured interviews with clients (Orford et al., 2006b, 2008).”
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“According to the informants’ reflections and former research, undergoing long-term inpatient treatment is highly demanding, and several of the informants discussed the benefits of working in groups with other patients (Nettleton et al., 2013; Orford et al., 2006; Robertson & Nesvåg, 2019).”
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Into the unknown: Treatment as a social arena for drug users’ transition into a non-using life
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“…in terms of establishing basic conventional or normative routines and rhythms of everyday life, which is consistent with other descriptions of the importance of the structure and regularities of the institution in creating positive changes (Orford et al., 2006; von Greiff & Skogens, 2013).”
BackgroundWillenbring, M. L. (2013) · Alcohol research · doi:10.35946/arcr.v35.2.14 · Cited by 18 · see citing works
“Likewise, in another study of treatment of alcohol dependence that examined events leading to treatment seeking (Orford et al. 2006), the findings suggested that the change point occurred prior to treatment entry.”
ResultPositive processes of change among male and female clients treated for alcohol and/or drug problems
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“These could act as a barrier to participation, but also as a catalyst to change by increasing self-awareness of alcohol-related problems in both groups [76, 77, 122, 127].”
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“Other studies have found that problem drinkers often identify their own determination and commitment as major factors leading to eventual reduction of alcohol use.(25,26) Being more concerned about alcohol-related risks and spending time to read through the booklet suggest higher intrinsic motivation and determination…”
BackgroundSvendsen, T. S., Bjørnestad, J., Slyngstad, T. E., McKay, J., Skaalevik, A. W., Veseth, M., Moltu, C., & Nesvaag, S. (2020) · Substance Abuse Treatment, Prevention, and Policy · doi:10.1186/s13011-020-0254-x · Cited by 13 · see citing works
Effect of early working alliance on retention in outpatient substance abuse treatment
Knuuttila, V., Kuusisto, K., Saarnio, P., & Nummi, T. (2012) · Counselling Psychology Quarterly · doi:10.1080/09515070.2012.707116 · Cited by 16 · see citing works
“Previous research has suggested that the impact of common factors on psychotherapy effectiveness is greater than that of therapy techniques (Luborsky et al., 2002; Orford et al., 2006; Wampold, 2001).”
BackgroundWatson, J. M., Toner, P., Day, E., Back, D., Brady, L., Fairhurst, C. M., Renwick, C., Templeton, L. J., Akhtar, S., Lloyd, C., et al. (2017) · Health Technology Assessment · doi:10.3310/hta21150 · Cited by 16 · see citing works
Self-citationvon Greiff, N., Skogens, L., & Topor, A. (2018) · Nordic Social Work Research · doi:10.1080/2156857x.2018.1520739 · Cited by 16 · see citing works
“A design aiming to gather data based on several shorter qualitative interviews, inspired by the approach used by Orford et al. (2006) and also used in previous projects by two of the authors in the project (von Greiff and Skogens 2012, 2017), was chosen.”
MethodKnuuttila, V., Kuusisto, K., Saarnio, P., & Nummi, T. (2012) · Clinical Psychologist · doi:10.1111/j.1742-9552.2012.00049.x · Cited by 16 · see citing works
Social Behavior and Network Therapy for Drug Problems: Evidence of Benefits and Challenges
Williamson, E., Smith, M. J., Orford, J., Copello, A. G., & Day, E. (2007) · Addictive Disorders & Their Treatment · doi:10.1097/adt.0b013e31802b4eb2 · Cited by 16 · see citing works
Self-citationCourse of recovery from alcoholism.
Venner, K., Matzger, H., Forcehimes, A. A., Moos, R., Feldstein, S. W., Willenbring, M., & Weisner, C. (2006) · Alcoholism: Clinical and Experimental Research · doi:10.1111/j.1530-0277.2006.00121.x · Cited by 18 · see citing works
“A qualitative study component of the recent UKATT trial found that treatment was part of a complex process that began in the weeks and months leading to treatment and that the social system of the participant continued playing an important role during and after treatment (Orford et al., 2006).”
BackgroundFredman Stein, K., Sawyer, K., Daryan, S., Allen, J., & Taylor, G. (2023) · Health Expectations · doi:10.1111/hex.13684 · Cited by 11 · see citing works
“It is also possible that the therapeutic alliance in psychological interventions could help facilitate behaviour change.(14,15) There are some evidence‐based models that we can use to investigate mechanisms of behavioural change.”
BackgroundMethodRaistrick, D., Tober, G., Heather, N., & Clark, J. A. (2007) · Psychiatric Bulletin · doi:10.1192/pb.bp.106.014258 · Cited by 15 · see citing works
Hadjistavropoulos, H. D., Chadwick, C., Beck, C. D., Edmonds, M., Sundström, C., Edwards, W., Ouellette, D., Waldrop, J., Adlam, K., Bourgeault, L., et al. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100474 · Cited by 15 · see citing works
[Commentary] JOINING THE QUEUE OF DISSENTERS
Orford, J. (2008) · Addiction · doi:10.1111/j.1360-0443.2007.02128.x · Cited by 15 · see citing works
Self-citationRemission ohne formelle Hilfe bei Alkoholabhängigkeit: Der Stand der Forschung
Rumpf, H., Bischof, G., Hapke, U., Meyer, C., & John, U. (2009) · SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice · doi:10.1024/2009.02.03 · Cited by 14 · see citing works
Berner, M. M., Wahl, S., Brueck, R. K., Frick, K., Smolka, R., Haug, M., Hoffmann, S., Reinhard, I., Leménager, T., Gann, H., et al. (2013) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.12317 · Cited by 14 · see citing works
ROCZNIKI PSYCHOLOGICZNE / ANNALS OF PSYCHOLOGY
Soroko, E., & Psychologii, I. (2013) · Cited by 14 · see citing works
Pettersen, H. (2014) · Journal of Addiction Research & Therapy · doi:10.4172/2155-6105.1000193 · Cited by 14 · see citing works
“Troublesome states of abstaining were more prevalent in our study than in similar research on individuals who had not been diagnosed with SMI [25-27].”
Stasiewicz, P. R., Bradizza, C. M., Ruszczyk, M. U., Lucke, J. F., Zhao, J., Linn, B. K., Slosman, K. S., & Dermen, K. H. (2019) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.14216 · Cited by 14 · see citing works
“Even among those entering treatment, there is much in their accounts to suggest that a large component of the change process is self-directed (Orford et al., 2006b).”
BackgroundMethodDay, E., Wall, R., Chohan, G., & Seddon, J. (2015) · Addiction Research & Theory · doi:10.3109/16066359.2014.976205 · Cited by 13 · see citing works
“…possible due to the constraints of a student project, and although the process of detailed note-taking is demanding of the interviewer, previous work by our research group (Clutterbuck et al., 2008; Orford et al., 2006) has shown that it is feasible, acceptable and effective (Orford et al., 2005).”
BackgroundStallvik, M., Flemmen, G., Salthammer, J. A., & Nordfjærn, T. (2019) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-019-0207-4 · Cited by 12 · see citing works
“Studies have shown that social support through one’s network is important in order to change behavior in a successful manner, like reducing or quitting substance use [20, 34].”
BackgroundClients' Self-efficacy and Outcome Expectations
Kuusisto, K., Knuuttila, V., & Saarnio, P. (2011) · Addictive Disorders & Their Treatment · doi:10.1097/adt.0b013e31820dd4ec · Cited by 12 · see citing works
“Overall, taking account of the client’s perspective is important in treatment research.(3) The client’s expectations and attributions concerning treatment are important for ADDICTIVE DISORDERS & THEIR TREATMENT”
BackgroundSmith, A. L., Carter, S. M., Dunlop, S. M., Freeman, B., & Chapman, S. F. (2017) · Tobacco Control · doi:10.1136/tobaccocontrol-2017-053919 · Cited by 12 · see citing works
McKay, J. R., Gustafson, D. H., Ivey, M. A., Mctavish, F. M., Pe‐Romashko, K., Curtis, B. L., OSLIN, D., Polsky, D. E., Quanbeck, A., & Lynch, K. G. (2018) · Trials · doi:10.1186/s13063-018-2466-1 · Cited by 12 · see citing works
von Greiff, N., & Skogens, L. (2012) · Nordic Studies on Alcohol and Drugs · doi:10.2478/v10199-012-0013-z · Cited by 12 · see citing works
Kuusisto, K., & Lintonen, T. (2020) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-020-00275-5 · Cited by 11 · see citing works
Randomized Study of Assessment Effects on Alcohol Use by Persons With HIV in Rural Uganda
Emenyonu, N. I., Fatch, R., Muyindike, W. R., Kekibiina, A., Woolf‐King, S. E., & Hahn, J. A. (2017) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2017.78.296 · Cited by 10 · see citing works
“Assessment before alcohol treatment was cited as a reason for change in drinking in a qualitative study (Orford et al., 2006).”
BackgroundSkogens, L., & von Greiff, N. (2016) · Nordic Social Work Research · doi:10.1080/2156857x.2016.1156018 · Cited by 10 · see citing works
“Factors highlighted in previous research for these processes of change can be summarised as internal, social and treatment related (Orford et al. 2006; Best et al. 2008).”
BackgroundMethodInfluentialPettersen, H., Landheim, A., Skeie, I., Biong, S., Brodahl, M., Benson, V., & Davidson, L. (2019) · Substance Abuse: Research and Treatment · doi:10.1177/1178221819844996 · Cited by 11 · see citing works
Skogens, L., & von Greiff, N. (2020) · Nordic Studies on Alcohol and Drugs · doi:10.1177/1455072520936814 · Cited by 10 · see citing works
“…(Laudet & White, 2010; Litt, Kadden, Kabela-Cormier, & Petry, 2009; Best et al., 2012; Best, Groshkova, Sadler, Day, & White, 2011) and between groups (Ammon, Bond, Matzger, & Weisner, 2008; Orford et al., 2006; Skogens & von Greiff, 2014; Timko, Finney, & Moos, 2005; von Greiff & Skogens, 2017).”
Knitting together some ripping yarns
Humphreys, K. N., & Wilbourne, P. L. (2005) · Addiction · doi:10.1111/j.1360-0443.2005.01325.x · Cited by 10 · see citing works
How enough becomes enough: Processes of change prior to treatment for substance use disorder
Årstad, J., Nesvåg, S. M., Njå, A.-L. M., & Biong, S. N. (2018) · Journal of Substance Use · doi:10.1080/14659891.2018.1436608 · Cited by 9 · see citing works
“In line with previous research (Orford et al., 2006), we found that accumulating and escalating disruption to other life domains, especially those related to health and loss of family and other close relationships, affected how patients perceived their substance use and life situation.”
BackgroundResultInfluentialMdege, N. D., Raistrick, D., & Johnson, G. (2013) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12092 · Cited by 9 · see citing works
von Greiff, N., & Skogens, L. (2017) · European Journal of Social Work · doi:10.1080/13691457.2017.1341388 · Cited by 9 · see citing works
“The importance of relations and the social network for initiating and maintaining change finds strong support in research (cf. Best, Groshkova, Sadler, Day, & White, 2011; Orford et al., 2006; Schön, Denhov, & Topor, 2009; Skogens & von Greiff, 2016; von Greiff & Skogens, 2017), and also the importance of a network of…”
BackgroundYang, Y., Perkins, D. R., & Stearns, A. E. (2019) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-019-00107-z · Cited by 9 · see citing works
“Collectively, the findings support the argument of Orford et al. (2006) that treatment assists clients in making changes, and highlight the role of qualitative method in delineating this type of discovery (Lindström 1991).”
BackgroundResultInfluentialKrampe, H., Stawicki, S., Ribbe, K., Wagner, T., Bartels, C., Kröner‐Herwig, B., & Ehrenreich, H. (2008) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2008.01.007 · Cited by 9 · see citing works
Janeiro, L. D. B., Ribeiro, E., & Miguel, M. J. L. (2017) · Addiction Research & Theory · doi:10.1080/16066359.2017.1362693 · Cited by 9 · see citing works
“In reviewing the literature, previous studies have pointed out that drug users’ agency is an important factor for change (Sommer 2004; Orford et al. 2006; Vigilant 2008).”
BackgroundTopor, A., von Greiff, N., & Skogens, L. (2019) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-019-00063-8 · Cited by 9 · see citing works
“Forty users in recovery and 15 professionals were interviewed according to a design developed by Orford et al. (2006).”
BackgroundMethodA New Approach for Detecting Client–Treatment Matching in Psychological Therapy
Lakey, B., & Ondersma, S. J. (2008) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2008.27.1.56 · Cited by 9 · see citing works
A briefAddiction Recovery Questionnairederived from the views of service users and concerned others
Iveson-Brown, K., & Raistrick, D. (2015) · Drugs Education Prevention and Policy · doi:10.3109/09687637.2015.1087968 · Cited by 8 · see citing works
“The positivity subscale is about a consolidation of changed thinking and changed responses to situations (Orford et al., 2006) – the stage of change model is a commonly used means of placing a person along their treatment journey.”
Method
- Authors
- Orford, J., Hodgson, R., Copello, A., John, B., Smith, M., Black, R., Fryer, K., Handforth, L., Alwyn, T., Kerr, C., Thistlethwaite, G., Slegg, G., & UKATT Research Team
- Affiliations
- Birmingham and Solihull Mental Health NHS Foundation Trust (GB)
- University of Wales Institute Cardiff (SG)
- Wythenshawe Hospital (GB)
- University of Sheffield (GB)
- Cardiff Metropolitan University (GB)
- University College London (GB)
- Bangor University (GB)
- Corresponding author
- Orford, Jim
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2005-11-18
- Volume
- 101
- Issue
- 1
- Pages
- 60-68
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- OpenAlex
- W2061468490
- Cited by
- 153
- References
- 25
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 2 · 2022: 5 · 2021: 4 · 2020: 7 · 2019: 9 · 2018: 16 · 2017: 13 · 2016: 5 · 2015: 8 · 2014: 8 · 2013: 14 · 2012: 11
- FWCI
- 6.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Kent Academic Repository (University of Kent) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Cardiff Metropolitan Research Repository (Cardiff Metropolitan University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Keywords
- customer perspective, change models, cognitive change, social support, self-directed change, catalytic systems, treatment system, follow-up interviews
- MeSH terms
- Adaptation, Psychological, Adult, Alcohol Drinking, Alcoholism, Family, Female, Humans, Interview, Psychological, Male, Models, Psychological, Motivation, Patients, Self-Assessment, Self Concept, Social Behavior, Social Support, Thinking
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