DEVELOPMENT AND EVALUATION OF A CULTURALLY APPROPRIATE TREATMENT PROGRAM FOR PEOPLE WITH ALCOHOL USE DISORDERS IN THAILAND

Development and evaluation of a culturally appropriate treatment program for people with alcohol use disorders in Thailand Rationale The increasing prevalence of alcohol dependence is well documented in Thailand. To date, no study has examined the effectiveness of inpatient psychological interventions to facilitate abstinent and reduce overall alcohol consumption. Objectives The aim of this study is to examine this issue through a randomized controlled trial. A psychological intervention was developed by integrating Buddhism-Thai cultural knowledge; MI-CBT (BUMICBT) to provide a culturally appropriate group based treatment. The central hypothesis was that providing a BUMICBT to Thai people with alcohol dependence in addition to standard inpatient treatment would facilitate abstinent and reduce overall alcohol consumption, increase motivation and coping skills at post treatment compared with a control group receiving the standard treatment only. Design Subjects were required to be aged 18-65 years and met the diagnostic criteria for alcohol abuse or dependence on the structured interview CIDI-AUTO. Subjects were randomly allocated to an experiment group, BUMICBT plus standard care (N=26) or a control group, standard care, alone (N=19). Setting Subjects were volunteers recruited from a central drug- treatment hospital, Thanyarak Hospital, Thailand. Measurement Measures of average alcohol consumption (Time Line Follow Back inventory), motivation to change (Contemplation ladder inventory), and coping skills (Process of change, alcohol inventory) were administered at pre and post intervention and at 1, 3 and 6-month follow up. Intervention The BUMICBT intervention involved providing five 2-hour daily sessions for 5 consecutive days. Group sizes did not exceed 8 participants. The BUMICBT approach consisted of providing psychological techniques in culturally acceptable philosophical context. Principles of BMICBT included Chanta (motivation) enhancement, Thai boxing principles for assisting patients in establishing their goals and plans for changing their drinking behaviour, Buddhism Contemplation self monitoring strategies for identifying components of problematic drinking behaviour, Buddhidm- Yonisomanasikarn-cognitive strategies for restructuring maladaptive thoughts encouraging patients to maintain problematic drinking behaviour, and behavioural strategies derived from behavioural therapy discipline and from the three fold training Buddhism principles for dealing with high risk situations tempting patient to drink. The Buddhism Four Noble Truth problem solving principle was employed as the therapeutic process to help people change. Findings There was a significant reduction in overall alcohol consumption in participants receiving BUMICBT in addition to standard care and this improvement remained relatively consistent and did not decline significantly over the 6-month follow up period. In addition, participants receiving BUMICBT in addition to standard care also demonstrated significantly higher levels of motivation to change, self-efficacy, working alliance and quality of life compared to the control group. However, no effect was found for coping skill enhancement. Conclusions This is the first randomized controlled trial conducted in Thailand evaluating the efficacy of a culturally appropriate treatment for treating inpatients with alcohol use disorders. Results provide preliminary support that a brief course of BUMICBT assists Thai inpatients with high level of alcohol dependence to reduce their alcohol consumption, increase motivation to change, increase self efficacy and achieve positive client rated working alliance ratings during treatment. BUMICBT represents an innovation of alcohol inpatient treatment as it is a culturally appropriate integrating evidence-based contemporary Western approaches which provides an effective option for Thai populations. In addition, this treatment can be provided in a group setting over a one-week period as an addition to existing treatment programs. Therefore, it represents another resource effective intervention that can be delivered by a suitably qualified health practitioner. Limitations are a small sample size limiting the generalizabilty of results. Replication is a priority to evaluate whether the effects found in this study can be found in other treatment settings