A Portfolio of Study, Practice and Research Including Changes in Motivation Over Time in an Acute Inpatient Treatment Service for Substance Misuse and Their Relationship to Withdrawal Symptoms and Attrition Rates.

Background: Attrition is particular problem in drug and alcohol services. Motivation at the start of treatment has been shown to be related to attrition. However, motivation changes throughout treatment and their ability to predict attrition from treatment have not yet been studied. Motivational interviewing has been shown to increase motivation, and decrease attrition rates in drug and alcohol patients. Principal Research Questions: How does motivation change over time during acute inpatient treatment? Does this predict unplanned discharge? Sample Group Description: 60 of 77 consecutive admissions on an acute inpatient drug treatment unit. Method: The study uses a time series design to measure motivation with additional baseline control data to evaluate any effect of this assessment on attrition rates. Participants were asked to complete questionnaires as soon as possible after admission, and three times weekly thereafter during their inpatient stay. Outcome Measures: Three questionnaires measuring different aspects of motivation. The Treatment Motivation Questionnaire, The Drug Avoidance Self Efficacy Scale and the Outcome Expectancies Questionnaire. The Opiate Withdrawal Symptom. Questionnaire was used to measure severity of withdrawal symptoms. The planned or unplanned nature of discharge was the measure of attrition. Results and Conclusions. Self-efficacy increases with time in treatment, consistent with previous research findings. Outcome expectations appear to decrease with time in treatment, but this finding needs replication. Greater increases in self-efficacy do appear to be negatively associated with attrition. A similar tendency was apparent for outcome expectations, but this was not significant. Severity of withdrawal symptoms is significantly related to low motivation, both in terms of self-efficacy.and outcome expectations. There was no evidence to suggest that participation in the study influences attrition rates