January 12, 2010

ALCOHOL TREATMENT IN PRIMARY CARE

Abstract

This particular research aims to establish the effectiveness of brief intervention in the prevention and treatment of alcohol abuse in the primary care setting. The term "brief intervention" refers to a time-limited, patient-centered counseling strategy that focuses on changing patient behavior and increasing patient compliance with therapy. The use of brief intervention for changing alcohol use patterns is not unique to the treatment of alcohol problems. In fact, physicians and other health care professionals widely employ this technique to help patients change a variety of behaviors - to modify dietary habits; stop smoking; and reduce weight, cholesterol levels, or blood pressure (Manwell, 1999). The researchers would also like to know what other forms of interventions the participants find effective in the treatment and prevention of alcohol abuse.

The study population will be a group of alcohol-dependent patients who are voluntarily seeking treatment at an alcohol dependence unit at a local hospital. The study will be conducted at the alcohol dependence units of five local hospitals during the span of treatment. The qualitative method of data collection will be employed, using the interview method specifically. The time frame for the collection of data is 12 months. Analysis of the data consists of grouping the data into meaning units.

 

Research question or objective

 

In this particular study, the researchers would like to know how effective is the use of brief intervention in prevention and treatment of alcohol abuse in primary care. Additionally, the researchers would also like to know what other interventions are used by the patient in prevention and treatment of alcohol abuse.

 

Scientific rationale or relevant theory

 

In this particular research, the goal of brief intervention with this study population is to reduce alcohol use to low-risk levels, in the process minimizing the drinkers' risk of developing alcohol-related social and medical problems. The researchers would like to find out, through study participants and the qualitative method of research the effectiveness of brief intervention in the primary care setting within a one-year period.

Other than establishing the effectiveness of brief intervention in the primary care setting within a one year period, the researchers would also like to know what other interventions or treatment options the participants find effective in treating alcohol abuse/dependence. This will provide further insight to the medical community on how to best treat the alcohol dependence/abuse and the various problems it brings with it.

 

Selection of research design/methodology

           

Methodologies are perspectives on research; they set out a vision for what research is and how it should be conducted (Potter, 1996). Qualitative research methods are those generally subsumed under the heading ethnography. Other headings and names include case studies, field studies, grounded theory, document studies, naturalistic inquiry, observational studies, interview studies, and descriptive studies.

Qualitative research designs in the social sciences stem from traditions in anthropology and sociology, where the philosophy emphasizes the phenomenological basis of a study, the elaborate description of the "meaning" of phenomena for the people or culture under examination. This is referred to as the verstehen approach. Often in a qualitative design only one subject, one case, or one unit is the focus of investigation over an extended period of time (Benz & Newman, 1998).

For this research proposal, the authors will employ the qualitative method. Qualitative research is multimethod in focus, involving an interpretive, naturalistic approach to its subject matter. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them. Qualitative research involves the studied use and collection of a variety of empirical materials--case study, personal experience, introspective, life story, interview, observational, historical, interactions, and visual texts --the described routine and problematic moments and meanings in individuals' lives (Denzin & Lincoln, 1994).

Phenomenological research is of great value to clinicians, policy makers, and ordinary persons because of its distinctive emphasis on making human behavior and experience intelligible with reference to the point of view of the actor (Halling, 2002). It is a qualitative research method founded by Edmund Husserl as a reaction against the empiricist conception of the world as an "objective universe of facts" (Benz & Newman, 1998).

            Phenomenology is the belief that the object of interest be examined without any preconceived notions or a priori expectations. Researchers attempt to get inside the mind of the actor to understand what the actor sees and believes. This understanding leads the researcher to explain how the actor constructs reality and why the actor behaves as he or she does (Potter, 1996). In phenomenology, the researchers should not have preconceived notions about the phenomenon, but keep themselves open to the experience fully.

            There are three ways in which phenomenological research can be useful. First, by providing a deeper understanding of what certain kinds of experiences (e.g., depression) are like, this type of research can be helpful to practitioners, be it nurses or psychologists, who work with persons having these experiences. Second, through its exploration of situated human consciousness, phenomenology can help to make sense in psychological and human terms of some of the findings of traditional research, which are typically presented in statistical language. These findings may be intriguing, but it is difficult to make sense of them. It is one thing to discern a pattern, it is quite another to grasp its meaning. Third, social action and public policy can be informed by this type of research. In fact, neither form of intervention is likely to be successful unless it is based on genuine insight into the lives of those people and groups one wants to help (Halling, 2002).

The phenomenological approach will be used in this research. The study participants will be asked of their experiences and if they feel there is a significant improvement in their problem of alcohol abuse. The effectiveness of brief intervention will be gauged by how the participants experience during the treatment. The participants will also provide answers to what other treatments they are using while under brief intervention which they find effective in curing alcohol abuse.

In-depth interviewing is the most commonly used data collection approach in qualitative research and this will be how data will be obtained in this study. This is hardly surprising, given the common concern of qualitative researchers to understand the meaning people make of their lives from their own perspective. The in-depth interview takes seriously the notion that people are experts on their own experience and so best able to report how they experienced a particular event or phenomenon. If we interview different people about the same event or phenomenon, we will inevitably get a range of perspectives. Where the research question requires it, the perspectives of members of a range of groups, such as clients and workers, or teachers, students and parents, should be obtained (Darlington & Scott, 2002).

In-depth interviews are particularly useful when the phenomena under investigation cannot be observed directly (Taylor & Bogdan, 1998). Thus they are an excellent means of finding out how people think or feel in relation to a given topic. They also enable us to talk with people about events that happened in the past and those that are yet to happen. These retrospective and anticipatory elements open up a world of experience that is not accessible via methods such as observation. Other than through diaries or other records made at the time, interviews in the present are the only way to access a person's perceptions of past events (Darlington & Scott, 2002).

Qualitative research is, however, labor intensive and time consuming, from data collection through to analysis, so there will often be practical constraints on the number of people who can be interviewed (Darlington & Scott, 2002). For this reason, the study will randomly select 50 participants for this study. These 50 participants will be selected from five local hospital's alcohol dependence unit. It is a must that these patients have to voluntarily enrolled in brief intervention programs. This means that the study participants are willing to overcome their problem of alcohol abuse.

Other than that, the participants are allowed to utilize other options in the prevention and treatment of alcohol abuse, as long as it is within the primary care setting. Collection of data will take place in the hospitals.

Experienced researchers will know, however, that potential research participants are not always easy to find. Participation in qualitative research requires a considerable commitment of time and energy and, often, the willingness to commit to reflection on deeply personal experiences. Researchers often have to take as many participants as they can get, within the constraints of time and other resources. It is common to have to try a number of avenues, each with its own pros and cons (Darlington & Scott, 2002).

 

Design outline

            This research aims to establish the effectiveness of brief intervention in the prevention and treatment of alcohol abuse in the primary care setting. Also, this research aims to find out what other treatment options are helpful for the participants while they are undergoing brief intervention.

            This particular topic is important not only for those who are patients of alcohol abuse but also for medical professionals. Understanding and knowing what the alcohol-dependent patients feel regarding the treatment they receive gives the medical community a better understanding on what treatment options are best and what kind of care is best suited for these patients. This could ultimately improve treatment options/choices of the patients.

            There is a vast array of literature that covers this area of concern. Brief interventions are gaining favor as a means of addressing the problems associated with hazardous and harmful drinking. Brief interventions commonly target people whose levels or patterns of use are not diagnosable as alcohol abuse or dependence (Finney, 2004).

            Brief interventions represent one of these "newer treatment modalities" and have received attention at this time because of their cost-effectiveness (Osborn, 2001). Although brief interventions are intended for individuals who present with less severe drinking problems, and not for those in the late stages of alcohol dependence or abuse, accommodations are made as will be done in this study. Exceptions are justified on the basis of accessibility to treatment, cost, client preference, and the need for problem determination.

            Two medications--disulfiram and naltrexone--have been approved by the FDA for the treatment of alcohol dependence in the United States. Some other medications, such as the selective serotonin reuptake inhibitors (SSRIs) and buspirone, have been used empirically studied by clinicians to treat alcohol dependence (Munch, 2002). A medication available in Europe (ie, acamprosate) is still under investigation.

            Psychotherapy is also another form of treatment option for patients of alcohol abuse or dependence. Some common roles and indications for psychotherapy include: setting the resolve to stop substance abuse, teaching coping skills, changing reinforcement contingencies, fostering management of painful effects, and improving interpersonal functioning and social supports (Munch, 2002).

            Pharmacologic interventions can also be used in addition to psychotherapy in prevention and treatment of alcohol abuse and dependence in the primary care setting.  This type of complementary relationship between psychotherapy and pharmacotherapy in treatment of alcohol dependence has been supported by a recent study combining naltrexone and CBT which demonstrated that motivated individuals with moderate alcohol dependence can be treated with greater effectiveness when naltrexone is used in conjunction with weekly outpatient CBT (Munch, 2002).

            The research methodology that will be used in answering the research questions will involve phenomenological qualitative methods of research and data collection. In-depth interviews will be conducted to gather data. The participants of the study will be randomly selected from alcohol dependence units of five local hospitals within the local vicinity. The data collected will be analyzed into meaning units and synthesized. Approval to conduct the study will be obtained from an ethics committee and the participants of the study will be assured confidentiality and anonymity through identification coding and reports of aggregate data. The participants will also be notified of the aims, methods, expected outcome, benefits and potential hazards of the study conducted

 

Data collection tools/technique

 

Before the study will be conducted, an approval to perform the study will be obtained.           An informed consent will also be obtained by the researchers from all the study participants.

There is a wide range of data-gathering techniques mentioned in the qualitative literature. A qualitative method of data collection will be employed in the study. Data will be collected using in-depth interviews. The participants will be interviewed alone using similar questions being posed several times in each interview. A total of 4 interviews per participant will be conducted within the period of one year. Each interview will last between 60-90 minutes. The interviews will be audio-taped and transcribed verbatim. Most researchers would agree that any audio-recorded data that are to be systematically analyzed will need to be transcribed (Darlington & Scott, 2002). The rationale behind the timing of the interviews is to include periods of improvement in alcohol treatment in both the short and the long term.

            The first interview will be held at the beginning of the study. This is before the patients' start with brief intervention. The participants will be asked of their drinking habits, lifestyle and all the factors relevant to the subject. The succeeding three interviews will be held every three months. More or less, the same questions will be asked in each interview. There will be emphasis more on what the participant has experienced during the treatment. There is a need for systematic follow up because clinical impressions are often misleading.

            Leading alcohol researchers have speculated that the protocols used to study various treatments affect clinical outcomes. Researchers argued that the research follow-up interview advantageously affected both attrition rates and data reliability. The research follow-up interview is an important component of treatment that increased its effectiveness. Other researchers also reported that the majority of individuals they interviewed indicated that "frequent follow-up contacts functioned as a `continuing care' process having beneficial and desirable consequences." These researchers hypothesized that the follow-up interview functioned as aftercare and contributed to patient improvement (Beattie, 2000)

After the one-year study period, all the data that were obtained will be reviewed, compared and analyzed. A review of the data allows for a description of the general characteristics of the phenomena.

 

Analysis

 

            Qualitative analysis is generally concerned with identifying patterns in the data—different ways in which the data relate to each other. The kinds of patterns identified depend very much on the focus of the study. There are many ways to do qualitative analysis. While there are many different approaches to qualitative data analysis, in practice most approaches involve similar stages. Whatever the research purpose and question, certain analytic choices have to be made—what data to collect, from whom, how to focus the analysis and how to structure the research report (Darlington & Scott, 2002).

Data analysis will be carried out in a stepwise manner. Every interview that was conducted will be read in order for the researchers to get an idea of the content of the data results as a whole. The data collected will then be divided into meaning units.

Each protocol will be separated into meaning units, meaning each response written by each participant was divided into a series of expressions, which, if read consecutively, match the original protocol. The next step is the condensation of each meaning unit to its central theme (e.g. what the participants experience during the treatment, or what other forms of intervention they found effective in treating alcohol abuse). The central themes will then be combined and form the final formal step in this qualitative analysis, namely, the demarcation of the typical components of "what people experience after brief intervention (either they find it effective or not)" and "what other interventions did the participants find helpful in prevention and treatment of alcohol abuse" for this sample of participants with alcohol abuse.

This will then be condensed and integrated into syntheses. The syntheses will then be checked and validated by the other researchers to eliminate any discrepancies in the results.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reference list

 

Beattie, M.C. 2000, Alcohol Treatment Research Follow-up Interviews and

Drinking Behaviors. Journal of Studies on Alcohol.

Benz, C.R. & Newman, I. 1998, Qualitative-Quantitative Research

Methodology: Exploring the Interactive Continuum, Southern Illinois University Press.

Darlington, Y. & Scott, D. 2002, Qualitative Research in Practice: Stones from

the Field, Allen & Unwin.

Denzin, N.K. & Lincoln, Y. 1994, Handbook of Qualitative Research, Sage

Publications.

Finney, J.W. 2004, Brief Interventions for Alcohol Problems: Factors that

Facilitate Implementation, Alcohol Research and Health.

Halling, S. 2002, Making Phenomenology Accessible to a Wider Audience,

Journal of Phenomenological Psychology.

Manwell, L.B. 1999, Brief Intervention in Primary Care Settings: A Primary

Treatment Method for At-Risk, Problem, and Dependent Drinkers, Alcohol Research and Health.

Munch, E.A. 2002, Understanding the Costs and Treatment of Alcohol Abuse

and Dependence. Formulary.

Osborn, C.J. 2001, Brief Interventions in the Treatment of Alcohol Use

Disorders: Definition and Overview, Journal of Addictions and Offender Counseling.

Potter, W.J. 1996, An Analysis of Thinking and Research about Qualitative

Methods, Lawrence Erlbaum Associates.


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