Critical misconceptions and knowledge gaps regarding alcohol cessation and risk of relapse in alcohol-related liver disease patients: A qualitative mental models study.

Autor: Mellinger JL; Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America; Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, United States of America. Electronic address: jmelling@med.umich.edu., Winder GS; Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, United States of America; University of Michigan Department of Surgery, Michigan Medicine, Ann Arbor, MI, United States of America; University of Michigan Department of Neurology, Michigan Medicine, Ann Arbor, MI, United States of America., Fernandez AC; Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, United States of America; University of Michigan Addiction Treatment Service, Michigan Medicine, Ann Arbor, MI, United States of America., Asefah H; Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America., Zikmund-Fisher BJ; Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America.
Jazyk: angličtina
Zdroj: Journal of substance use and addiction treatment [J Subst Use Addict Treat] 2024 Jun; Vol. 161, pp. 209292. Date of Electronic Publication: 2024 Feb 14.
DOI: 10.1016/j.josat.2024.209292
Abstrakt: Introduction: Despite the mortality benefits of alcohol cessation and alcohol treatment, few patients with alcohol-related liver disease (ALD) get such treatment. To understand reasons for low treatment rates, we performed a qualitative mental models study to explore how ALD patients understand factors influencing alcohol cessation, relapse and their liver health.
Methods: Using a mental models framework, we interviewed experts in alcohol use disorder (AUD) and ALD to determine factors influencing alcohol cessation, risk of relapse and liver health. An expert influence diagram was constructed and used to develop a patient interview guide. We recruited participants with ALD enrolled in hepatology or transplant clinics at a single tertiary-care center. We conducted interviews either face-to-face or by phone, per participant preference. We transcribed all interviews verbatim and analyzed them using combined deductive coding schema based on both the interview guide and emergent coding.
Results: 25 (10 women, 15 men) participants with a mean age of 57 years completed interviews. 68 % had decompensated cirrhosis. Major omissions included gender (as a factor in alcohol use or liver disease) and the influence of benzodiazepines/opioids on relapse. Misconceptions were common, in particular the idea that the absence of urges to drink meant participants were safe from relapse. Conceptual differences from the expert model emerged as well. Participants tended to view the self as primary and the only thing that could influence relapse in many cases, resulting in a linear mental model with few nodes influencing alcohol cessation. Participants' risky drinking signals (i.e., elevated liver enzymes) differed from known definitions of hazardous or high-risk drinking, which largely emphasize dose of alcohol consumed irrespective of consequences. Finally, participants sometimes viewed stopping on one's own as the primary means of stopping alcohol use, not recognizing the many other nodes in the influence diagram impacting ability to stop alcohol.
Conclusion: Patients with ALD had critical misconceptions, omissions, and conceptual reorganizations in their mental models of the ability to stop alcohol use. Attention to these differences may allow clinicians and researchers to craft more impactful interventions to improve rates of alcohol abstinence and AUD treatment engagement.
Competing Interests: Declaration of competing interest None.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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