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Abstract Substance use disorders are chronic conditions characterized by repeated cycles of abstinence and relapse. Relapse is a significant barrier to sustained abstinence for clients with SUDs, estimated at 40 and 60% in the first weeks to six months of recovery. The relapse is triggered by significant difficulties, such as high desire thinking, craving, and low self-efficacy. Some clients begin to experience these barriers, during detoxification, leading to premature discharge before completion of detoxification. It is essential to target those specific barriers that prevent clients from successfully completing treatment and reaching full recovery and causing relapse. Therefore, psychological interventions that reducing the probability of relapse and its risk factors, e.g., craving and desirethinking, as well as enhancing its protective factors, e.g., motivation and selfefficacy could provide valuable support during detoxification and enhance recovery outcomes. Motivational Enhancement Therapy is a client-centered approach designed to provide tailored interventions to increase intrinsic motivation, resolve ambivalence, and empower clients with SUDs. The present study aimed at determining the effect of implementing Motivational Enhancement Therapy on desire thinking, craving, probability of relapse, and self-efficacy among clients with Substance Use Disorders. Materials & Method The study followed a quasi-experimental research design. It was conducted at the inpatient detoxification unit of the addiction center at Al-Maamoura Hospital for Psychiatric Medicine in Alexandria. The study subjects comprised 70 clients, assigned to two equal groups. The control group was subjected to unit routine care, and the study group was subjected to the Motivational Enhancement Therapy. Tools used for data collection: Tool I: A Socio-Demographic and Clinical Data Structured Interview Schedule for clients with SUDs. Tool II: General Craving Scale (GCS): GCS developed by Flannery et al.,1999 to measure the duration, frequency, and intensity of craving for both alcohol and other drugs. Tool III: Desire Thinking Questionnaire (DTQ): DTQ is a self-report instrument developed by Caselli & Spada, (2011) to assess the cognitive process of desire thinking. The questionnaire adapted to specify the substance. It consists of 10 items with two subscales: verbal perseveration and imaginal prefiguration. Tool IV: Advance Warning of Relapse Questionnaire (AWARE): AWARE Questionnaire was designed by Gorski and Miller (1982) to assess the probability of relapse for alcohol or drug dependence. The scale is 28-item (version 3.0). Tool V: Drug Abstinence Self-Efficacy Scale (DASES): The DASES is a modified version of the Alcohol Abstinence Self-Efficacy Scale (AASES) by Hiller et al. (2000) to assesses an individual’s efficacy in abstaining from drugs in specific situations. It consists of 20 typical drug-taking situations with four subscales that measure types of relapse precipitants. Methods - The study tools were translated into Arabic and retranslated into English. The content validity was examined by a jury of five experts in the field of Psychiatric Nursing. - A pilot study using 30 clients with SUDs was conducted to assess and ensure the clarity, consistency, and applicability of the study tools and to identify any obstacles and problems that might hinder data collection and adjustment accordingly. The results of the pilot study showed that the study tools were clear, understandable, and applicable. Study tools were tested for reliability and internal consistency. They proved to be reliable with high internal consistency. - The researcher completed an online training program on Motivational Interviewing for Addiction under the supervision of Dr William Miller & Dr Theresa Moyers. The researcher also completed an online training on Motivational Enhancement Techniques: Working with Patients with Opioid & Substance Use Disorders or High-Risk Use conducted by the University of Virginia. - The MET was conducted in six sessions, each lasting one hour, three times per week for two weeks, utilizing clipboards, audio-visual materials, and handouts, tailored to the client and researcher’s schedule. The sessions began with a relaxation exercise, a discussion on the cycle of change, and a discussion on substance use impact. MET sessions begin with an orientation session, discussing group norms and goals. Clients explore substance use’s impact, pros and cons, and discrepancies between values and behavior. Strategies for coping with cravings and high-risk situations are learned. Relapse prevention strategies are discussed, emphasizing rewarding successes and setting goals. Clients review progress and future goals, reassessing commitment, confidence, and motivation to change. The field work in the present study was implemented in three phases: Phase I: selection of the subjects: • Newly admitted detoxification unit clients who met the criteria were recruited as studied clients, who were individually met to establish rapport, explain the study purpose, and obtain consent. • Data was collected from the control group first, followed by the study group to prevent double contamination, which could affect the study results. • The baseline tests of tools I and II were conducted individually for the studied groups. Then, both control and study groups had received routine hospital care, including meditation and pharmacotherapy in detoxification unit. Phase II: Implementation of Motivational Enhancement Therapy (MET) sessions: • The study group’s clients were divided into small groups and the first five clients of them received six one-hour MET sessions three times a week for two weeks. • The researcher and recruited clients were working together to practice MET skills to achieve the sessions’ objective throughout therapy, different audiovisual materials. • After completion of MET sessions, another group was selected until the required number of study subjects was achieved. • Phase III: Evaluation of the effectiveness of MET • The post-test was administered using study tools for control group before the clients were transferred to the rehabilitation unit and administered to the study group after completion of the MET sessions. • Both groups were transferred to rehabilitation and received NA program and group therapy. Follow-up post-test was repeated in both the study group and the control group in the rehabilitation unit after the completion of the hospital program (before the patients were discharged). The following is a list of the most significant findings from this investigation: • The age of the study group ranged from 20 to 48 years old, with a mean age of 34.2 ± 6.72 years, while the age of the control group ranged from 21 to 47, with a mean age of 32.8 ± 6.15 years. The majority of both the study and control groups were craft workers or laborers (40% and 45.7%, respectively). • Concerning substance use, 82.9% of the study group and 85.7% of the control group were using heroin. Additionally, tramadol was mentioned to be used by more than 70% of either the study or control groups. • The craving mean score among the study group significantly decreased from 26.37 ± 2.47 to 5.0 ± 2.33 after implementation of MET, and to 2.40 ± 1.95 after three months follow-up. This difference was statistically significant (P=0.001 for both), with a large effect size of 98 %. • The desire thinking mean score significantly decreased from 36.68 ± 1.89 to 13.91 ± 3.50 immediately after MET and then 11.60 ± 2.17 after three months of follow-up, with a statistically significant change over time (F = 59.138, p<0.001) and a large effect size of 97%. • The drug abstinence self-efficacy of the study group showed significantly improving from 11.34 ± 3.17 to 67.85 ± 2.52 after implementation of MET. Furthermore, after 3 months of follow-up, it was noticed that this mean score was increased to 74.77 ± 3.04 with a statistically significant change (F = 7945.518, p<0.001) and a large effect size of 96%. • The probability of relapse of the study group significant decreased from 174.0±8.37 to 58.0±5.09 immediately after implementation of MET. Furthermore, after 3 months of follow-up, it was noticed that this mean score was decreased to 43.45 ± 5.35 with a statistically significant change (F = 7945.518, p<0.001) and a large effect size of 99%. • There are no drop-out clients in the study group overall treatment in hospital. In contrast, the number of clients in the control group decreased from 35 at preintervention to 27 at post-intervention and further to 23 at follow-up, with a total of 12 clients dropping out. This indicates a substantial improvement in the treatment adherence and continuity of care of the study group. • There is a significant negative correlation between self-efficacy and the probability of relapse and its risk factors as desire thinking and craving. Based on the results of the present study, the following recommendations can be suggested: 13. Educate clients with SUDs about protective factors such as motivation and self-efficacy, to overcome probability of relapse by providing from time to time with opportunities and means to participate in at least one MET session to enhance clients’ intrinsic motivation to initiate treatment. 14. Family psychoeducation should be developed to increase family awareness of the benefits of MET in order to encourage and support their clients to seek MET at an early treatment stage. 15. Include MET into psychiatric hospital treatment protocols for clients with SUDs during outpatient care and in the detoxification unit. This could potentially increase treatment engagement and commitment to abstinence. 16. Introduce the concept and principles of MET in theoretical and practical educational programs for psychiatric nurses to help them improve their skills in empowering clients to continue care and decrease probability of relapse. 17. Further studies are needed to assess the effect of MET on relapse risk factors in other areas of addiction, such as eating disorders, internet addiction, and gambling. |