Louise Roper

To Approach or Avoid Alcohol? Automatic and Self-Reported Motivational Tendencies in Alcohol Dependence

Background: Motivational conflict is central to alcohol dependence, with patients reporting motivation to limit their drinking at the same time as urges to drink alcohol. In addition, dual process models of addiction emphasise the power of automatic cognitive processes, particularly automatic approach responses elicited by alcohol-related cues, as determinants of drinking behavior. We aimed to examine the strength of automatic and self-reported alcohol approach and avoidance tendencies among alcohol-dependent inpatients relative to matched controls. Methods: A total of 63 alcohol-dependent patients undergoing detoxification and 64 light-drinking controls completed a stimulus-response compatibility (SRC) task, which assesses the speed of categorization of alcohol-related pictures by making symbolic approach and avoidance movements. We also included modified versions of the SRC task to assess automatic motivational conflict, that is, strong approach and avoidance tendencies elicited simultaneously by alcohol-related cues. Results: There were no differences between alcohol-dependent patients and controls on the SRC task, although individual differences in the quantity of alcohol consumed before entering treatment were significantly positively correlated with the strength of approach (but not avoidance) tendencies elicited by alcohol-related cues. Automatic approach tendencies were also positively correlated with self-reported “approach” inclinations and negatively correlated with self-reported “avoidance” inclinations. Conclusions: Although alcohol-dependent patients and matched controls did not differ on automatic approach and avoidance tendencies elicited by alcohol-related cues, individual differences in the quantity of alcohol consumed before entering treatment were associated with the strength of automatic approach tendencies elicited by alcohol cues.

Treatment-seeking for alcohol problems: The influence of mirroring events and windows of opportunity

The current study aimed to investigate the range of influences on peoples decisions to seek alcohol treatment and develop a model of treatment-seeking based on participants’ accounts. Understanding these influences could inform clinical practice and aid development of effective motivational interventions for the majority of people with alcohol problems who avoid or delay seeking treatment. Individual, semi-structured interviews were conducted with 30 participants who had been referred to an NHS alcohol treatment unit. To ensure, a broad range of treatment-seekers was investigated; participants were recruited according to the principles of maximum variation sampling whereby we interviewed participants at varying stages of engagement. Verbatim transcripts of the interviews were analysed within a thematic analytic framework. Contrary to expectations participants had not worked up gradually to seek help. Rather, participants described the decision to seek treatment as sudden and prompted by events that mirrored the extent of their drinking. Participants described their response to these mirroring events as both passive and autonomous. Furthermore, a window of opportunity was initiated by these events, during which participants were responsive to suggestions to make changes to their drinking and practitioners could influence the treatment-seeking process. This evidence is inconsistent with influential models of treatment-seeking behaviour. It suggests an alternative view that treatment-seeking is externally influenced and the result of a step-wise rather than gradual process. The findings indicate how practitioners might encourage treatment-seeking, particularly for participants who may not appear ready to change.

“The deceased has left; the alive has to move on”: Experiences of Chinese Widows in the UK

ABSTRACT Relatively little is known about the experiences of Chinese widows, especially those living outside China. This qualitative study examines the experiences of eight Chinese or Hong Kong-born widows living in the UK. Using a semistructured approach to interviewing, participants were asked about their lives before, during, and after their spousal bereavement. Five major themes emerged: (1) complexity of marital lives; (2) experiences around the time of the death including fate; (3) loneliness and isolation; (4) the challenges of practical tasks; and finally, (5) current life. The implications of the findings for social policy and practice are briefly discussed.

Children’s views on research without prior consent in emergency situations: a UK qualitative study

Objectives We explored children’s views on research without prior consent (RWPC) and sought to identify ways of involving children in research discussions. Design Qualitative interview study. Setting Participants were recruited through a UK children’s hospital and online advertising. Participants 16 children aged 7–15 years with a diagnosis of asthma (n=14) or anaphylaxis (n=2) with recent (<12 months) experience of emergency care. Results Children were keen to be included in medical research and viewed RWPC as acceptable in emergency situations if trial interventions were judged safe. Children trusted that doctors would know about their trial participation and act in their best interests. All felt that children should be informed about the research following their recovery and involved in discussions with a clinician or their parent(s) about the use of data already collected as well as continued participation in the trial (if applicable). Participants suggested methods to inform children about their trial participation including an animation. Conclusions Children supported, and were keen to be involved in, clinical trials in emergency situations. We present guidance and an animation that practitioners and parents might use to involve children in trial discussions following their recovery.

Decision-making throughout the whole process of relapse: a qualitative analysis of problem drinkers’ accounts of recent episodes

Background & Aims: Models of relapse have usually focused on the antecedents to a drinking session. This qualitative study examined themes within the whole process of relapse in alcohol use (including four phases: before, during, ending and following a drinking session). Methods: Fifteen clients from a UK alcohol treatment clinic received a semi-structured interview, and in-depth accounts of their most recent relapse experiences were obtained. Interview transcripts were analysed using thematic analysis. Results: Participants made sense of their relapse as being caused by circumstantial and compelling triggers, over which they perceived having little control. However, less readily identified, the whole process of relapse was underpinned by a sequence of ordinary decisions. Participants selected options in beverage choice, purchasing and drinking behaviour, which minimised anticipated negative outcomes of a relapse. Their continued drinking was reinforced by primary and secondary gains, and beliefs of uncontrollability. Participants were able to stop drinking, without assistance, when they had enough. Negative consequences of relapse were delayed and less serious than drinkers anticipated. Sharing their accounts with supportive others gave them a sense of consolation. Conclusions: Reflecting on the whole process of relapse and building up drinkers’ sense of control may be important components of relapse prevention.