Characteristics and Processes of Treatment Seeking for Alcohol Problems -findings from epidemiological and qualitative studies

Abstract

Background: Alcohol use and misuse are related to several physical, mental, and social harms in Sweden. Early identification of risky alcohol consumption followed by appropriate intervention can lead to decreased alcohol consumption and prevention of aggravation. However, for many individuals, seeking help or treatment does not seem to become an option until the problems have become severe. Increased knowledge of characteristics and processes of treatment-seeking is needed. Aims: The overall aim of this thesis was to explore treatment-seeking behaviour in people with alcohol problems. Its specific aims were to investigate whether there were differences in women diagnosed with alcohol use disorders (AUD) between those who had or had not received treatment, to analyse the associations between personality and treatment-seeking in women, to explore the processes leading to treatment-seeking, and to analyse treatment-seeking for alcohol problems from a gender perspective. Methods: The thesis was based on both quantitative and qualitative data. Quantitative data was taken from the multipurpose, longitudinal, general population-based project “Women and Alcohol in Göteborg” (WAG). A sample of women with a lifetime diagnosis of alcohol use disorders (n=52) was identified among 3130 women. Pooled cross-sectional data from three population samples and one clinical sample from the WAG project (n=1,342) formed the basis for the analysis of associations between treatment-seeking and personality traits using the Karolinska Scales of Personality (KSP). Qualitative data was gathered via interviews with 12 women and men who had sought treatment for the first time. The qualitative study was based on grounded theory. Content analysis was used to analyse the interviews from a gender perspective. Results: Among women diagnosed with AUD, the AUD was significantly more severe in those who had received treatment. Women with resolved AUD who had received treatment were more anxious, tense, irritable, and showed more guilt, than untreated women with resolved AUD. Untreated women with resolved AUD resembled women without AUD on most personality traits. Developing a willingness to change was found to be the basic psychosocial process leading to treatment-seeking for both women and men. The categories that constituted sub-processes and supported the development of willingness to change were: 1) actuating inner forces; 2) dealing with conflicting feelings and thoughts; and 3) hoping to turn the situation around. These processes were continuously assisted by demanding and caring support from partners, friends, or professionals. The analysis of gendered conceptions in treatment-seeking showed that promoting factors for treatment-seeking in men were characterised by beliefs in their own capability, and future prospects. Women placed importance on pressure from someone significant, and sharing the problem with someone else. Hindrances for both women and men were feelings of shame and the significance of alcohol in their lives. Conclusions: In motivating people to seek treatment, professionals and the social network can play a vital role by showing demanding and caring support. Gendered conceptions of alcohol problems and treatment-seeking should be considered both in planning prevention strategies and treatment. Future studies focusing on the significance of alcohol in people’s lives and perceptions of gendered behavior could increase the understanding of what promotes and what hinders treatment-seeking in people with alcohol problems.