The relationship between treatment motivation and cravings in patients with alcohol addiction

Aim: Alcohol addiction is a psychiatric disorder characterized by chronic course, cravings and relapses. Motivation is an internal state influenced by external factors and can be defined as the willingness to accept change and readiness to change, and can vary depending on the situation and time. There are few studies that examine the relationship between treatment motivation and cravings in individuals, and investigate possible variables affecting this relationship. Our study aims to investigate changes in cravings and treatment motivation, as well as the relationship between cravings and treatment moivation during admission and a three-month follow-up period in patients with alcohol addiction. Materials and Methods: Our study included 102 patients who applied to the Alcohol Addiction Polyclinic of the Department of Psychiatry at Ankara University Faculty of Medicine. Patients who completed detoxification treatment were included in the study, and treatment goals were questioned at the beginning, first month, and second month of follow-up. Treatment motivation was evaluated using the Treatment Motivation Questionnaire and the Readiness to Change and Treatment Desire Scale, while cravings were evaluated using the Penn Alcohol Craving Scale and the Yale Brown Obsessive Compulsive Drinking Scale. The Addiction Severity Index, Beck Depression Inventory, State Anxiety Inventory, General Self-Efficacy Scale, and Multidimensional Perceived Social Support Scale were applied at admission. Patients were contacted via telephone for semi-structured interviews lasting 15-30 minutes weekly for 12 weeks. Results: Participants who did not complete (n=59) the 12-week follow-up did not differ from those who completed (n=43) in terms of gender, education level, employment status, income level, marital status, cohabitation, age of first alcohol use, and history of hospitalization or additional psychiatric disorders. However, depression and anxiety scores given at admission were higher in those who did not complete the follow up. Statistically significantly higher levels of craving were observed in those who did not complete the follow-up at admission and first month follow-up. In terms of motivation scales, TMA DM subscale and SOCRATES FV subscale were found to be statistically significantly higher in those who did not complete the follow-up. In those who completed the follow-up, the TMA TG subscale was found to be significantly higher in the first month of the follow-up. In the follow-up period, craving decreased significantly in the participants who completed and did not; In motivation, while TMA total and TMA IM, SOCRATES AA subscales increased significantly, SOCRATES IK subscale decreased significantly in participants who completed the follow-up; No significant changes were observed in the participants who did not complete. There was no significant change in treatment goals, and most patients wanted to quit completely during the follow-up, and it was found that alcohol use was lower in this group. There were significant differences in motivation and craving levels between treatment goal groups. The role of depression in the correlation between treatment motivation and craving was observed, and the effect of motivation on craving in the same direction decreased. Conclusion: When looking at the craving scales and subjective craving scores queried during phone interviews in our sample, it was found that craving decreased during the 12-week follow-up period, along with a similar decrease in alcohol consumption. In patients with high depression scores, treatment motivation was found to be positively associated with high craving, while motivation was inversely associated with depression, indicating that depression played an important role in the relationship between treatment motivation and craving. Longitudinal studies with frequent mood monitoring may more clearly elucidate the relationship between motivation and craving. Key Words: Alcohol addiction, treatment motivation, craving, treatment goal, depression