The mechanisms of treatment – client and treatment staff perspectives on change during treatment for alcohol problems

Abstract

The overall aim of this study is to increase the understanding of operative factors in the treatment process by studying how clients and treatment unit staff perceive the relevance and value of the alcohol treatment intervention for a positive process of change. The specific research questions are: (1) How do clients describe the relevance and importance of treatment interventions in their own process of change? (2) How do treatment staffs describe experience and perceptions of how their work can contribute to a successful change process among treated clients? (3) How do client and the treatment staff descriptions relate to each other? Interviewees (40 clients and eight professionals) were recruited from four treatment units in the Stockholm area. In the results, the three treatment components most emphasised by clients are structure and regularity, friendship and support of the group and the personal conduct and professionalism of the staff. Both of the components referring to the client group and to the staff were also brought forward by the professionals interviewed. In treatment, the client group is used as an important tool for creating a sense of trust, confidence, acceptance and collaboration – all central components of the treatment alliance concept. With reference to the notion of rebuilding/extending recovery capital, it is suggested that in addition to the addiction problem intervention, a more extended system of support is vital for more marginalised clients.

Keywords:

• mechanisms of treatment
• alcohol problems
• process of change
• client perspective

Acknowledgement

The study was financed by the Swedish Council for Working Life and Social Research.

Notes

1. The main focus with the qualitative part of UKATT was to, based on the results from interviews with clients treated for alcohol problems, create a model of change. Short interviews were conducted with a large number of clients using an interview guide with overall themes. Instead of transcribing short reports were written on each interview and analysed with Grounded Theory.

2. The client group consisted of 32 men and 8 women aged 21 to 70 (mean 45) of whom a considerable majority at the time of the interview was in aftercare (on average six months). A vast majority of the clients had problems only with alcohol but a few clients, in both the marginalised and the integrated group, also had problems with other drugs. A more detailed description of the client group can be found in previous articles on the project (von Greiff and Skogens 2012; Skogens and von Greiff 2012).

3. A twelve-step programme is a set of guiding principles (accepted by members as 'spiritual principles') outlining a course of action for recovery from addiction or other behavioural problems. It was originally proposed by Alcoholics Anonymous (AA) as a method of recovery from alcoholism and it is suggested that members regularly attend meetings with other members who share their particular recovery problem.