Motivational subgroups: Exploring behavior change variables and drinking outcomes among at risk drinkers admitted to a trauma unit
by Schumann, Kristina, P., M.A., University of Maryland, Baltimore County, 2009
Heavy consumption of alcohol has many dire consequences: physical, psychological, and interpersonal. Alcohol use plays a major role in both injury and emergency setting admissions. These medical settings provide clinicians with a unique opportunity to intervene with risky alcohol users who are not presenting for substance abuse treatment and may be more or less motivated for change. Examining readiness to change, an important component of the intentional behavior change process, is important in medical settings. The current study examined readiness to modify drinking upon admission to a shock trauma unit and it’s relation with other behavior change variables including: temptation, confidence, processes of change, and drinking consequences, as well as subsequent drinking behavior. The current study attempted to replicate the five group cluster solution of DiClemente and Hughes (1990) on stage based subscales. Five motivational profiles, similar to those previously found were evaluated as reasonable clusters in this sample. However, the percentages of individuals classified into each subgroup were somewhat different, with fewer individuals in the current sample falling into the Precontemplation cluster (13% in the current sample versus 28% in the previous sample) and more individuals falling into the Contemplation cluster (31% in the current sample versus 24% in the previous sample) and the Ambivalent cluster (20% in the current sample versus 13% in the previous sample). These motivational subgroups differed significantly on levels of: temptation, self-efficacy, processes of change, and drinking consequences with the Precontemplation, Uninvolved, and Contemplation groups reporting less temptation, greater self-efficacy, and fewer drinking related consequences as compared to the Ambivalent and Participation groups. The Precontemplation and Uninvolved groups also demonstrated less use of the processes of change as compared to the Ambivalent and Participation groups. However, motivational subgroups did not differ significantly on baseline drinking, but demonstrated significant differences in drinking behavior at the six-month follow-up assessment when controlling for baseline drinking and intervention assignment, with the Precontemplation and Uninvolved groups reporting more drinks per drinking day than the Contemplation and Participation groups. The patterns detected among the motivational subgroups, the behavior change variables, and the drinking patterns can be used in clinical settings to inform treatment planning and outcome prediction.