Drinking episodes during abstinence-oriented inpatient treatment: Dual perspectives of patients and therapists-a qualitative analysis

Abstract

Aims: Treatment programs are frequently confronted with the consumption of alcohol by patients during therapy. This is in conflict with the abstinence agreement upon admission, which is considered to be instrumental for positive treatment outcomes. This qualitative analysis aims, first, to identify the range of patients' causal attributions, addiction concepts and control strategies detected in the narratives of off-site consumption episodes and, secondly, to compare this inventory with the response of the therapists. Methods: A total of 42 semi-structured face-to face interviews were conducted with patients and their therapists (n = 22) from two major Swiss inpatient alcohol clinics in 2010/2011. Interviews were conducted shortly after the detection of a patient's off-premises alcohol consumption. Textual exploration and systematic coding used ATLAS.ti to identify themes, interpretative categories and prevention strategies shared by the therapists. Results: Elements of outpatient-controlled drinking programs are mirrored in the patients' lay strategies, and similarities with self-change mechanisms can be observed. The dimensionality of therapists' views of the consumption incidents-illustrated by their prevention recommendations-proves to be less differentiated than the control strategies and situational framing of the patients. Conclusions: The focus on abstinence only and the adoption of the loss-of-control concept limits therapists' ability to feed patients' reports of their drinking episodes and coping efforts into a strength-based approach including a wider range of treatment outcomes. © The Author 2013. Medical Council on Alcohol and Oxford University Press. All rights reserved.