IN PATIENTS WITH CHRONIC ALCOHOLISM. Anne-Pascale Le Berre1,2, Géraldine Rauchs1, Renaud La Joie1, Florence Mézenge 1, Céline Boudehent1, ...
READINESS TO CHANGE AND BRAIN DAMAGE IN PATIENTS WITH CHRONIC ALCOHOLISM Anne-Pascale Le Berre1,2, Géraldine Rauchs1, Renaud La Joie1, Florence Mézenge 1, Céline Boudehent1, François Vabret1, Francis Eustache1, Anne-Lise Pitel1, Hélène Beaunieux1 1Inserm-EPHE, Université de Caen/Basse-Normandie, , Unité U1077, GIP Cyceron, CHU Côte de Nacre, Caen, France 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, États-Unis Support: Inserm and Basse-Normandie Regional Council (R07012EE)
Introduction High motivation to change is a crucial triggering factor to patients’ engagement in clinical treatment. Sometimes, alcoholic patients come to treatment and are open to participating in treatment without being genuinely ready to abstain from alcohol.
Method
According to the Transtheoretical Model of Behavior Change, change consists of a cycle of five ‘stages of change’. The first three ‘Preaction’ stages preceding the effective implementation of actions in addiction change include ‘Precontemplation’, ‘Contemplation’ and ‘Preparation’. The two last stages correspond to ‘Action’ and finally ‘Maintenance’.
Readiness To Change Questionnaire (completed by patients) designed to assess three main stages of change: Precontemplation: substance misuse and no intention of stopping drinking Contemplation: strong intention of changing addictive habits but ambivalent attitude Action: cessation of excessive alcohol consumption and adoption of previously envisaged healthier lifestyle Alcoholic patients divided into ‘Action’ (i.e. patients in action stage) and ‘PreAction’ (i.e. patients in precontemplation or contemplation stages) subgroups
The shift from a low to a high level of motivation to change drinking behaviour requires patients: To complete a ‘decisional balance’ To apply ‘processes of change’
Patients and controls underwent 1.5-T magnetic resonance imaging Preprocessing steps performed using both the VBM5.1 and the DARTEL toolboxes implemented in SPM5 software
To progress through the ‘PreAction’ stages, patients need experiential (cognitive-affective) activities enabling them to change the way they think and feel about their alcohol abuse such as: Consciousness raising = gaining knowledge about the problem behaviour and the advantages of changing Dramatic relief = experiencing and expressing feelings about the problem behaviour and solutions Environmental reevaluation = assessing how the problem behaviour affects the physical and social environment High motivation to change drinking behaviour requires effective cognitive faculties such as episodic memory, executive and decision making skills and emotional and social abilities, which rely in turn on the integrity of the frontal and temporal cortices.
Participants 27 controls (mean = 44.7 years old) 31 alcoholic patients (mean = 43.9 years old) without any other substance dependence, early in abstinence, and at alcohol treatment entry Chronic alcoholism: 8.26 years +/- 8.26; sobriety: 12.64 days +/- 7.16 Alcohol consumption: 21.95 +/- 11.70 standard drinks per day
Action group 21 patients
Results Frontal cortex:
‘Action’ group compared with controls (p
