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|Title: ||Barriers and Resistance to Specialty Alcohol Treatment Amongst Alcoholic Liver Disease Transplant Candidates Preceding and Following Liver Transplantation|
|Authors: ||Heyes, Cathy Mary|
|Keywords: ||Alcoholic liver disease, liver transplantation; relapse, alcohol treatment, treatment seeking, treatment resistance, stigma|
|Issue Date: ||3-Apr-2013|
|Publisher: ||Faculty of Health Sciences/University of Sydney.|
|Abstract: ||End stage alcoholic liver disease (ESALD) is a leading yet controversial indication for orthotopic liver transplantation (OLT). Around one third of these patients will return to harmful alcohol use after transplantation. Despite the availability of established alcohol treatment, ESALD transplant patients avoid such services. The aim of this study was to evaluate factors contributing to treatment reluctance among ALD transplant patients using a mixed method approach.
A case control study compared 40 ESALD transplant patients (cases) matched for age and sex with 40 alcohol treatment seekers without liver disease (controls). The results of the case control study showed that ESALD transplant patients perceive no need for treatment due to their lengthy abstinence and high motivation for change. Standard alcohol interventions are not tailored to the ESALD transplant population as they differ from ATS on alcohol severity, health beliefs, psychiatric co-morbidity and quality of life. Barriers to help seeking amongst ESALD transplant subjects consisted of possible fear of stigma and limited access to alcohol services.
A qualitative study involving semi-structured interviews amongst 42 ESALD transplant candidates study found 62% of ESALD transplant participants reporting stigma to be a major deterrent to utilizing specialty alcohol treatment because of its association with the label ‘alcoholic’. Self-management by ESALD transplant participants to achieve substantial abstinence removed the necessity for professional support services. A major barrier to alcohol treatment seeking was the lack of an appropriate and suitable alcohol treatment integrated with the transplant program and actively incorporating the social and interpersonal dimensions of transplantation.
The findings of the research provide significant therapeutic implications to tailoring a more suitable and efficacious approach to the management of alcohol relapse within the liver transplant context.|
|Type of Work: ||PhD Doctorate|
|Type of Publication: ||Doctor of Philosophy Ph.D.|
|Appears in Collections:||Sydney Digital Theses (Open Access)|
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