title: Facilitators and barriers to initiating change in medical intensive care unit survivors with alcohol use disorders: a qualitative study.
abstract: OBJECTIVE
  Alcohol abuse and dependence are collectively referred to as alcohol use disorders (AUD). An AUD is present in up to one third of patients admitted to an intensive care unit (ICU). We sought to understand the barriers and facilitators to change in ICU survivors with an AUD to provide a foundation upon which to tailor alcohol-related interventions.
  
  
  METHODS
  We used a qualitative approach with a broad constructivist framework, conducting semistructured interviews in medical ICU survivors with an AUD. Patients were included if they were admitted to 1 of 2 medical ICUs and were excluded if they refused participation, were unable to participate, or did not speak English. Digitally recorded and professionally transcribed interviews were analyzed using a general inductive approach and grouped into themes.
  
  
  RESULTS
  Nineteen patients were included, with an average age of 51 (interquartile range, 36-51) years and an average Acute Physiology and Chronic Health Evaluation II score of 9 (interquartile range, 5-13); 68% were white, 74% were male, and the most common reason for admission was alcohol withdrawal (n=8). We identified 5 facilitators of change: empathy of the inpatient health care environment, recognition of accumulating problems, religion, pressure from others to stop drinking, and trigger events. We identified 3 barriers to change: missed opportunities, psychiatric comorbidity, and cognitive dysfunction. Social networks were identified as either a barrier or facilitator to change depending on the specific context.
  
  
  CONCLUSIONS
  Alcohol-related interventions to motivate and sustain behavior change could be tailored to ICU survivors by accounting for unique barriers and facilitators.
authors.affiliation: Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO. Electronic address: brendan.clark@ucdenver.edu.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Clark
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jones
authors.forename: Paul
authors.initials: P
authors.lastname: Cook
authors.forename: Karen
authors.initials: K
authors.lastname: Tian
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
mesh_terms: D018806:APACHE; D000328:Adult; D000437:Alcoholism / Q000517:prevention & control* / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome
keywords: Alcohol use disorder; Brief intervention; Critical illness; Intensive care unit; Motivational interviewing