title: Readiness to change is a predictor of reduced substance use involvement: findings from a randomized controlled trial of patients attending South African emergency departments.
abstract: BACKGROUND
  This study examines whether readiness to change is a predictor of substance use outcomes and explores factors associated with RTC substance use among patients at South African emergency departments.
  
  
  METHODS
  We use data from participants enrolled into a randomized controlled trial of a brief substance use intervention conducted in three emergency departments in Cape Town, South Africa.
  
  
  RESULTS
  In adjusted analyses, the SOCRATES "Recognition" (B = 11.6; 95 % CI = 6.2-17.0) and "Taking Steps" score (B = -9.5; 95 % CI = -15.5- -3.5) as well as alcohol problems (B = 4.4; 95 % CI = 0.9-7.9) predicted change in substance use involvement at 3 month follow-up. Severity of depression (B = 0.2; 95 % CI = 0.1-0.3), methamphetamine use (B = 3.4; 95 % CI = 0.5- 6.3) and substance-related injury (B = 1.9; 95 % CI = 0.6-3.2) were associated with greater recognition of the need for change. Depression (B = 0.1; 95 % CI = 0.04 -0.1) and methamphetamine use (B = 2.3; 95 % CI = 0.1 -4.2) were also associated with more ambivalence about whether to change. Participants who presented with an injury that was preceded by substance use were less likely to be taking steps to reduce their substance use compared to individuals who did not (B = -1.7; 95 % CI = -5.0- -0.6).
  
  
  CONCLUSIONS
  Findings suggest that brief interventions for this population should include a strong focus on building readiness to change substance use through motivational enhancement strategies. Findings also suggest that providing additional support to individuals with depression may enhance intervention outcomes.
  
  
  BACKGROUND
  This trial registered with the Pan African Clinical Trial Registry (PACTR201308000591418) on 14/07/2013.
authors.affiliation: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zyl Drive, PO Box 19070, Tygerberg, 7505, Parow, South Africa. bmyers@mrc.ac.za.|Department of Psychiatry and Mental Health, University of Cape Town, J block, Groote Schuur Hospital, Anzio Road, Observatory, 7935, South Africa. bmyers@mrc.ac.za.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Myers
authors.affiliation: Alan J Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa. clairevanderwest@gmail.com.
authors.forename: Claire
authors.initials: C
authors.lastname: van der Westhuizen
authors.affiliation: Western Cape Department of Health, 8 Riebeeck Street, Cape Town, 8001, South Africa. Tracey.Naledi@westerncape.gov.za.
authors.forename: Tracey
authors.initials: T
authors.lastname: Naledi
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, J block, Groote Schuur Hospital, Anzio Road, Observatory, 7935, South Africa. dan.stein@uct.ac.za.|Anxiety and Stress Disorders Unit, South African Medical Research Council, Francie Van Zyl Drive, Parow, 7505, South Africa. dan.stein@uct.ac.za.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.affiliation: Alan J Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa. katherine.sorsdahl@uct.ac.za.
authors.forename: Katherine
authors.initials: K
authors.lastname: Sorsdahl
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D062405:Motivational Interviewing / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods*; D013019:South Africa; D019966:Substance-Related Disorders / Q000534:rehabilitation*