P6 Willpower, identity, and negative attitudes may impede engagement with relapse prevention for patients with alcohol related cirrhosis

<h3>Introduction</h3> Abstinence from alcohol is of critical importance following a hospital admission with decompensated alcohol related cirrhosis. Despite this, a majority of patients relapse to alcohol and uptake of relapse prevention therapies is low. We sought to better understand this phenomenon by conducting in-depth interviews with patients. <h3>Method</h3> We conducted semi-structured interviews with patients with alcohol related cirrhosis during a hospital admission. Patients were recruited from two sites: a transplant centre and a district general hospital. We used a grounded theory approach. We used purposive sampling to identify patients with range of alcohol histories and demographics. <h3>Results</h3> We interviewed 33 patients with a mean age of 52 (range 30–69). 31% were female. Median UKELD score was 55 (range 46–75). 47% of the cohort were interviewed during their index admission with alcohol related cirrhosis and 78% were drinking alcohol at the time of admission. Many patients were reluctant to engage in relapse prevention therapies. At the point of interview, patients felt confident that the hospital admission would be a turning point and expressed a renewed personal commitment to abstinence. Having faced a life-threatening hospital admission, patients understood the risks of returning to alcohol and expressed confidence that fear would be a sufficient motivator to remain abstinent. There was a strong belief in willpower and personal determination as being the key determinants of long-term abstinence. In this context many viewed additional therapies as unnecessary. In addition, while some patients accepted that they were alcohol dependent, most rejected the lable ‘alcoholic’. Despite having developed advanced alcohol related liver disease, patients rationalised and contextualised their alcohol consumption, drawing on social norms to justify their previous alcohol use. Since they did not identify as having a substance dependence, they saw no need for relapse prevention therapies. Finally, many patients expressed negative attitudes or recounted negative experiences when dealing with alcohol services and relapse prevention groups. Common themes were: not wanting to talk about alcohol use, not wishing to interact with other service users, delays in accessing treatment, and experience or fear of stigma. <h3>Conclusion</h3> Following an episode of decompensation, patients understand the risks of returning to alcohol. However, high levels of self-confidence, a rejection of the alcoholic identity and negative attitudes to alcohol treatment combine to create a major barrier to engagement with relapse prevention therapies. Services should be redesigned to address these barriers.