Introduction: Alcohol misuse emerges from a complex range of psychopathological experiences and personal and cultural values. For this reason, understanding the reasons why a person seeks treatment is crucial to effective care. This study aimed to identify the values which guide the decision-making process of persons seeking voluntary hospitalization for treatment for alcohol misuse, as well as the values of significant others. Methods: A phenomenological investigation was conducted through interviews with 25 individuals (and family members) who had voluntarily admitted themselves to a hospital in São Paulo, Brazil, with the objective of maintaining abstinence from alcohol dependence. Results: The main factors that determined the treatment-seeking decision were damage to social relationships and fear of illness and deterioration of the physical condition; the factors related to treatment expectations were restoring personality and awareness of morbidity; and the single factor considered most important to the success of the treatment was willpower. Conclusions: The results of this study contribute to developing strategies for bringing care closer to the patient’s perspective of the disease and encourage their active participation in the formulation of care.

1.
World Health Organization
.
Global status report on alcohol and health 2018
.
Geneva, Switzerland
:
World Health Organization
;
2018
.
2.
Nutt
DJ
,
Gual
A
,
Anderson
P
,
Rehm
J
.
Why less is always more in the treatment of alcohol use disorders
.
JAMA Psychiatry
.
2019
;
76
(
4
):
359
60
.
3.
Connor
JP
,
Haber
PS
,
Hall
WD
.
Alcohol use disorders
.
Lancet
.
2016
;
387
(
10022
):
988
98
.
4.
Messas
GP
,
Fukuda
L
,
Pienkos
E
.
A phenomenological contribution to substance misuse treatment: principles for person-centered care
.
Psychopathology
.
2019
;
52
(
2
):
85
93
.
5.
Lieberman
DZ
,
Cioletti
A
,
Massey
SH
,
Collantes
RS
,
Moore
BB
.
Treatment preferences among problem drinkers in primary care
.
Int J Psychiatry Med
.
2014
;
47
(
3
):
231
40
.
6.
Fulford
KWM
.
The value of evidence and evidence of values: bringing together values based and evidence-based practice in policy and service development in mental health
.
J Eval Clin Pract
.
2011
;
17
(
5
):
976
87
.
7.
Sackett
DL
,
Straus
SE
,
Richardson
WS
,
Rosenberg
W
,
Haynes
RB
.
Evidence-based medicine: how to practice and teach EBM
. 2nd ed.
Edinburgh; London
:
Churchill Livingstone
;
2000
.
8.
Sadler
JZ
.
Values in psychiatric diagnosis and classification
. In:
Fulford
KWM
,
Davies
M
,
Gipps
RGT
,
Graham
G
,
Sadler
J
,
Stanghellini
G
,
, editors.
The oxford handbook of philosophy and psychiatry
.
Oxford
:
Oxford University Press
;
2013
. p.
753
79
.
9.
Stanghellini
G
,
Ballerini
M
.
Values in persons with schizophrenia
.
Schizophr Bull
.
2007
;
33
(
1
):
131
41
.
10.
Fuchs
T
.
Values as relational phenomena: a sketch of an enactive theory of value
. In:
Muhling
M
,
Gilland
DA
,
Förster
Y
, editors.
Perceiving truth and value: interdisciplinary discussions on perception as the foundation of ethics
.
Göttingen
:
Vandenhoeck & Ruprecht
;
2019
. p.
23
42
.
11.
Fulford
KWM
.
Vectors of best practice: an introduction to part III, practice
. In:
Stoyanov
D
,
Stanghellini
G
,
Van Staden
W
,
Wong
MT
,
Fulford
KWM
, editors.
International perspectives in values-based mental health practice: case studies and commentaries
.
Berlin
:
Springer Nature
;
2021
. p.
129
38
.
12.
Messas
G
.
The existential structure of substance misuse
. In:
A psychopathological study
.
Springer Nature
;
2021
.
13.
Fusar-Poli
P
,
Estradé
A
,
Stanghellini
G
,
Venables
J
,
Onwumere
J
,
Messas
G
,
.
The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics
.
World Psychiatry
.
2022
;
21
(
2
):
168
88
.
14.
The Lancet Psychiatry (Editorial)
.
The things themselves
.
Lancet Psychiatry
.
2021
;
8
(
3
):
169
.
15.
Messas
G
,
Fulford
KWM
.
A values-based phenomenology for substance use disorder: a new approach for clinical decision-making
.
Estudos de Psicologia
.
2021
;
38
:
e200102
.
16.
Fulford
KWM
,
Handa
A
.
New resources for understanding patients' values in the context of shared clinical decision-making
.
World Psychiatry
.
2021
;
20
(
3
):
446
7
.
17.
Messas
G
,
Fukuda
L
,
Fulford
KWM
.
The dialectics of altered experience: how to validly construct a phenomenologically based diagnosis in psychiatry
.
Front Psychiatry
.
2022
;
13
:
867706
.
18.
Fernandez
AV
.
Phenomenology, typification, and ideal types in psychiatric diagnosis and classification
. In:
Bluhm
R
, editor.
Knowing and acting in medicine
.
Lanham, MD
:
Rowman & Littlefield International
;
2016
. p.
39
58
.
19.
Klinke
ME
,
Fernandez
AV
.
Taking phenomenology beyond the first-person perspective: conceptual grounding in the collection and analysis of observational evidence
.
Phenom Cogn Sci
.
2022
. https://doi.org/10.1007/s11097-021-09796-1.
20.
van Emmerik-van Oortmerssen
K
,
Blankers
M
,
Vedel
E
,
Kramer
F
,
Goudriaan
AE
,
van den Brink
W
,
.
Prediction of drop-out and outcome in integrated cognitive behavioral therapy for ADHD and SUD: results from a randomized clinical trial
.
Addict Behav
.
2020
;
103
:
106228
.
21.
Copello
AG
,
Velleman
RDB
,
Templeton
LJ
.
Family interventions in the treatment of alcohol and drug problems
.
Drug Alcohol Rev
.
2005
;
24
(
4
):
369
85
.
22.
Bauer
S
,
Strik
W
,
Moggi
F
.
Motivation as a predictor of drinking outcomes after residential treatment programs for alcohol dependence
.
J Addict Med
.
2014
;
8
(
2
):
137
42
.
23.
Rubak
S
,
Sandbaek
A
,
Lauritzen
T
,
Christensen
B
.
Motivational interviewing: a systematic review and meta-analysis
.
Br J Gen Pract
.
2005
;
55
(
513
):
305
12
.
24.
Grekin
ER
,
Beatty
JR
,
McGoron
L
,
Kugler
KC
,
McClure
JB
,
Pop
DE
,
.
Testing the efficacy of motivational strategies, empathic reflections, and lifelike features in a computerized intervention for alcohol use: a factorial trial
.
Psychol Addict Behav
.
2019
;
33
(
6
):
511
9
.
25.
Fonsi Elbreder
M
,
Carvalho De Humerez
D
,
Laranjeira
R
.
Analysis of the obstacles related to treatment entry, adherence and drop out among alcoholic patients
.
Riv Psichiatr
.
2009
;
44
(
6
):
351
6
.
26.
McKay
JR
,
Hiller-Sturmhofel
S
.
Treating alcoholism as a chronic disease: approaches to long-term continuing care
.
Alcohol Res Health
.
2011
;
33
(
4
):
356
70
.
27.
Batra
A
,
Müller
CA
,
Mann
K
,
Heinz
A
.
Alcohol dependence and harmful use of alcohol
.
Dtsch Arztebl Int
.
2016
;
113
(
17
):
301
10
.
28.
Crowe
SF
,
Cammisuli
DM
,
Stranks
EK
.
Widespread cognitive deficits in alcoholism persistent following prolonged abstinence: an updated meta-analysis of studies that used standardised neuropsychological assessment tools
.
Arch Clin Neuropsychol
.
2019
;
35
(
1
):
31
45
.
29.
Sakiyama
HMT
,
de Fatima Rato Padin
M
,
Canfield
M
,
Laranjeira
R
,
Mitsuhiro
SS
.
Family members affected by a relative’s substance misuse looking for social support: who are they
.
Drug Alcohol Depend
.
2015
;
147
:
276
9
.
30.
Orford
J
,
Padin
MDFR
,
Canfield
MJ
,
Sakiyama
HMT
,
Laranjeira
R
,
Mitsuhiro
SS
.
The burden experienced by Brazilian family members affected by their relatives’ alcohol or drug misuse
.
Drugs Educ Prev Policy
.
2017
;
26
(
2
):
157
65
.
31.
Messas
G
.
Plea for using dialectical phenomenological psychopathology as an approach for substance-use disorders
.
Clin Neuropsychiatry
.
2021
;
18
(
4
):
185
7
.
32.
Messas
GP
,
Soares
MJRF
.
Alcohol use disorder in a culture that normalizes the consumption of alcoholic beverages: the conflicts for decision-making
. In:
Stoyanov
D
,
Stanghellini
G
,
Van Staden
W
,
Wong
MT
,
Fulford
KWM
, editors.
International perspectives in values-based mental health practice: case studies and commentaries
.
Berlin
:
Springer Nature
;
2021
. p.
163
70
.
33.
Tomes
N
.
The patient as a policy factor: a historical case study of the consumer/survivor movement in mental health
.
Health Aff
.
2006
;
25
(
3
):
720
9
.
34.
Hyshka
E
,
Karekezi
K
,
Tan
B
,
Slater
LG
,
Jahrig
J
,
Wild
TC
.
The role of consumer perspectives in estimating population need for substance use services: a scoping review
.
BMC Health Serv Res
.
2017
;
17
(
1
):
217
.
35.
Druss
BG
.
Do we know need when we see it
.
Psychiatr Serv
.
2007
;
58
(
3
):
295
.
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