Clinical insight level predicts successful quit or control attempts during the first three months of outpatient addiction treatment

Lambert L(1), Serre F(1), Thirioux B(2), Jaafari N(2), Auriacombe M(3).

Author information:
(1)University of Bordeaux, SANPSY, F-33076 Bordeaux, France; CNRS, SANPSY, UMR
6033, F-33076 Bordeaux, France; Pôle Interétablissement d’Addictologie, CH Ch.
Perrens and CHU de Bordeaux, F-33076 Bordeaux, France.
(2)Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation
régionale Pierre Deniker, Centre Hospitalier Henri Laborit, F-86000 Poitiers,
France; Université de Poitiers, CNRS 7295, Centre de Recherches sur la Cognition
et l’Apprentissage, 86021 Poitiers, France.
(3)University of Bordeaux, SANPSY, F-33076 Bordeaux, France; CNRS, SANPSY, UMR
6033, F-33076 Bordeaux, France; Pôle Interétablissement d’Addictologie, CH Ch.
Perrens and CHU de Bordeaux, F-33076 Bordeaux, France; Department of Psychiatry,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Electronic address: .

INTRODUCTION: Low clinical insight in psychiatry is defined as poor recognition
of one’s mental illness, including disability to self-evaluate symptom severity.
It has been reported as common in addiction and is associated with lower
treatment compliance. Longitudinal studies suggest that low clinical insight
could be linked to more relapse. However, association with successful quit
attempts remains unknown.

OBJECTIVE: Our objective was to examine the prospective link between baseline
clinical insight level and self-reports of successful attempts to quit / control
use during the first 3 months of outpatient addiction treatment.

METHODS: Participants were recruited from the ADDICTAQUI cohort at outpatient
treatment intake for substance or behavioral addictions. They completed a
baseline evaluation using the Addiction Severity Index (ASI), the Mini
International Neuropsychiatric Interview (MINI), and the modified Hanil Alcohol
Insight Scale (m-HAIS) with a follow-up ASI 3 months later. Data were analyzed
using multiple logistic regression and non-parametric tests.

RESULTS: Lower clinical insight level at baseline was associated with less
successful quit / control attempts during the first 3 months of outpatient
treatment compared to a higher clinical insight level, controlling for
sociodemographic factors, baseline addiction severity, and comorbidities (n = 54;
exp(B) = 0.76; p (FDRcor) = 0.033).

CONCLUSION: Poor clinical insight may be a barrier to treatment success, and
future studies should examine underlying mechanisms.

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