Note: Abstracts are arranged by the last name of first author. Conversion to a sortable database is in progress. To add an abstract to this list, please email chriscwagner@gmail.com with your abstract summary. Pleasee do not forward copyrighted abstracts unless you have permission to post these.
Abstracts are also categorized according to study type:
BOOK TREATMENT
MANUAL
CONCEPTUAL OTHER EMPIRICAL STUDY
TRAINING STUDY INSTRUMENT
DEVELOPMENT
CASE STUDY OUTCOME STUDY
PROCESS STUDY LITERATURE
REVIEW
Allsop,
S., Saunders, B., Philips, M., & Carr, A. (1997). A trial of relapse prevention with severely dependent male problem
drinkers. Addiction, 92, 61-74.
Regardless
of therapeutic approach, relatively poor outcomes are the norm in the treatment
of alcohol related problems. This report presents the results of a controlled
trial of a relapse prevention program with 60 male problem drinkers (ages
21-60) in an alcohol treatment facility in
Abstract by Patricia Juarez
OUTCOME
STUDY
Agostinelli,
G., Brown, J. M., & Miller W. R. (1995). Effects of normative feedback on consumption among heavy drinking
college students. Journal of Drug Education, 25, 31-40.
It
is widely recognized that alcohol consumption is related to serious and significant
problems for college students and young adults. For this reason, college
students are often the targets for preventive interventions on alcohol use. It
has been hypothesized that this problem stems from the fact that students fail
to recognize the risks and problems involved in alcohol consumption. They
usually overestimate the incidence of drinking among people their age, and
therefore, they don't perceive their behavior as abnormal, thus perpetuating
risky behaviors. In the present study, 64 college students identified as heavy
drinkers completed a survey on drinking behavior. Only 26 completed and
returned the questionnaires. These participants were then randomly assigned to
receive or not to receive mailed personal feedback on their drinking behavior,
in comparison with actual population data and norms. Those participants who
received the feedback reported drinking less and getting less intoxicated at
a
follow-up interview, than those who didn't receive the feedback. It was
therefore concluded that this type of impersonal intervention may indeed be
effective and inexpensive at reducing alcohol consumption and risky related
behaviors.
Abstract by Patricia Juarez
Amato, L., Davoli M., Ferri, M., Gowing, L. & Perucci, C. (2004), Effectiveness of interventions on opiate withdrawal treatment: an overview of systematic reviews. Drug and Alcohol Dependence, 73, 219-226
The aim
is to provide an overview of 5 Cochrane reviews of different approaches for
treating opioid withdrawal. It was
comprised of a narrative and quantitative summary of the findings of 46 studies
covering seven different comparisons.
Several conclusions could be drawn, however because much of the data was
heterogeneous in nature, it was difficult to incorporate it into quantitative
meta-analysis. Consensus in measurements
and results should be reached among researchers involved in the evaluation of
treatments for opiate addiction in order to produce consistent outcomes in the
measuring and reporting of results from clinical trials.
CONCEPTUAL
Treatment for alcoholism come in a variety of approaches that may go from brief
inpatient hospital treatment to outpatient detoxification programs. The present
article compares two community based detoxification programs: "social
setting" and "medical nonhospital." The
social setting detoxification program was designed for clients who did not need
intensive care, but that still required a supportive and structured
environment. On the other hand, the medical non hospital programs have medical
trained staff, and employ different treatment approaches. It was found that the
social setting programs are less expensive in the cost per bed, physicians and
drugs. But since the medical programs tend to elicit positive results in a
short amount of time, the overall costs per client are comparable.
Abstract by Patricia Juarez
CONCEPTUAL
Amrhein, p., Miller, W. Yahne, C., Palmer, M. & Fulcher, L. (2003). Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology, 71, 862-878.
Motivational interview (MI) sessions of 84 drug abusing clients were coded for strength of commitment language utterances. Cluster analyses allowed the division of participants into three outcome groups: those who maintained low levels of drinking throughout the study (maintainers) , those who decreased their drinking (changers), and those who failed to decrease their drinking (strugglers). Commitment strength language during a change plan was more common among maintainers and changers and was predictive of follow-up percent days abstinent.
Abstract by
Jennifer Hettema
CONCEPTUAL
Annis, H.M., Schober, R., & Kelly, E. (1996). Matching addiction outpatient
counseling to client readiness for change: the role of structured relapse
prevention counseling. Experimental
and Clinical Psychopharmacology, 4, 37-45.
Due to the widespread recognition in the addictions treatment field of the clinical importance of matching counseling techniques to the client’s readiness for change, the level of client motivation must first be considered before treatment. This article illustrates a cognitive-behavioral outpatient counseling program for substance abusers incorporating the following components: assessment, motivational interviewing, preparation of an individualized treatment plan, “initiation of change” counseling procedures, and “maintenance of change” counseling procedures”). The relationship of each of these components to Prochaska & DiClemente’s 5 stages of change (precontemplation, contemplation, preparation, action, and maintenance) is discussed. This article also describes a basic assessment tool for ascertaining the client’s stage of change, the Commitment to Change Algorithm. In addition, it emphasizes the difference between initiation and maintenance of change homework assignments in structured relapse prevention counseling.
Abstract by Julie Steele
CONCEPTUAL
Annis,
H. M., Schober, R., & Kelly, E. (1995). Matching addiction outpatient counseling to client readiness for
change: The role of structured relapse prevention counseling.
Experimental and Clinical Psychopharmacology, In
press.
It is
becoming of greater importance in the area of addiction treatment to recognize
the client's readiness for change and to match them to appropriate therapeutic
strategies. This idea was developed out of the recent definition of motivation
as a process of change in which people move back and ford from one stage of
change to another. This paper describes a comprehensive cognitive-behavioral
outpatient counseling approach for substance abusers. This program includes
five components: assessment, motivational interviewing, preparation
of an individual treatment plan, counseling procedures for the initiation of
change, and counseling techniques for the maintenance of change. Each of these
components are closely related and carefully matched to approach the five
stages of change described by Diclemente and Prochasta (1984), which are precontemplation,
contemplation, preparation, action and maintenance. The paper further describes
the Commitment to Change Algorithm (CCA), which is a measure designed to
identify the client's stage of change for alcohol and drug use. Therefore, it
is suggested that after an assessment of the clients' stage of change, they
should be matched to an individually tailored therapeutic approach which would
focus on helping each client move to higher stages of change. However, it is
acknowledged that clients may fall back to previous stages, and therefore,
appropriate strategies are suggested to cope with these situations. Finally,
the paper emphasizes the difference between the homework assignments in the
Structured Relapse Prevention (SRP) counseling for the "initiation/action" and the "maintenance" stages
of change.
Abstract by Patricia Juarez
CONCEPTUAL
Annis, H.M.,
Schober, R., & Kelly, E. (1996). Matching addiction outpatient counseling to client readiness for
change: The role of structured relapse prevention counseling. Experimental
and Clinical Psychopharmacology, 4, 37-45.
This
article describes a structured, comprehensive cognitive-behavioral outpatient
counseling program (SRP) for substance abusers consisting of 5 components:
Assessment, motivational enhancement, preparation of individualized treatment
plans, “initiation of change” counseling procedures, and “maintenance of
change” counseling procedures. The program includes use of the Inventory
of Drug-Taking Situations and homework forms for the initiation and maintenance
phases. SRP has been shown to “dramatically” reduce clients substance
use, work effectively in individual or group formats, work best with
individuals who use in specific situations or under specific conditions, and
good outcome is related to high confidence and good use of coping strategies.
OUTCOME STUDY – UNPUBLISHED
Aubrey Lawendowski, L.
(1998). Motivational interviewing with adolescents
presenting for outpatient substance abuse treatment (Doctoral dissertation,
University of New Mexico, 1998). Dissertation
Abstracts International, 59-03B, 1357.
Supported by a grant from NIAAA: Aubrey, L. L. (1995, March). Motivational induction for adolescents seeking treatment. NIAAA #1 R03 AA10648-01.Motivational Interviewing (MI) is a brief psychotherapeutic intervention to increase the likelihood of a client’s considering, initiating and maintaining specific change strategies to reduce harmful behavior. MI is founded on principles of motivational psychology, client-centered therapy and stages of change in natural recovery from addiction. MI treatment includes components common to most brief interventions for addictive behavior that have been empirically tested (Bien, Miller and Tonigan, 1993). This paper presents research evidence for the efficacy of MI, a description of the methods and goals of MI, the rationale for MI as an appropriate brief intervention for adolescents, and a specific application of MI to an adolescent sample.
Seventy-seven
youths (14 to 20 years old) presenting for outpatient substance abuse treatment
at The University of New Mexico’s Center on Alcoholism, Substance Abuse and
Addictions (CASAA) Adolescent Treatment Program consented to participate in
this study. After completing a lengthy assessment, participants were
randomly assigned to receive or not receive personalized MI feedback of
assessment results conducted in an empathic, nonjudgmental, objective and
supportive manner. All participants, regardless of study condition, were
strongly encouraged to attend at least one session with
their assigned CASAA program counselor. Three-month follow-up
interviews were completed for half of the study sample and CASAA records were
reviewed for the entire sample. Participants receiving the MI feedback
showed significantly better treatment engagement and outcome as well as significant
decreases in substance use. These findings are consistent with previous
research of MI with adult samples, and support the utility of this brief
intervention with adolescents with substance use problems.
CONCEPTUAL
Aubrey Lawendowski,
L. (1998). A motivational intervention for adolescent
smokers. Preventive Medicine, 27, A39-A46.
Motivational
interviewing (MI) is a brief therapeutic intervention designed to increase the
likelihood that a person will consider, initiate and maintain behavior change.
MI is based on principles of motivational psychology, client-centered therapy,
and stages of change. The MI approach is usually applied in 5 to 15 minute
sessions, but it can also take the form of Motivational Enhancement Therapy
(MET). The basic components that make MI effective include options for change,
feedback on personal risk and negative consequences, empathy and respect for
the client's individuality, enhancement of self-efficacy and personal
responsibility, and advice for change. The main goals of these
strategies is to elicit discrepancy between present behavior and future
goals and expectations, and to reflect self-motivational statements. Research
supporting the effectiveness of this approach is described in detail. MI can
be
a very useful approach to be used for adolescents with substance abuse
problems, who usually don't respond well to more long-term treatments, and who
tend to be more ambivalent and resistant about change. Interventions for
adolescents are therefore suggested to be brief (one or two sessions), take
into account the client's ambivalence, be empathic and supportive, include
personally relevant assessment and objective feedback, explore discrepancy,
offer a menu of alternatives for change, encourage self-efficacy and
responsibility, and select appropriate strategies based on the client's stage
of readiness for change. MET for adolescents should also include at least a
follow up session, within six weeks of the intervention, in order to reinforce
progress, collect outcome information and to conduct a booster motivational
session.
Abstract by Patricia Juarez
Baer, J.S., Marlatt, A.G., Kivlahan, D.R., Fromme, K.,
134 young
adult college students who had at least one alcohol-related problem, drank on
at least two days a week, and had blood alcohol levels of .10% were randomly
assigned to either a six week cognitive-behavioral, classroom format discussion
group, which utilized a simulation bar and placebo drinks, a six-week cognitive
behavioral self-help manual group, who read information and completed exercises
regarding alcohol use, or one session of individualized feedback and a
motivational interview (MI). Subjects in the MI condition had significantly
higher treatment exposure than the other two conditions, while the self-help
manual condition had significantly lower exposure. In fact, self help manual participants had
such low treatment exposure that they were not included in the analyses,
although, among those who were adequately exposed to the condition, no changes
in drinking were observed. Moth MI and
classroom format participants rated their programs as helpful and both groups demonstrated significant reductions in drinking which
were maintained throughout a two year follow-up. No significant differences on changes in
drinking were observed between the two treatment groups.
CONCEPTUAL
Baer, J. S., Kivlahan, D. R., & Donovan, D. M., (1999). Integrating skills training and motivational therapies. Implications for the treatment of substance dependence.
Journal of Substance Abuse Treatment, 17, 15-23.
This
article discusses how treatments for substance abuse and addictions would
benefit from integrating aspects of motivational therapy and skills training
approaches. These two approaches have recently received a lot of attention and
support in research, but they have not been described as an integrative
approach. The article first details the history, theoretical background, and
differences between these two strategies. The purpose of skills training is to
help clients learn and improve their coping skills. On the other hand,
motivational approaches attempt to increase and maintain people's motivation to
change, by helping them resolve the ambivalence about change with an empathic
therapeutic style. Both approaches share similar assumptions about addictive behaviors,
such that motivation is a crucial requisite prior and during behavior change,
that there are individual differences in the levels and nature of skills
necessary for behavior change, and that the degree of motivation and risk for
relapse vary during the course of treatment and everyday life. It is therefore
suggested that treatment for addictive behaviors should begin with an
assessment of both readiness to change and skills deficits. If these two
approaches were integrated, they could provide more flexibility for therapists
to better meet clients specific needs.
Abstract by Patricia Juarez
Baer, J., Kiviahan D., Blume, A. McKnight P. & Marlatt, G (2001). Brief intrvention for heavy-drinking college students: 4-year follow-up and natural history. American Journal of Public Health, 91, 1310-1316.
This
study examined long-term (4 years) response to an individual preventative
intervention session for high risk heavy-drinking college students. Results
suggest that participants receiving the brief intervention were more likely to
improve and less likely to worsen regarding negative drinking consequences.
Findings also indicated that much heavy drinking in college is transitory.
Baker, A., Boggs, T.G., & Lewin, T. (2001). Randomized controlled clinical trial of brief cognitive-behavioural interventions among regular users of amphetamine. Addiction, 96, 1297-1287.
In this
study, sixty-four regular amphetamine users were recruited from a needle
exchange program and randomized to receive either four sessions of cognitive
behavioral intervention including a motivational interview A(MI),
two sessions of cognitive behavioral intervention including a MI, or a
self-help booklet (control condition).
There was a great deal of variance in the number of sessions attended
and individuals in the two session condition attend a greater percentage of
sessions that the four session participants.
Amphetamine use fell significantly among all study participants. These
decreases were larger for intervention participants than control condition
participants but the differences were not statistically significant. However, rates of abstinence were
significantly greater for intervention subjects. Few differences were noted
between intervention groups.
Baker, A., Lewin, T., Reichler, H., Clancy,
R., Vaughan, C., Garrett, R., Sly, K., Devir, H., & Terry,
M. (2002). Evaluation of a motivational interview
for substance use within psychiatric in-patient services. Addiction, 97, 1329-1337.
Hospitalized psychiatric patients with comorbid substance use problems are under represented in research. In this study, 160 psychiatric inpatients with alcohol or drug use disorders were randomly assigned to receive either a brief session of motivational interviewing or were assigned to a brief advice control condition. Participant were then encourage to attend outpatient services. With the exception of marijuana use, both groups showed modest but significant reductions in most substance use areas, including symptom severity at three months, but no significant between group differences were observed. Few significant changes and no between groups differences were seen at later follow-up points, which extended to one year. It is suggested that brief interventions, such as MI may be less effective among highly dependent samples such as the one in this study.
Abstract by Jennifer Hettema
OUTCOME STUDY
Ball, S., Bachrach, K., DeCarlo,
J., Farentinos, C., Keen, M., McSherry,
T., Polcin D., Snead, N., Sockriter,
R., Wrigley,P., Zammerelli,
L. & Carroll, K. (2002), Characteristics, beliefs, and practices of
community clinicians trained to provide manual-guided therapy for substance abusers.
Journal of Substance Abuse Treatment, 23, 309-318.
The penetration of treatment manuals into standard clinical practice remains a major issue and researchers have begin to evaluate the awareness and attitudes of providers towards manuals. Sixty-six clinician participants completed training specifically developed for motivational interviewing and motivational enhancement therapy prior and were then randomly assigned to the treatment condition that they would be providing. Results of this study include clinical demographics and experience, counseling orientation and techniques, and clinician beliefs. In general, many of the clinicians reported beliefs and techniques that were consistent with their stated theoretical orientation and recovery status. Relatively few participants reported relying on one dominant orientation or set of techniques.
Abstract by Jennifer Hettema
OUTCOME STUDY
Barnett, N., Monti,
P. & Wood, M. (2001). Motivational interviewing for alcohol-involved adolescents in the
emergency room. Innovations in Adolescent Substance
Abuse Interventions, Wagner, E. & Waldron, editors, Kidlington,
In recent years clinicians and researchers have been more concerned with individuals who are at risk because of their use of alcohol. The authors describe their research with alcohol-involved adolescents in an urban trauma center, using motivational interviewing (MI) as a brief intervention approach. Motivational interviewing has shown great promise with adults and this study suggests that a brief MI when introduced at a “teachable moment” can be particularly effective in reducing a number of dangerous behaviors and consequences, including drinking and driving, injuries, alcohol-related injuries, and traffic violations for older adolescents. However, there are less convincing results with younger adolescents.
More research is needed in this
area.
Abstract by Jennifer Hettema
OUTCOME
STUDY
Barrowclough, C., Haddock, G., Tarrier, N., Lewis, S.W., Moring,
J., O’Brien, R., Schofield, N., & McGovern, J. (2001). Randomized controlled
trial of motivational interviewing, cognitive behavior therapy, and family
intervention for patients with comorbid schizophrenia
and substance use disorders.
American Journal of Psychiatry, 158, 1706-1713.
Despite the fact that the comorbidity of substance use disorders and schizophrenia is related to poorer outcome, few studies have investigated treatments directed at this population. In this study, hospital patients with these comorbid disorders were randomized, along with their existing caregiver, to receive either standard care, or standard care plus motivational interviewing (MI), cognitive behavioral therapy (CBT), and family therapy. Both interventions took place for nine months and the experimental group received five weeks of MI, and eighteen weeks of CBT, followed by six weeks of bi-weekly CBT. Promoting family response was encouraged throughout treatment and ten to sixteen sessions of family therapy were provided. The experimental group demonstrated significant improvement in general functioning compared to controls. In addition, significant reductions in positive symptoms and percent days abstinent were observed among integrated care participants.
Abstract by Jennifer Hettema
CONCEPTUAL
Barsky, A. & Coleman, H.
(2001). Evaluating
skill acquisition in motivational interviewing: The development of an
instrument to measure practice skills. Journal of Drug Education, 31,
69-82.
Within social work, and social
sciences in general, it is important that education increase competence.
Unfortunately, little work has been done evaluating competencies in substance
abuse interventions. This study was designed to teach and evaluate the use of
motivational interviewing (MI) among social work students. This study utilized
the
Abstract by Jennifer Hettema
Berg-Smith, S. M., Stevens, V. J., Brown, K. M, Van Horn,
L. Gernhofer, N., Peters, E., Greenberg, R., Snetselaar, L., Ahrens, L., & Smith K. (1996) A brief
motivational intervention to improve dietary adherence in adolescents. In press (Health Education Research).
Motivational
interviewing (MI) is a therapeutic technique that can be effective at
increasing clients' motivation, or readiness, to change problem health
behaviors. The components of this technique have been incorporated into a brief
therapy format for its use in health care settings, and it has been shown to
be effective for a wide range of behaviors. The present paper describes
a brief
motivational intervention designed to improve and renew dietary adherence with
adolescents in the Dietary Intervention Study in Children (DISC). It further
provides a description of DISC, reasons why this kind of intervention should
be
appropriate and effective for adolescents, and results from a preliminary
feasibility test. In the first phase of the study, 334 children (ages 8-13)
were given family-based group therapy to change their diets. During adolescence
(ages 13-17), 127 of these participants were given individual, brief motivational
therapy. The components of this intervention include: establishment of rapport,
opening statement, assessment of current eating behavior and progress,
feedback, assessment of readiness to change, tailored intervention, final
encounter, follow up sessions, and training of practitioners. It was found that
this intervention showed improvements in dietary adherence, it was also
acceptable for the participants, the practitioners liked it, and it seemed to
be an age-appropriate next step from a family intervention approach. The need
to evaluate the effects of the program against a control group is encouraged,
as well as further investigations with other health behaviors.
Abstract by Patricia Juarez
CONCEPTUAL
Berg-Smith, S.M. . Hypertension
Intervention Project. (Need more bibliographic record)
This training package was designed for training nurses in the Hypertension Intervention Project designed to help individuals reduce or eliminate high risk behaviors such as tobacco use, alcohol use, poor diet, and lack of exercise. The training manual describe the principles and guidelines of motivational interviewing (MI), describes intervention protocols for targeted risk factors. Also included is a training outline describing how effective training in MI might be conducted and exercises that might be used in such a training. MI and brief intervention resources are also offered.
Abstract by Jennifer Hettema
Bernstein, E., Bernstein, J., & Levenson,
S. (1997). Project ASSERT: An ED-based intervention to increase access to
primary care, preventive services, and the substance abuse treatment system.
Annuals of Emergency Medicine, 30, 181-189.
The purpose of the present study
was to investigate the effects and feasibility of Project ASSERT (Alcohol and
Substance abuse Services and Education providers to Refer patients to
Treatment), which is a program designed to increase the use of substance abuse
treatment, primary care and preventive services, for patients with drug and
alcohol related problems entering the emergency department. Patients were first
screened for alcohol or illicit drug problems and then referred for any service
required. Patients were then given a brief negotiated interview (BNI) based on
the stages of change model and the readiness to change construct. A total of
1096 participants were assessed on their number of referrals to the substance
abuse treatment system, self-reported satisfaction with and use of the
services, and self-reported frequency of drug and alcohol use between intake
and follow up (60 to 90 days). Those clients who returned for follow-up (n =
245) showed significant reductions in the severity of their drug problems, and
they used less alcohol. Furthermore, participants also expressed satisfaction
with the services, especially regarding their referrals for further treatment.
Due to the effectiveness of Project ASSERT, it was adopted by
Abstract by Patricia Juarez
OUTCOME STUDY
Bien,
T. H., Miller, W. R., & Boroughs, J. M. (1993). Motivational interviewing with alcohol outpatients. Behavioural and Cognitive Psychotherapy, 21,
347-356.
Therapist behavior can directly
affect clients' motivation for change. Motivation should be viewed as a result
of interpersonal processes rather than of personal characteristics. Other
studies have also showed that brief outpatient interventions can be successful
at reducing alcohol use and abuse among problem drinkers. This kind of
intervention involves aspects such as: objective feedback, acceptance of
personal responsibility, advice, menu of alternatives for treatment, empathy
and self-efficacy. The present investigation studied the effects of this kind
of brief intervention with 32 clients seeking treatment for severe substance
abuse. Participants were thoroughly assessed before being randomly assigned
either to the MI brief intervention or control group as a prelude to outpatient
alcoholism treatment. All participants in this study were considered to be
relatively severe alcohol abusers according to the Michigan Alcoholism
Screening test (MAST; Selzer, 1971). At the 3-moth
follow up, participants receiving the brief MI intervention showed significant
decreases in their total standard drinks, their peak alcohol levels and in
their percent days abstinent, relative to those in the control group who
received the outpatient treatment program. These results were further validated
by the reports of significant others. By 6-month follow up, no significant between-group
differences remained.
Abstract by Patricia Juarez
LITERATURE REVIEW
Bien,
T. H., Miller, W. R., & Tonigan, J. S. (1993). Brief
interventions for alcohol problems: A review. Addiction, 88, 315-336.
This
article summarizes findings of 32 studies investigating the effectiveness of
brief interventions for alcohol problems in general health care settings, with
self-referred drinkers, and in specialist treatment contexts. It further
attempts to identify those components that make this kind of intervention
successful. In general, this kind of brief motivational intervention focuses on
eliciting problem awareness and giving advice for change using an empathic
therapeutic style. Overall, brief motivational interventions have been found to
be relatively effective at reducing alcohol consumption and at motivating
clients to enter treatment, when compared with control or more long term
interventions. Brief motivational interventions represent a cost-effective
method for reducing alcohol consumption and/or for motivating clients to seek
further treatment for alcohol problems.
Abstract by Patricia Juarez
CONCEPTUAL
Bien, T. H.,
Miller,. W. R., &
Tonigan. (1995) Brief intervention: a reply to a
review. Response to a critique by Johnson et al. (1995), about review of brief
interventions for problem drinking (Bien, Miller & Tonigan, 1993).
The review includes several definitions for "brief" interventions, due to the variety of different interventions studied in the different articles reviewed, but still, brief interventions referred overall to interventions with 3 or fewer sessions. It is suggested that the confusion involves the distinction between counseling, follow-up or assessment sessions. It is then concluded that there is a lot of evidence for the effectiveness of brief interventions, and there are no differences between in the effectiveness of brief and more long-term interventions, but it still suggested that these techniques may be more appropriate for different patients. Furthermore, a question remains: Why does brief intervention or single assessment sessions work, and for whom?
Abstract by Patricia Juarez
Other Empirical Study
Bombardier, C. H., Ehde, D., & Kilmer,
J. (1997). Readiness to change alcohol
drinking habits after traumatic brain injury. Archives of
Physical Medicine and Rehabilitation, 78, 592-596.
The
goal of this study was to describe the level of readiness to change alcohol
use, and the factors that affect this motivation, in persons with recent
traumatic brain injury (TBI). 50 patients in an acute rehabilitation program
were surveyed on two main outcome measures: the Readiness to Change
Questionnaire (RTC), the Michigan Alcoholism Screening Test (MAST), and other
questions on frequency and quantity of alcohol consumption. Eighty percent of
the participants were found to be in the contemplation or action stage of
change. Compared to a general medical sample of heavy alcohol users, the TBI
patients showed a higher contemplation of change, and a higher readiness to
take action and change drinking behavior, which was hypothesized to be related
to the TBI. It was also found that in the TBI sample, a positive history of
alcoholism, involvement of alcohol in the accident, and a higher frequency of
alcohol use were associated with higher contemplation and therefore higher
readiness to change. It was concluded that after a TBI, drinkers usually
contemplate changing their drinking, which suggests that this is a good
opportunity to prevent further alcohol use, abuse and injury. The authors
finally suggest that Motivational Enhancement therapy may be an appropriate
intervention to encourage behavior change in this situations,
due to its nonconfrontational nature.
Abstract by Patricia Juarez
OUTCOME
STUDY
Borsari, B. & Carey, K.B.
(2000). Effects
of brief motivational intervention with college student drinkers.
Journal of Consulting and Clinical Psychology, 68, 728-733.
Undergraduate students who reported binge drinking during the previous month were randomized to either a control condition or a brief motivational intervention (MI), which included personal assessment of drinking behavior, norm comparisons, identifying negative consequences of drinking, investigation of expectancies, perceived risks and benefits of drinking, challenging misconceptions about drinking, and skills to facilitate decreases in drinking. Membership in the MI group predicted significant decreases in drinking quantity, drinking frequency, and binge drinking. These effects were mediated by the number of drinks students consumed per week, with those consuming large amounts experiencing less benefit from the MI intervention.
Abstract by Jennifer Hettema
CONCEPTUAL
Botelho, R. J., & Novak,
S. (1993). Dealing with substance misuse, abuse and
dependency. Primary Care, 20, 51-70.
The
present article describes a six-step model, with specific strategies in each
plan, for primary care clinicians to deal with the wide range of alcohol and
drug related problems. This model can be applied in private offices and in
hospital settings. The patient should be first screened for high risk drinking
and/or substance abuse, then assessed on their substance abuse related problems
and risks. Then patients should be given information on the results of this
assessment in order to educate the patients about the health risks associated
with their drinking and/or substance abuse. According to the seriousness of the
addiction problem, the physician can then select the most appropriate strategy
for the particular problem, help the patients become aware of the problem, and
negotiate a plan for change. Finally, the last step of the model is one or
several follow up visits in order to keep track of the patient and help him
keep moving forward on his/her recovery. This six-step model is based on
concepts derived from the transtheoretical model of
behavior change, brief interventions and motivational interviewing techniques.
The transtheoretical model of
change suggest that people go through several stages when changing a
behavior, and they can dictate the best approach to take with a particular
patient. These stages are precontemplation,
contemplation, preparation, action, maintenance and relapse. Research in the
area of substance abuse treatment has shown that early brief interventions can
be as or even more effective than more long term therapies. Finally,
motivational interviewing (MI) assumes that it is the patient's responsibility
to decide what changes he/she wants to do and how, and it is based on empathy
as the key strategy to help patients make these decisions. Specific guidelines
and case examples to apply and integrate the bases of these three constructs, are provided for each of the six steps of the
model.
Abstract by Patricia Juarez
CONCEPTUAL
Bowen, S.K. (2001). The motivational interviewer: Social simulation as
pedagogical technique. Dissertation.
This dissertation begins with a thorough discussion of Prochaska and DiClemente’s stages and processes of change, motivational interviewing (MI), and simulation gaming theory and research. The author created The Motivational Interviewer, a social simulation game to increase knowledge of stages of change and MI among twenty-five graduate psychology students. Students were randomized to either The Motivational Interviewer, an unrelated game, or a no game control group. The students were given a quiz prior to and following administration of the game to measure their stages of change and MI knowledge. Levels of quiz reliability and validity were also discussed. A trend towards increase in knowledge was observed among The Motivational Interviewer groups and the quiz seems to have acceptable levels of validity and reliability.
Abstract by Jennifer Hettema
CONCEPTUAL
Brady, M., Sibthorpe, B., Bailie,
R., Ball, S., & Summerdodd, P. (2002). The
feasibility and acceptability of introducing brief intervention for alcohol
misuse in an urban Aboriginal medical service.
Drug and Alcohol Review, 21, 375-380.
Although brief motivational interventions (MI) have been found to be effective at reducing alcohol use in general medical practices (GMPs) in many cultures, these finding have not been generalized to Aboriginal individuals. In this study, two randomized controlled pilot projects were conducted at GMPs with Aboriginal individuals. After training health care workers and general practitioners (GPs) in MI GMP clients were screened using the AUDIT. Participants found the instrument to be long, intrusive, and difficult to comprehend. The AUDIT was replaced with a screening measure which assessed drinking quantity and frequency. Although GPs were mixed on their perception of the effectiveness of training, twenty-five brief MIs were conducted and were deemed by GPs to be culturally appropriate and helpful. Health care workers on the other hand were more resistant to administer MIs. Specific cultural barriers to the administration of MIs are discussed.
Abstract by Jennifer Hettema
CONCEPTUAL
Bradley, K., Amee, J., Bush, K., Sporleder, J., Dunn, C., Cochran, N., Braddock, C., McDonell, M. & Fihn, S. (2002)
Alcohol-related discussions during general medicine appointments of male VA
patients who screen positive for at-risk drinking. Journal of General Internal
Medicine, 17, 315-326.
47 male VA patients who screened positive for at-risk drinking were enrolled in 1 of 2 firms in the clinic (intervention or control), Appointments with these patients were taped over six months. Intervention providers were most likely to discuss alcohol use with their patients. Research over the past two decades suggests that patient centered non-confrontational interventions are most effective at promoting behavior change. While confrontation was rarely observed, important elements of effective brief interventions were missing from many alcohol –related discussions.
Abstract by Jennifer Hettema
OUTCOME STUDY
Brown, J. M., & Miller, W. R.
(1993). Impact of motivational interviewing on
participation in residential alcoholism treatment. Psychology of
Addictive Behaviors, 7, 211-218.
Motivational
interviewing (MI) is a therapeutic approach originally designed to increase
people's motivation to seek and remain in treatment. This study investigated
the effects of this approach as a preparation for inpatient alcoholism
treatment in a private psychiatric hospital, and also tested a new measure of
client treatment expectations. 28 clients entering an inpatient substance abuse
treatment program were assessed and then alternately assigned to receive or not
receive an MI intervention, in addition to receiving a standard treatment
protocol and a 3-month follow up interview. Patients who received MI sessions
were judged by therapists to be more engaged in treatment, and showed a
substantially larger decrease in alcohol use 3-months after discharge. Client
treatment expectations also influenced the final outcome of therapy. At the
beginning of treatment, clients were asked to indicate (via questionnaire) what
items they wanted from treatment. Then after treatment they were asked what
items they had actually received during treatment. Better treatment outcomes
were predicted by the extent to which clients received what they said they
wanted. The extent to which clients were given other components, which they had
said they did not want, was unrelated to outcomes. This study provides further
support for the effectiveness of brief feedback and motivational interventions
in increasing treatment involvement and improving treatment results.
Abstract by Patricia Juarez
CONCEPTUAL
Brown,L. &Lourie, K.
(2001). Motivational interviewing and the prevention of HIV
among adolescents. In P.M Monti, S.M Colby, & T.A. O’Leary (Eds.): Adolescents,
Alcohol, and Substance Abuse
Reaching Teens through Brief Interventions.
Adolescent sexual risk behavior and substance use are related to the majority of adolescent morbidity and mortality. The authors compare and contrast motivational methods used to prevent HIV (motivational interviewing, collaborative techniques, and brief delivery). Specific strategies to increase perceived susceptibility with accompanying case studies are presented. More studies are needed to examine the advantages and limitations of integrating motivational methods and the social learning approach in order to enhance HIV prevention techniques.
Abstract by Jennifer Hettema
OUTCOME
STUDY
Budney, A.J., Higgins, S.T., Radonovich, K.J., & Novy,
P.L. (2000). Adding
voucher-based incentives to coping skills and motivational enhancement improves
outcome during treatment for marijuana dependence. Journal of Consulting and
Clinical Psychology, 68, 1051-1061.
Sixty individuals seeking treatment for marijuana dependence were randomly assigned to either a motivational enhancement (M) group, which included four sessions of feedback and motivational interviewing (MI), an M plus behavioral coping-skills therapy (MBT) group, which included one session of MI and thirteen sessions of behavioral therapy, or a MBT plus voucher (MBTV) group, which added monetary value vouchers as an incentive for negative drug screens. No significant between group differences were found in levels of acceptability and attrition. Levels of continuous abstinence, duration of abstinence, end of treatment abstinence, and Alcohol Severity Index Drug composite scores were all significantly better among MBTV participants than M or MBT participants following treatment. No significant differences were observed between M and MBT participants.
LITERATURE REVIEW
Burke, B.L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843-861.
This meta-analysis of motivational interviewing (MI) compared individual based controlled trials. Thirty studies examining drug use, drinking, diet, exercise, smoking, and HIV-risk behaviors were included. Effect sizes were calculated on all studies and it was found that, when compared to no-treatment placebo groups, MI had significant effects sizes in the areas drug, diet, and exercise, but produced virtually no effects in the areas of smoking and HIV-risk behaviors. In addition, no significant effect sizes were found when comparing MI to other established treatment techniques. Additional analyses were conducted to determine whether MI has sustained efficacy at distal follow-up points and no significant differences were observed between early and late follow-up point effects sizes. Within group effect size measures and qualitative data seem to suggest that MI does have a clinical impact, as those who receive seem to improve. In addition, poor methodological quality and high treatment dose may be predictive of positive outcome measures.
536
cigarette smokers visiting general practices were randomized to receive either
motivational interviewing (MI) or brief advise during
one consultation. The MI participants were encouraged to find arguments for
change and set meaningful goals, while the brief advise
participants were told that they must give up smoking to avoid serious future
health problems. Participants in the MI conditions were significantly more
likely delay the first cigarette of the day, make an attempt to quite lasting
more than two weeks, Many other differences in favor
of the MI condition approached, but did not reach significance. A significant interaction between condition,
outcome, and clinician rating of readiness to quit was found, with those rated
as less ready to quit performing better in the MI condition. However, cost
effectiveness evaluations revealed that MI did not perform significantly better
enough to merit its increased cost over brief advice.
Abstract by Jennifer Hettema
CONCEPTUAL
Carey K. (1996). Substance use
reduction in the context of outpatient psychiatric treatment: a collaborative,
motivational, harm reduction approach. Community Mental Health Journal,
32: 291-306.
This
article describes a model of reducing substance use through psychiatric
outpatient treatment that is based on the intensity of treatment, stage of
change, motivational psychology, and harm reduction concepts. Carey
describes five steps of treatment, including establishing a working alliance,
helping the client to evaluate the costs and benefits of continued substance
use, setting individualized goals, creating a lifestyle that can support
abstinence, and coping with crises. The model depends upon a primary
therapist or case manager who can coordinate these steps of treatment, and
draws heavily from practical experience, as well as the research showing the
importance of considering the client’s readiness and motivation to change, and
personal values. The article provides an example of adapting
theoretically based treatments to a typical community mental health setting
where dual diagnosis is the norm.
OUTCOME
STUDY
Carey, K., Carey, M., Maisto, S. & Purnine, D. (2002) The feasibility of enhancing psychiatric outpatients’ readiness to change their substance use. Psychiatric Services, 53, 602-608.
Patients with comorbid mental illness and substance use disorders often have low readiness to change their substance use. In this study, patients seeking treatment for schizophrenia or bipolar disorder with comorbid substance use received four sessions of motivational interviewing in a harm reduction context that included feedback, a decisional balance, goal exploration, readiness rulers, and development of a change plan. Participants were assessed pre and post intervention and at a three month follow-up point. Patients had favorable impressions of the intervention and tx retention was good. In addition, participants increased their readiness to change. At post-intervention, participants did not decrease their quantity of use, but more were abstinent. Most of these paients, however, were not retained for a three month follow-up.
Abstract by Jennifer Hettema
Carey, M., Maisto, S.M.,
102
women at high risk for HIV were recruited from a community-based organization
serving largely ethnic-minority and financially disadvantaged individuals. Subjects were randomly assigned to a
motivational interviewing (MI) group or a wait-list control group. The MI
intervention was four sessions long, followed a group format, and included some
traditional skill training components.
All participants were assessed after the intervention and at a
three-month follow-up point. Results indicated that communication with
partners, substance use before sex, and use of protection during vaginal sex
were significantly better among the MI group post intervention, but not at
follow-up. In addition, significant
differences between groups in favor of the MI condition were found at
post-intervention and follow-up for HIV-related knowledge, risk perception,
behavioral intentions.
Abstract by Jennifer Hettema
Carey, M., Braaten, L.S.,
This study is an extension of a previous study which found HIV risk behavior improvements among women exposed to a motivational interviewing (MI) intervention that also included some skill training components when compared to wait list control participants. In this study, the MI intervention was compared to a structurally equivalent health promotion group which focused on stress, anger, nutrition and breast health. Women were recruited from a community-based organization serving largely ethnic-minority and financially disenfranchised individuals at assessed at intake, post intervention, and at a three month follow-up point. Levels of HIV knowledge and behavioral intention improved for MI participants but not for control participants.
CONCEPTUAL
Carpenter, K.M., Watson, J.M., Raffety, B., Chabal, C. (2003). Teaching brief interventions for smoking cessation via an interactive computer-based tutorial. Journal of Health Psychology, 8, 149-160.
Health care providers are encouraged to intervene with patients who use tobacco, but lack of training is a barrier for such interventions. In this study, a computer-based program was designed to train health care providers to use a motivational interviewing strategy in helping clients move towards increased readiness to change their smoking habits. The program was designed to be interactive, by requesting information from the clinician, and then tailoring appropriate feedback and lessons. Two pilot studies were conducted to determine clinician perspectives on the effectiveness of the training program and improvements in clinical knowledge. Overall, health care professionals who used the program improved in general MI knowledge, learned specific techniques, and reported enjoying the program.
Abstract by Jennifer Hettema
CONCEPTUAL
Carroll, K.M.,
Farentinos, C.,
A
significant gap exists between treatment research and practice
in the substance abuse field, as many research findings fail to be
implemented in clinical practice. The Clinical Trials Network was designed to
help bridge this gap by developing research with previously demonstrated
efficacious treatment within community treatment programs. Motivational interviewing (MI) is one such
treatment protocol and this article discusses the rationale for evaluating MI
in CTN in addition to design and training challenges and strategies. While MI had strong empirical support, little
research has been conducted in community clinical settings and some question
whether the technique could be appropriately applied by clinicians in these
organizations and, if so, what type of training and supervision might be
necessary. Other methodological concerns
include, whether to study MI as an initial adjunct to treatment or as a
stand-alone treatment of its own, whether it should be delivered in a group of
individual format.
Channon, S. Smith, V. & Gregory, J (2002). A pilot study of motivational interviewing in adolescents with diabetes. Arch Dis Child, 680-683.
Twenty-two
patients, ages 14-18
and diagnosed with diabetes participated in this study for a
period of six months. The
effectiveness of motivational interviewing (MI) as a counseling technique
toward behavioral change was addressed.
Results suggest that MI has the potential to improve glycaemic
control in adolescents with diabetes.
Emotional improvements were also noted.
Respondents indicated a reduction in fear of hypoglycaemia
and reported that they had come to think about their diabetes more positively
over the duration of the study.
This research examines the efficacy of integrating brief motivational treatment prior to the onset of other treatment strategies for problem drinkers in a large, private-practice-model, behavioral health clinic. The participants (N = 256) were exposed to a Drinking Check-Up (DCU) program with emphasis on a brief treatment including facilitating client treatment goals, motivational interviewing, screening and assessment, feedback/treatment planning, and check-ups. A process and outcome evaluation was then administered to all eligible DCU clients over a seven year period that encompassed: a detailed description of all clients enrolled in the DCU; a description of client utilization of DCU and other program services; and, a preliminary outcome evaluation of DCU participants. 98% of DCU clients who completed the initial screening and assessment also attended the feedback/treatment planning. 59% attended at least one check-up and 36% attended at least two check-ups. Moreover, the majority reported abstinent or light/moderate current drinking, few alcohol-related negative consequences, a low rate of re-entry into alcohol and/or psychiatric treatment since DCU, and the majority expressed satisfaction with the DCU services.
Colby, S.M., Monti, P.M., Barnett, N.P., & Rohsenow, D.J. (1998). Brief motivational interviewing in a hospital setting for adolescent smoking: A preliminary study. Journal of Consulting and Clinical Psychology, 66, 574-578.
Cigarette smoking is a very problematic phenomenon among youth. In this study, forty adolescent smokers were recruited from a hospital setting and randomized to a motivational interviewing (MI) or brief advice condition. The MI group received a thirty-minute intervention which included individualized feedback, empathetic, reflective listening, and help participants identify goals for behavior change. Brief advices participant were told to quit smoking and given an informational pamphlet. Although no significant differences were found between the groups on levels of abstinence, nicotine dependence, smoking rate, serious quit attempt,, both groups significantly improved their smoking outcomes and effect sizes were larger for MI participants.
CONCEPTUAL
Corcoran, J. (2002). The transtheoretical stages of change model and motivational interviewing for building maternal supportiveness in cases of sexual abuse. Journal of Child Sexual Abuse, 11-17.
The
non-abusing parents of sexually abused children play an important role in their
children’s recovery, but are often ambivalent in their feelings regarding the
event. This article describes the transtheoretical stages of change model and motivational
interviewing and applies these concepts to aiding mothers move towards behavior
that most facilitates their children’s recovery. Specific stages of change that may be
observed among such mothers and specific strategies for moving them toward
positive change are offered. Lastly, a
case application is offered to demonstrate the use of these strategies and
skills
OUTCOME STUDY
Cordova, J.V., Warren, L.Z., & Gee, C.B. (2001). Motivational interviewing as an intervention for at-risk couples. Journal of Marital and Family Therapy, 27, 315-326.
Marital distress is a significant stressor that has serious psychological and physical consequences. In this study, thirty-one couples at risk couples were administered a “Marriage Check-up” (MC) a two-session intervention modeled after Miller’s Drinker’s Check-up, that gives assessment and individualized feedback using motivational interviewing approaches. Participants were administered questionnaires assessing marital satisfaction and adjustment before and after treatment and compared to non-distressed comparison group. Overall, marital satisfaction score improved after the intervention and the intervention group was much more similar to the non-distress comparison group following the intervention.
Abstract by Jennifer Hettema
CONCEPTUAL
Cowley,
C.B.,
Farley, T., & Beamis, K. (2002). “Well, maybe I’ll try the pill for
just a few months….” Brief
motivational and narrative-based interventions to encourage contraceptive use
among adolescents at high risk for early childbearing. Families, Systems & Health,
20.
This pilot study recruited 40 young, adolescent females seeking reproductive health services and were at increased risk of becoming pregnant either due to their desire for pregnancy or their ambivalence about using contraceptives. All of these individuals were exposed to Motivational Interviewing (MI) and Narrative Therapy with the goal of encouraging short-term contraceptive use among these adolescents. The mean number of sessions were two and the average length of follow-up was 10.3 months. More than 1/3 of the individuals eventually initiated a hormonal method of contraception due to various concerns such as their partner’s intentions, their own capabilities as a mother, need for treatment of other reproductive problems, or an meaningful conversation with an important adult in their life.
Abstract by Julie Steele
Daley, D. C., Salloum,
The
purpose of the present pilot study was to investigate the effects of a modified
version of an individual and group motivational therapy intervention on
treatment adherence and completion among 23 outpatients diagnosed with
depression and cocaine dependence. After being stabilized with antidepressants
and discharged from a psychiatric dual diagnosis unit, patients were assigned
to either motivational therapy or regular treatment during the first month of
outpatient treatment. The motivational intervention was based on the
motivational interviewing strategies described by Miller and colleagues, which
are primarily designed to increase patients' internal motivation for change.
Patients assigned to the motivational therapy reported more days of sobriety,
showed an improvement of mood, attended to more treatment sessions during the
first month, completed more 30 and 90 days of outpatient treatment, and had
fewer psychiatric rehospitalizations and days in the
hospital during the first year of being in outpatient treatment. It was
therefore concluded that combining individual and group motivational therapy
sessions for the treatment of depressed and cocaine dependant patients is a
promising alternative for improving treatment adherence and completion.
Abstract by Patricia Juarez
CONCEPTUAL
Individuals with comorbid psychiatric and substance use disorders are much less likely to enter, comply with, or complete outpatient treatment after an initial inpatient stay. Several strategies have been developed to improve outpatient treatment entry and compliance, including motivational interviewing (MI) prior to discharge from inpatient treatment. The authors describe the steps involved in conducting such a MI and report that following such an interview twice as many clients attend their first outpatient session. In addition, the MI intervention improves treatment compliance.
Abstract by Jennifer Hettema
BOOK
This
comprehensive, concise, and practical book integrates extensive clinical
experience and an exhaustive review of the psychiatric and addictions
literature on compliance-related issues, to help counselors, therapists, and
other treatment professionals engage and keep clients in treatment while
enhancing their motivation to actively participate in the process of change.
The book, written in a style both clear and accessible, and rich in clinical
examples and sample dialogues, is organized into three parts. Part I (pages
1-48) provides the overview, describing types of compliance problems, factors
that affect compliance, and the effects of limited compliance on clients,
family members, and treatment providers. Part II (49-102) presents a menu of
counseling and systems strategies to improve compliance. Part III (103-216)
builds explicitly on the foundation of motivational interviewing to describe
specific, semi-structured interventions for helping clients to enter outpatient
treatment, make the transition from residential or inpatient facilities to
aftercare, and actively and consistently participate in treatment during the
first, crucial weeks.
Abstract by Allen Zuckoff
In this
randomized clinical trial, 80 incarcerated Veterans with a diagnosed substance
use disorders were randomly assigned to a control condition or a brief
motivational interview (MI) feedback session. All participants received an
assessment including the Addiction Severity Index, the Form-90 and several
other measures of use related variables, readiness to change, general
intellectual functioning, and neuropsychological functioning five to thirty
days before their schedule release date. Individuals in the MI session then
received a feedback session an average of twelve days before their
release. Following release, participants
in the MI condition were significantly more likely to schedule a substance use
treatment appointment and be retained in treatment a three-month follow-up.
Abstract by Jennifer Hettema
Dench, S. & Bennett, G. (2000). The impact of brief motivational intervention at the start of an outpatient day programme for alcohol dependence. Behavioural and Cognitive Psychotherapy, 28, 121-130.
Motivation for change has been identified as an important part of treatment. In this study, 60 individuals attending a day program for the treatment of alcohol dependence were randomized to receive either thwo sessions of motivational interviewing (MI) or an educational control intervention. Results indicated that MI participants significantly increased their problem recognition, while this factor decreased for control participants. In addition, MI participants had significantly less ambivalence, more problem recognition, and were taking more steps than control participants, as measures by the SOCRATES. However, no groups differences were found for treatment drop out rates or number of day participants attended treatment.
CONCEPTUAL
DiClemente, C.C., Marinilli, A.S., Singh, M., & Bellino, L.E. (2001). The role of feedback in the process of health behavior change. American Journal of Health Behavior, 25, 217-227.
Feedback is pervasive in our environment and an essential biological phenomenon. In addition, health care professionals often use feedback in behavioral interventions, but feedback varies in its quality and quantity. In this article, DiClemente reviews a taxonomy of feedback types including generic (general information relevant to the population), targeted (adapting material to adjust to participant characteristics), and personalized (providing personal information based on participant assessment). Possible mechanisms of action by which these feedback types may operate are also discussed. It is argued that all three types of feedback likely influence behavior through education, by motivating clients, by changing attitudes and beliefs, by providing a relationship of support, by offering comparisons, by increasing engagement, and by providing critical risk and skill information. The use of feedback in areas of alcohol abuse, smoking, and nutrition are discussed.
LITERATURE
REVIEW
Digiuseppe,
R., Linscott, J., & Jilton,
R. (1996). Developing the therapeutic alliance in
child-adolescent psychotherapy. Applied & Preventive Psychology, 5,
85-100.
Research
in the area of child and adolescent psychotherapy is scarce in comparison to
research in adult psychotherapy. This article reviews the literature on the
therapeutic alliance in child-adolescent psychotherapy, and suggests research
strategies and techniques to develop this alliance with these populations. A
positive therapeutic alliance is that in which there is a warm bond and an
agreement between client and therapist on what is hoped to be achieved during
therapy. However, most types of psychotherapy are targeted for self-referred
clients in the contemplative or action stage, and the majority
of young people are not self-referred for treatment and are usually in
the precontemplative state of change. This in turn
makes the development of the therapeutic alliance, and mainly the agreement on
the goals of therapy, harder for these populations. The agreement on
therapeutic goals may be attained if self-evaluation skills are taught and
strengthened in child and adolescent clients, taking into account their
particular developmental stage. The social problem-solving literature, the
emotional script construct in the sociology of emotions, strategic family
systems, and the concepts of motivational interviewing (MI) may help therapists
understand the change processes as applied to the particular characteristics
of
children and adolescents, and therefore to use age appropriate therapeutic
strategies to develop this therapeutic alliance. The main goal of these
strategies is basically to help the clients evaluate the consequences of their
behavior and the consequences of other alternatives. Thus, when the therapist
attempts to achieve the therapeutic alliance, he/she can demonstrate a respect
and concern to the client that they may have not experienced before.
Abstract by Patricia Juarez
CONCEPTUAL
DiLillo, V., Siegfried,
N.J., & Smith West, D.
(2003).
Incorporating motivational interviewing into behavioral obesity
treatment. Cognitive and Behavioral
Practice 10, 120-130.
Many individuals struggle with either initial weight loss or the maintenance of weight loss when using a comprehensive behavioral weight loss program, even though it has proven effective for others. Therefore, it is surmised that the addition of a theory based strategy may enhance the effectiveness of weight loss when used in conjunction with a behavioral program. This article discusses the essentials of Motivational Interviewing (MI) and gives specific examples of applications within a behavioral weight control program.
Abstract by Julie Steele
Donovan, D., Rosengren,
D.,
Attrition prevention with individuals awaiting publicly funded drug treatment. Addiction 96,
1149-1160.
654
substance abusers participated in a study to evaluate the effectiveness of a
motivational intervention (MI) designed to reduce attrition from a waiting list
for publicly funded drug abuse treatment. In an attempt to reinforce the
initial decision to seek treatment, the MI focused on the nature and extent of
the individual’s substance abuse problem, the negative consequences resulting
from it, and the need for help in a variety of areas of life functioning,.
While substance abuse and psychosocial functioning improved at three month
follow-up, long term results indicated that MI did not enhance treatment entry,
completion, or outcome for those substance abusers.
LITERATURE
REVIEW
Draycott,
S., & Dabss, A. (1998). Cognitive
dissonance 1: An overview of the literature and its integration into theory and
practice in clinical psychology. British Journal of Clinical Psychology, 37,
341-353.
One of
the recent concerns in clinical psychology is that experimental research is not
reaching actual clinical practice. The present article presents a review of the
literature on cognitive dissonance and its possible applications in clinical
psychological therapies and practice. In summary, the literature supports the
idea that creating inconsistencies in individuals has an impact on attitudes
and behavior, that can not be explained by other
theories. This state of cognitive dissonance usually lasts for a few minutes
but it is argued that its effects can have effects that can last for up to two
weeks, and that can be easily back if this dissonance is made to be salient
again. It is suggested that the effects of dissonance on behavior are due to
the individual's attempts to restore consistency, response which may vary in
terms of salience and difficulty or cost. Therefore, it is suggested that this
construct may provide important insights into the strategies and mechanisms of
therapies, and to the development of more effective interventions to promote
behavior change.
Abstract by Patricia Juarez
CONCEPTUAL
Draycott,
S., & Dabbs, A. (1998). Cognitive
dissonance 2: A theoretical grounding of motivational interviewing. British
Journal of Clinical Psychology, 37, 355-364.
The goal
of the present article is to show how the concept of cognitive dissonance can
be applied in the area of clinical psychology, especially by explaining how it
may form the main theoretical basis of Motivational Interviewing (MI). The
authors further suggest that explaining how MI works, through the concepts of
cognitive dissonance may provide a better understanding of the processes of
change that MI promotes. The article presents a matching of the cognitive
dissonance constructs, to the principles of MI, in order to identify areas
where MI interventions may be improved or modified. It is concluded that the
main goal of MI, in terms of cognitive dissonance theory, is to produce a
dissonant state and then to control the direction of the response to it. The
authors suggest that there are still several aspects of cognitive dissonance theory, that could improve the MI style and make it even
more effective at producing behavior change. These aspects are a visual record
of consistent and inconsistent cognitions to emphasize the dissonance further,
maximizing dissonance by reinforcing self-motivational statements, the
awareness of the different possible client responses to dissonance, immediate
therapist responses to the dissonant state, and greater structure of the
sessions. In conclusion, the concept of cognitive dissonance can be useful in
the theory and practice of clinical psychology in general.
Abstract by Patricia Juarez
Dunn, C.W. & Ries, R. (1997). Linking substance abuse services with general medical care: Integrated, brief interventions with hospitalized patients . American Journal of Drug and Alcohol Abuse, 23, 1-13.
Individuals among general hospital populations have increased rates of substance use disorders and brief interventions have been found to be effective in this setting. In this study, four substance abuse counselors were assigned to work in varying services of a general hospital setting and patients with suspected substance use disorders were referred to them by hospital staff. The 363 referred patients received assessment, feedback, and referrals in a brief motivationally based intervention. 95% of the sample received a diagnosis of abuse or dependences, 62% had received professional treatment in the past, and 21% were currently receiving treatment. While motivation to change did not increase at a one to two week follow-up point, rates of treatment attendance did increase.
CONCEPTUAL
Dunn, C. (2003). Brief motivational
interviewing interventions targeting substance abuse in the acute care medical
setting. Seminars in Clinical
Neuropsychiatry, 8, 188-196.
Forty seven percent of hospitalized injury survivors in trauma centers are alcohol-positive and over 24% are suffering from alcohol dependence, and although the rates are unknown, the use of other drugs of abuse are also very high. A previous study found that when brief interventions are provided by trauma centers for substance use, drinking and injury recidivism is reduced for up to 1 year after discharge. This article provides the following: an explanation of the reasons for and the theoretical underpinnings of brief interventions in the trauma center setting; a literature review on the outcomes of brief interventions for substance abuse in general medical settings and trauma centers; and a description of a level 1 trauma center’s screening and use of motivational interviewing that has been used for over a decade and evaluated in a randomized trial, including the protocols used and the specific clinical challenges it faced.
LITERATURE
REVIEW
Dunn, C., Deroo, L., & Rivara, F.P. (2001). The use of brief interventions adapted from motivational interviewing across behavioral domains: A systematic review. Addiction, 96, 1725-1742.
A
systematic review of 29 randomized trials of MI interventions was conducted to
assess the effectiveness of motivational interviewing in four behavioral
domains: substance abuse, smoking, HIV risk, and diet/exercise. Effect sizes and confidence intervals for all
outcomes and at all follow-up points were calculated. Overall, 17 of the 26
analyzed studies had a least one significant effect size that favored MI. The largest and smallest behavioral domain
effect sizes were in diet/exercise and smoking respectively. Between group length
of follow-up variance was not significantly related to effect size, while
within group differences were more mixed. Lastly, training time and MI
treatment duration means, interactions between client characteristics and outcomes,
and change in treatment readiness are discussed.
CONCEPTUAL
Dunn, L.S. (2003). Motivating health: Strategies for the nurse practitioner. Journal of the American Society of Nurse Practitioners, 15, 200-205.
Nurse practitioners frequently have contact with patients in need of health behavior change. Principles from the transtheoretical model of change and motivational interviewing may be helpful strategies for these health care professionals. This article describes the transtheoretical stages of change and components of motivational interviewing in the context of nurse practitioner health care Issues such as building rapport, rolling with resistance, assessing readiness, and exploring ambivalence are discussed and helpful suggestions and practical examples are offered.
Abstract by Jennifer Hettema
Emmons, K., Hammond S., Fava, J., Velicer, W., Evans, J. & Monroe,
A. (2001) A randomized trial to reduce passive smoke exposure in low-income
households with young children. American
291
smoking parents/caregivers of children who were younger than three years of age
were studied to determine whether a motivational intervention would lead to
reduced household passive smoke exposure for the children in those homes. One group received motivational intervention
(MI) and the other group was given a self-help program. Results indicated that nicotine levels were
significantly lower over time in MI households.
Nicotine levels for the SH group 9increased, but were not significantly
different from the baseline.
Abstract by Jennifer Hettema
CONCEPTUAL
Emmons, K. & Rollnick. (2001). Motivational
interviewing in health care settings. American Journal of Preventative
Medicine, 20, 68-74.
The
purpose of this paper is to provide the background of motivational interviewing
(MI) and to identify and discuss the key issues likely to arise when MI is used
in health care/public health settings.
MI may succeed where traditional therapy fails because of minimal
resources and low client motivation and behavior changes. Success must be
evaluated on two levels: skill
acquisition and behavior change of clients. Specific training is needed for
practitioners.
This randomized clinical trial was based in a managed care clinical practice focusing on pregnant women who were active smokers (N = 390) and was designed to investigate if the use of brief counseling from prenatal care providers and a self-help booklet could be enhanced through the use of more resource-intensive cognitive-behavioral programs. These individuals were randomized into one of three groups: (1) a self-help booklet that was individualized according to smoking patterns, stage of change, and lifestyle of the participant; (2) the booklet in addition to access to a computerized telephone cessation program; or (3), the booklet plus proactive telephone counseling sessions from nurse educators trained to use motivation interviewing (MI) techniques and strategies. The nurses received a 6-hour training session in MI led by nationally known experts, a 2-hour small-group meeting, and an 85-page reference manual with salary support to self-study for eight hours. They were asked to make at least 4-6 calls of 10 – 15 minutes each. Nicotine use was determined by the level of cotinine in urine samples obtained in their scheduled prenatal appointment around the 34th week of pregnancy. Although smoking abstinence was found to be 20 percent in this study, there was no significant advantage in using either the computerized telephone cessation program or the MI telephone counseling to encourage smoking abstinence. Furthermore, the heavy smokers were found to have very low cessation rates in all groups and the majority of lighter smokers also continued to smoke throughout their pregnancy.
Abstract by Julie Steele
OUTCOME STUDY - UNPUBLISHED
Fisher, Douglass and Ryan,
Rosemary. The effect of a brief
MI-related intervention upon the high-risk sexual practices of HIV+ men.
Overview: Project SHAPE works with HIV+ gay and bisexual men to reduce the occurrence of their articipation in unprotected anal sex with partners whose HIV serostatus is negative or unknown. It is a collaboration of the UW School of Social Work and POCAAN, in which POCAAN provides targeted services to Latino and African American MSM and the UW serves other populations.
The
intervention consists of an interview and a feedback session for which participants are paid $50. In the first session
they complete a structured, closed-ended questionnaire that collects
detailed information about their attitudes, beliefs, substance use, and
up to four of their most recent anal and/or vaginal sex partners in the past four
months (past 12 months for Latino and African American men due to these
being harder to each opulations). The
second session is based on Motivational Interviewing principles and
consists of a discussion of information they provided in the questionnaire,
selected to highlight areas of apparent conflict between values,
beliefs and risky sexual behaviors. Staff explore these
conflicts or paradoxes with participants, and support and amplify self-motivating
statements by respondents that indicate some interest in
adopting safer sex practices.
At
6 months, the interview and feedback sessions are repeated. In this
second round, participants are given feedback that compares their responses on
the baseline and the 6-month interview. This provides the interviewer and
client with the opportunity to explore evidence of change, or the lack of
same. Participants are again paid $50.
Results:
Data collection is still going on. As of the end of March (this month)
we
will add new cases and reanalyze the data. 107 men have completed baseline interviews and 38 have completed 6 month follow-up
sessions. Mean age is 39, range is
20-62. Men of color comprise 36% of the sample, roughly double their representation among local AIDS cases. On
average, the men have known they were seropositive for 8 years (range 1 month - 17
years). Nearly 2/3 are disabled (largely
due to HIV/AIDS), 62% receive HAART (highly active anti-retroviral
therapies), and 74% report annual incomes of less than $15,000. Respondents
reported anal sex during the prior 4 months with a total of 466 partners. Detailed
partner reports were completed for 253 of them, and represent complete partner
reporting for 83% of respondents.
Methamphetamine
use in the last 4 months was reported by 31% of participants, half of
whom used at least weekly.
Out
of 107 HIV+ men, 53 (50%) reported unprotected anal sex (UA) with 88 partners whose serostatus was
negative or not known. Among this group, 30 reported UA with 51 partners who may not have know the respondent was seropositive.
Outcome: Six month follow-up data
with 38 participants showed a 31% reduction in the proportion
of participants reporting unprotected anal sex with a partner
of negative or unknown serostatus.
CONCEPTUAL
Floyd, A.S.,
This article provides a review of the types of alcoholism treatment outcome research reported in the English language between the years 1980 and 1992. 339 outcome studies were examined. After an initial examination of single and multiple treatment group studies, the authors focused on multiple group studies, examining and comparing principal investigator and study characteristics, patient characteristics, treatment modalities and characteristics, and follow-up points and outcome variables in published and unpublished studies. 166 studies had one treatment group and 173 studies had at least two treatment conditions, with an average of 2.6 treatment groups per study. The majority of investigators were affiliated with a university, male, and held PhDs. The participants were typically white, high-school educated males between the ages of 35-40. Almost half were married; nearly 60% were employed; and more than half had received previous treatment for alcohol abuse. 36% of published studies and 60% of unpublished studies had at least one cognitive behavioral condition. 21% of published studies focused on at least one form of counseling and usually with emphasis on supportive counseling and group psychotherapy. 19% of the 173 multiple group studies used a waitlist, no-treatment or minimal-treatment control group. 9% of all published studies used a placebo condition. Almost 40% of all studies did not mention goal setting, but for those who did, abstinence was the primary goal (40%). Published studies had an average follow-up rate of 14.06 months, while unpublished studies had an average of 7.67 months. 50% of published and 43% of unpublished reported quantity of alcohol consumed, with number of abstinent patients as the second most highly reported outcome variable (33% for both conditions). Finally, the majority of data was collected from self-reports (90% published and 97% unpublished).
Abstract by Julie Steele
CONCEPTUAL
Foote, J., DeLuca, A., Magura, S., Warner, A., Grand, A., Rosenblum, A., & Stahl, S. (1999). A group motivational treatment for chemical dependency. Journal of Substance Abuse Treatment, 17, 181-192.
This
article describes a group motivational intervention to be used in the treatment
of chemical dependency. The authors describe4 the
acronym FRAMES (feedback, responsibility, advice, menu of options, empathy, self-efficacy)
and discuss its congruence with self-determination theory, which emphasizes the
importance of internal/autonomous motivation. The group motivational intervention is a
four-session, manual guided treatment, which utilizes FRAMES and self-determination
elements. In addition, specific strategies and obstacles involved in the group
format are discussed.
Freeborn, D.K., Polen, M.R., Hollis, J.F., & Senft, R.A. (2000). Screening and brief intervention for hazardous drinking in an HMO: Effects on medical care utilization. The Journal of Behavioral Health Services & Research, 27, 446-453.
Society may benefit greatly from screening for dangerous drinking and providing brief interventions to individuals identified as hazardous drinkers. Individuals attending primary care clinics are a very appropriate sample for such an intervention. In this study, 514 non-dependent moderate to heavy drinkers were identified through screening at a large HMO. Subjects were then randomly assigned to receive care as usual or a brief intervention consisting of brief advice to reduce drinking by a physician and a 15 minute motivational interview by a trained counselor. No differences between groups were found on utilization of medical services in the two years following treatment.
CONCEPTUAL
Gatchel, R.J. (2003). Diabetes mellitus. Clinical health psychology and primary
care: Practical advice and clinical guidance for successful collaboration, 39-63.
Diabetes is a disease that is particularly affected by patient behavior and merits the need for effective interventions. This article describes diabetes and its effects on the body and describes common medical treatments and recommendations, including monitoring blood glucose, appropriate nutrition, exercise, and insulin therapy. Unfortunately, many patients fail to adhere to these recommendations as a result of inadequate knowledge, misbeliefs, poor social support, inconvenience, or lack of reinforcement. The article offers suggestions to health psychologists assisting physician in assessment and intervention techniques. Motivational interviewing is described and offered as an efficacious treatment to encourage patients to effectively manage their diabetes.
Geller, J., Brown, K.E., Zaitsoff, S.L., Goodrich, S., & Hastings, F. (2003). Collaborative versus directive interventions in the treatment of eating disorders: Implications for care providers. Professional Psychology: Research and Practice, 34, 406-413.
Little research has investigated the impact of the manner in which treatment interventions are delivered in eating disorders. In this study, directive versus collaborative interventions were compared with 58 eating disorder clients. 8 vignettes depicting clinical situations followed by either directive or collaborative interventions were developed and rated by clients and care providers. Both clients and care providers rated the collaborative interventions as being significantly more acceptable and likely to produce follow through with recommendations than directive approaches. These effects were significantly stronger among clients who were ambivalent about change.
CONCEPTUAL
Geller, J., Williams, K., & Srikameswaran, S. (2001), Clinical stance in the treatment
of chronic eating disorders. European Eating Disorders Review 9, 365-373.
Graeber, D., Moyers, T., Griffith, G., Guajardo, E. & Tonigan, S.. (2003) Addictions services: A pilot study comparing motivational interviewing and an educational intervention in patients with schizophrenia and alcohol use disorders. Community Mental Health Journal, 39, 189-202.
The authors conducted a study involving 30 subjects with comorbid schizophrenia and alcohol use disorders. The subjects were split into two groups for treatment. One group received motivational interviewing intervention (MI) and the other group received educational treatment (ET). Outcome measures included number of drinking days, abstinence rates, average blood alcohol concentration and standard ethanol content per drinking day. The group receiving MI treatment had a significant reduction in drinking days and an increase in abstinence rates when compared to subjects receiving ET. Although the study had some limitations, the results are compelling for the treatment of individuals affected with schizophrenia and alcoholism.
CONCEPTUAL
Graham, H.L. (1998). The role of dysfunctional beliefs in individuals who experience psychosis and use substances: Implications for cognitive therapy and medication adherence. Behavioural and Cognitive Psychotherapy, 26, 193-208.
Cognitive-behavioral interventions may not adequately account for the unique problems seen among individuals with dually diagnosed psychosis and substance use disorders. Such clients have poorer treatment outcomes, perhaps because of inconsistencies between the two treatments of the their respective disorders. Identifying dysfunctional beliefs present in psychosis and substance abuse may help bridge this gap. This article discusses the role of dysfunctional beliefs in both disorders and describes how they may interact to a form a vicious cycle of mental illness. Case studies describing this phenomenon are presented and it is argued that case conceptualization may help the therapist identify cognitions that are important for intervention. A cognitive-behavioral treatment with motivational interviewing components is proposed.
Greenwald, R. (2002). Motivation-adaptive skills-trauma resolution (MASTR) therapy for adolescents with conduct problems: An open trial. Trauma and Juvenile Delinquency: Theory, Research, and Interventions, 6, 237-261.
Conduct problems constitute a great deal of child and adolescent clinical referrals and are a significant precursor to more serious problems. Addressing the contribution of trauma to conduct problems in therapy may help diminish problems associated with the disorder. This study was an investigation of motivation-adaptive skills-trauma resolution (MASTR) treatment with adolescents. MASTR involves the use of motivational interviewing techniques to increase commitment to treatment, cognitive behavioral coping skills training, and working through traumatic material using eye movement desensitization and reprocessing. Six adolescents, who had been referred for school-related problems participated in the study. Detailed case descriptions are offered for each of the participants and problem rating scale scores decreased for all of the participants.
TRAINING STUDY
Handmaker,
N. S., Hester, R. K., & Delaney, H. D. (1999). Videotaped
training in alcohol counseling for obstetric care practitioners: A randomized
controlled trial. 93, 213-217.
The
purpose of the present study was to see how effective is videotape training for
obstetric care practitioners on brief sessions of motivational interviewing
(MI) to address problem drinking. 15 health care practitioners were randomly
assigned to see a 20-minute MI training videotape. The other 15 practitioners
were assigned to see a 20-minute docu drama of a
pregnant problem drinker. All participants were required to role play and
record two sessions with an hypothetical pregnant
drinker, one before the videotapes and one after. Ratings of all these role
plays, individually rated by two graduate students, and participant evaluations
of the MI video constituted the main measures of interest. Overall,
participants reported that the MI video was clear at showing and explaining MI
skills and strategies. Ancova analysis of the role
play ratings, to control for pre existing differences on clinical skills, also
showed that global MI skills improved from pre to post test for those in the
experimental group. The health care practitioners in the MI group were rated
as
showing more empathy, minimizing client resistance, and supporting
self-efficacy, whereas those in the control group showed more confrontational
behaviors. It was therefore concluded that obstetric care practitioners can
improve their clinical interviewing skills with a 20 minute MI training video,
which would in turn provide them the skills to better intervene with their
drinking pregnant clients.
Abstract by Patricia Juarez
42 pregnant drinkers were randomly assigned to either a control condition, in which they received information about the risks of drinking during pregnancy or to a motivational interviewing (MI) condition, in which they received a one-hour motivational interview. Clients were assessed at baseline and at a two-month follow-up point. While no differences between the control and intervention groups were observed on levels of total alcohol consumed or abstinent days, a significant interaction between treatment group and peak BAC was observed, with those who had higher BACs at intake performing better in the MI condition.
Abstract by Jennifer Hettema
CONCEPTUAL
This overview of motivational interviewing (MI) discusses the philosophy of MI as a treatment approach that avoids labeling and an emphasis on denial and instead views ambivalence as a natural part of the change process. A brief history of the development of MI is offered and important components of MI, such as expressing empathy, developing a discrepancy, rolling with resistance, and supporting self-efficacy are discussed. Specific skill and strategies are offered, as the authors describe the steps involved in a motivational interview to target addictive behaviors. Throughout this discussion , clinical vignettes are offered to demonstrate important strategic points. Lastly, some consideration is given to adapting MI to special populations.
Abstract by Jennifer Hettema
CONCEPTUAL
Harding, R., Dockrell,
M.J., Dockrell, J., & Corrigan, N. (2001). Motivational
interviewing for HIV among gay men in commercial and public sex settings.
AIDS Care, 13, 493-501.
While commercial venues and public sex environments provide great opportunities for HIV risk reduction interventions, few in-depth intervention have been conducted in these contexts due to complicating environmental factors. This paper discusses a brief intervention utilizing motivational interviewing strategies that could be implemented in such community-based settings. This motivational interview utilizes cognitive approaches, such as recognizing risk-taking cognitions, as well as motivational interviewing techniques, such as utilizing a non-judgmental style, expressing empathy, asking permission, using open-ended questions, and highlighting discrepancies. Forty volunteers have been trained by the authors to implement this approach and 900 interviews have been conducted Individuals receiving the intervention seem willing to participate and interest feedback was given by volunteers during a focus group that is discussed in the article.
Abstract by Jennifer Hettema
Harper, R. (1998). An Evaluation of Motivational Interviewing. Middlesex Probation Service,
The
present report describes a an evaluation of
motivational interviewing (MI) with a nonrandom sample of 36 probation
practitioners in Middlesex Probation Service, as a technique to help in the
assessment and supervision of offenders with alcohol or drug problems. The
purpose was to investigate the impact of MI on the attitudes of 65 offenders,
staff reactions towards the implementation of this intervention, and on
integration of MI into actual practice. It was found that all offenders showed
an improvement on their CRIME PICS II scores during the contact with the
probation service regardless of type of treatment received. More specifically,
those who received the intervention reported less anticipation for
re-offending, less positive evaluations of crime as worthwhile, decreases in
the general attitude to offending, and a decrease in the perception of current
life problems. There were no significant differences on SOCRATES scores among
the offenders. In terms of the qualitative evaluation of the MI intervention,
the18 officers interviewed reported that it enhanced and complemented their
training, that it was easily implemented into practice, and that it was less
confrontational. Nevertheless, they said that it was time consuming. Most of
the officers considered MI as "nothing new" and said it contradicted
the demands of the probation service. Officers also showed fatalistic views
about recovery such that offenders had to recognize their drug/alcohol problem
in order for something to be done about it. Officers also complained about all
the paper work involved in research, and they felt their role was changing
towards risk assessment and administration rather than welfare orientation.
Abstract by Patricia Juarez
OUTCOME STUDY
Marlatt, G. A.,
Baer, J. S., Kivlahan, D. R., Dimeff,
L. A., Larimer, M. E., Quigley, L. A., Somers J. M., & Williams E. (1998).
Screening and brief intervention for high-risk college student drinkers: Results
from a 2-year follow-up assessment. Journal of Consulting and Clinical
Psychology, 66, 604-615.
This
study was conducted in order to investigate the effects of a brief motivational
intervention to reduce the negative consequences of alcohol abuse among heavy
drinking college students, using a randomized controlled design. 188 women and
160 men were identified as being at risk for alcohol problems during their
senior year in high school. They were then randomly assigned to either receive
a motivational brief intervention during their first year in college, or to a
control condition. Furthermore, they also included another comparison group of
students selected from the total screening pool (regardless of their level of
risk), in order to have a natural history group. Two years after the
intervention it was found that the students who received the motivational
session reported less drinking and fewer negative consequences, than those in
the control condition. It was also found that high-risk students still experienced
more alcohol related problems than the natural history group, but they still
had a reduction in their problems over time, which was suggested to be due to
a
maturational effect.
Abstract by Patricia Juarez
OTHER EMPIRICAL STUDY
Haynes, P., & Ayliffe,
G. (1991). Locus of control of behavior: Is high externality
associated with substance misuse? British Journal of Addiction, 86,
1111-1117.
According
to the motivational interviewing therapeutic technique, clients' personal
characteristics such as internal attribution, self-efficacy and self-esteem are
key elements that have to be considered in order to produce positive change in
the treatment of alcohol abuse. Motivational interviewing encourages clients to
acquire an internal attributional style such that
they associate change with internal or personal factors through reflective
listening and empathy. Also referred to as internal locus of control, internal
attribution is closely related to self-efficacy and to learned helplessness.
The purpose of the present study was to investigate the differences in locus of
control among alcohol and drug users and three other non-user groups. It was
found that users indeed differed from the other three groups such that users
tended to believe they had less personal control. Furthermore, regression
analyses showed that there was no significant correlation between locus of
control and variables such as class, sex and age. Finally, it was found that
self-diagnosed substance misuse was significantly related to locus of control.
It was concluded that high external control tends to be associated with
substance abuse. In order to produce behavior change these beliefs in personal
control should be carefully considered and addressed. Abstract by
Patricia Juarez
OUTCOME
STUDY
While psychotropic medications are very important components of treatments for a variety of psychological disorders, medication compliance is often quite poor. In this study, 36 inpatients at an acute admissions ward of a hospital with non-organic psychotic illness were randomly assigned to receive either 2 to 3 sessions of medication self-management therapy or treatment as usual. Medication self-management therapy was conducted in a motivational interviewing style. No significant differences were found between treatment groups on measures of incite or medication compliance. Changes did occur in a positive direction for the intervention group, however, these changes did not reach statistical significance.
Abstract by Jennifer Hettema
Berg-Smith, S. M., Stevens, V. J., Brown, K. M, Van Horn,
L. Gernhofer, N., Peters, E., Greenberg, R., Snetselaar, L., Ahrens, L., & Smith K. (1996) A brief
motivational intervention to improve dietary adherence in adolescents. In press (Health Education Research).
Motivational
interviewing (MI) is a therapeutic technique that can be effective at
increasing clients' motivation, or readiness, to change problem health
behaviors. The components of this technique have been incorporated into a brief
therapy format for its use in health care settings, and it has been shown to
be effective for a wide range of behaviors. The present paper describes
a brief
motivational intervention designed to improve and renew dietary adherence with
adolescents in the Dietary Intervention Study in Children (DISC). It further
provides a description of DISC, reasons why this kind of intervention should
be appropriate and effective for adolescents, and results from a preliminary
feasibility test. In the first phase of the study, 334 children (ages 8-13)
were given family-based group therapy to change their diets. During adolescence
(ages 13-17), 127 of these participants were given individual, brief
motivational therapy. The components of this intervention include:
establishment of rapport, opening statement, assessment of current eating
behavior and progress, feedback, assessment of readiness to change, tailored
intervention, final encounter, follow up sessions, and training of
practitioners. It was found that this intervention showed improvements in
dietary adherence, it was also acceptable for the participants, the
practitioners liked it, and it seemed to be an age-appropriate next step from
a
family intervention approach. The need to evaluate the effects of the program
against a control group is encouraged, as well as further investigations with
other health behaviors.
Abstract by Patricia Juarez
OUTCOME
STUDY
Hodgins, D.C., Currie, S.R., & el-Guebaly, N. (2001). Motivational enhancement and self-help treatments for problem gambling. Journal of Consulting and Clinical Psychology, 69, 50-57.
102 individuals concerned about their gambling were randomly assigned to either a short workbook group, a short workbook plus a telephone-based motivational interview (MI) group, or a waiting list control group. The short workbook included cognitive-behavioral and relapse prevention techniques for eliminating problem gambling. The MI consisted of information gathering regarding the participants’ gambling and attempted to build commitment to change using the principles of MI. At a one-month follow-up point, all three groups significantly reduced their gambling. The MI group, but not the workbook group, improved significantly more than the control group. While improvement on some gambling variables was significantly higher among MI versus workbook participants at three and six month follow-up points, no significant differences were observed at twelve months. No significant between group differences on levels of treatment seeking , workbook use, at program satisfaction were observed.
Abstract by Jennifer Hettema
LITERATURE
REVIEW
Holder, H. D.
(1993). Changes in access to and availability of alcohol in the
In recent
years, the availability and access to alcohol has changed significantly in the
Abstract by Patricia Juarez
Holder, H.D., Cisler, R.A., Longabaugh, R.,
Stout, R.L., Treno, A.J., & Zweben,
A. (2000). Alcoholism
treatment and medical care costs from Project MATCH. Addiction, 95, 999-1013.
This research is a longitudinal study of the medical care costs prior to and after receiving treatment of participants partaking in a project that attempted to match patient characteristics with various treatment modalities. The three forms of treatment included: a 12-session cognitive behavioral therapy (CBT); a 4-session Motivational Enhancement Therapy (MET); or a 12-session 12-Step Facilitation (TSF). Two of the nine sites involved in the original research were used to conduct this study. 279 people participated in this study out of a potential 430. The total medical care costs for each of the participants were totaled for a three year period after treatment. The three dependent variables measured included: inpatient care costs, outpatient care costs, and total medical costs. It was found that total medical care costs decreased overall for each treatment modality. The MET condition showed promise for medical care cost savings independent of clinical prognosis. However, for the individuals with poor prognostic characteristics, CBT and TSF demonstrated greater cost savings potential. Therefore, this study concluded that matching variables for various alcohol treatment modalities significantly increases the potential of medical care cost savings.
Abstract by Julie Steele
OUTCOME
STUDY
Hulse, G.K. & Tait, R.J. (2002). Six-month outcomes associated with a brief alcohol intervention for adult in-patients with psychiatric disorders. Drug and Alcohol Review, 21, 105-112.
There is a high rate of comorbidity between alcohol use and other psychiatric disorders. In this study, 120 psychiatric inpatients with hazardous levels of drinking were randomly assigned to receive an information package with information about reducing drinking, or a brief motivational interview with feedback. At a 6-month follow-up point, both groups reduced their consumption, but the motivational interviewing group reduced significantly more. Results suggest that motivational interviewing may be an effective intervention for this group.
Hulse, G.K. & Tait, R.J. (2003). Five-year outcomes of a brief alcohol intervention for adult in-patients with psychiatric disorders. Addiction, 98, 1061-1068.
This study is a follow-up to a previous study designed to assess the efficacy of motivational interviewing (MI) among inpatients with comorbid psychiatric and substance use disorders. 120 patients were randomly assigned to receive either an information pack or a brief motivational interview with feedback. Matched controls were identified from the inpatient population who met the same inclusion criteria as intervention participants. Hospital records were then used to compare the groups at a 5 year follow-up point. No differences in time to fist mental health admission were found between the two intervention groups, but control participants had significantly shorter times to admission, more inpatients stays, and longer durations of stay than either of the intervention groups.
MANUAL
Ingersoll,
K.S., Wagner, C.C., & Gharib, S. (2000). Motivational groups
for community substance abuse programs.
This training manual was designed to help individuals deliver motivational enhancement therapy (MET) in a group format in community-based agencies. The manual provides information on the background, theory, and techniques involved in motivational interviewing(MI), including activities to practice the techniques. Guidelines for adapting this treatment to a group format, specific steps involved in conducting group MI, and specific issues involved in conducting MI in a community setting are also offered.
CONCEPTUAL
Isenhart, C. (2001). Treating substance abuse in men.
In
The traditional masculine role has clear expectations for behavior. Alcohol use can in itself become part of the masculine identity. Men are less likely to consult physicians, follow standard health procedures, and report symptoms. The author reviews research involving intervention strategies which may be more appropriate for the treatment of men with substance abuse problems. He describes the stages of change model and motivational interviewing as strategies to address men’s issues in treatment. A number of treatment options are available to staff and patients.
Abstract by Jennifer Hettema
CONCEPTUAL
Jarvis, T. J., Tebbutt, J., & Mattick, R. P.
(1995). Motivational Interviewing.
Treatment Approaches for Alcohol and Drug Dependence: An introductory Guide. (ch. 3. pp. 35-50).
Motivational
Interviewing (MI) is a therapeutic style that is particularly recommended to be
used in the initial sessions of the treatment of drug users. The primary goal
of MI is to have the clients voice their own concerns and reasons for changing,
emphasizing their own responsibility and choice. The key concepts in MI are
empathy (i.e. reflective listening), ambivalence about change,
self-motivational statements (e.g. recognition of the problem, desire to
change, concerns), counseling microskills (e.g.
open-ended questions, affirmations, summaries), and client resistance. This
chapter summarizes the basic strategies of MI, which include: exploring the
good and less good things about drug use, summarizing, perceptions of past and
present, decision making, and providing information for precontemplators.
Furthermore, the chapter also presents some other applications of MI
strategies, such as presenting personalized feedback on assessment results, and
group therapy. Finally, the five basic clinical principles of MI are presented,
which are: expression of empathy, development of discrepancy, avoidance of
argumentation, rolling with resistance, and support of client responsibility
and choice.
Abstract by Patricia Juarez
CONCEPTUAL
Jensen, M. P. (1995). Enhancing
Motivation to change in pain treatment. In D. C. Turk & R. J. Gatchel (Eds.), Psychological Treatments for Pain: A
Practitioner's Handbook. (in press).
One of
the possible causes of the partial success of current pain treatments is the
patients' own motivation for treatment. For this reason it is suggested that an
intervention referred to as Motivational Enhancement therapy (MET), designed to
increase people's motivation for change, would be
beneficial in the area of pain treatment and management. The present chapter
intends to introduce the MET procedure to clinicians so that they can help
their clients change behaviors that would lead to a better adaptation to pain
situations. MET is based on the assumption that people go through a series of
stages when trying to change a behavior, which suggest that some approaches to
treatment might be most suited for people at different stages of change.
Therefore, the main purpose of MET is to provide clients with a therapeutic
approach appropriate to their stage of change, so that they can more easily
move to higher stages. The main components of MET are
empathic reflective listening, discrepancy between present behavior and goals,
avoidance of argumentation, rolling with resistance, and the emphasis on the
clients' self-efficacy. The main basic strategies that MET uses to
achieve these goals are clustered together in three phases which are:
strategies that enhance motivation for change, those that strengthen commitment
for behavior change, and strategies for follow up or maintenance. In summary,
MET may prove a useful approach for the treatment of pain and for the
prevention of relapses for patients for whom previous pain treatments have not
been effective, by making the process more satisfactory for both the client and
therapist.
Abstract by Patricia Juarez
CONCEPTUAL
Kadden, R.M. (1994). Cogntive-behavioral approaches to alcoholism treatment. Alcohol Health and Research World, 18, 279-286.
This article describes various cognitive-behavioral approaches to alcoholism treatment. Cognitive-behavioral therapy views alcoholism as learned behaviors that are maladaptive means of coping with problems. Knowing the antecedents and consequences of drinking and coping strategies and skills of an individual can help form a clinical picture of why drinking may occur. Various interventions are describe which may target these phenomenon, including coping skills training, relapse prevention, marital and family therapy, community reinforcement, self-control training, aversion therapy, and cue exposure therapy. Attention is also given to motivational interviewing and descriptions of its theory and application are provided.
HIV presents a serious risk to heterosexual men who are often resistant to use condoms. In this study, 17 African American men recruited from a county sexually transmitted disease clinic were randomly assigned to receive either a motivational skills building intervention, including feedback, or a video-based education comparison intervention. No differences were found between groups on measures of AIDS knowledge, condom attitudes, or behavioral intentions at immediate post intervention, three month, or six month follow-up points. Motivational interviewing participants had higher condom use during every incident of intercourse at three month, but not at six month follow-up, at which time control participant also increased this behavior. Motivational interview participants also used less substances in conjunction with sex at both follow-up points.
Abstract by Jennifer Hettema
Keller, V. F., & White,
M. K. (1997). Choices and Changes: A new model for
influencing patient health behavior. Journal of Communications on Medicine,
4(6), 33-36.
The
present article describes a new model, based on recent literature, that can be
easy to use for clinicians in brief medical
interviews, to influence clients' behavior. The purpose of the model is to
improve clients' health, to promote adherence to therapy, and to reduce
self-destructive behaviors. The therapeutic relationship is based on rapport,
trust and respect in order to help clients to change. This relationship is
achieved by making open-ended questions, using reflective listening and by
empathizing with the client. According to this model, for change to occur, the
client must feel convinced that change will improve his/her well being, and
confident that he/she can make this change. These two constructs should be
assessed in order to understand barriers for change, and therefore to guide the
therapist in selecting interventions that would match the level of conviction
and confidence in the patient. This article suggests specific guidelines for
the treatment of the four different combinations of conviction and confidence
that might be encountered in patients.
Abstract by Patricia Juarez
Kemp, R.,
This research investigated the efficacy of brief compliance therapy based on motivational interviewing (MI) and recent cognitive approaches to those suffering from psychotic disorders. Participants (N = 74) were recruited from an inpatient unit and had previous admissions for psychotic episodes and were diagnosed with psychotic disorders according the DSM-III-R. Each participant received either 4-6 sessions of 20-60 minutes, approximately twice weekly of either compliance therapy or non-specific supportive counseling and were followed up over the course of 18 months. The compliance group were encouraged to discuss issues regarding medication while the control group were told to take that topic up with their treating physicians. Booster sessions for both groups were offered at 3,6, and 12 months. Results indicated that those individuals assigned to the compliance group had significant advantages on measures of insight, attitudes toward treatment and observer-rated compliance over the follow-up period. Furthermore, global social functioning improved relatively more over time and readmission length was longer in the compliance therapy group than the non-specific counseling group.
Abstract by Julie Steele
CONCEPTUAL
Kemp, R., David, A., &
Non-compliance, especially regarding adherence to medications, is a significant problem among psychotic patients. In this article, the authors discuss compliance therapy, which combines cognitive-behavioral and motivational interviewing strategies for change. In compliance therapy, a reflective, non-confrontational, normalizing, and empathetic role is adopted by the therapist in an attempt to help the patient acknowledge their disorder and comply with medication. The first step involves reviewing the patient’s illness history, emphasizing reports of medication cessation associated with relapse and positive aspects of treatment. Patients are then encouraged to explore the pros and cons of medication use and the positive aspects are differentially reinforced. When making logical disputations regarding psychotic perceptions, therapists are encouraged to remind client of the normality of misperceptions in order to preserve self-esteem. A medical model of psychological illness is offered in an attempt to avoid stigmatization and guilt that may lead to depression. Two case examples are discussed and outcome data is provided.
OUTCOME STUDY
Knight, K.M.,
Bundy, C., Morris, R., Higgs, J.F., Jmaeson, R.A., Unsworth, P., & Jayson, D. (2003). The effects of group motivation
interviewing and externalizing conversations for adolescents with Type-1
diabetes. Psychology,
Health & Medicine, 8.
Many adolescents inflicted with Type-1 diabetes have difficulty coping with the psychosocial stressors associated with their illness. This qualitative research investigated the effect of group Motivational Interviewing (MI) and externalizing conversation (EC) in changing the perceptions and coping skills of the adolescents inflicted with diabetes. Twenty individuals with inadequately controlled diabetes were assigned to treatment and control conditions. The treatment group received six 1-hour weekly sessions of MI and EC. The control group received usual care. Semi-structured questionnaires were given to all participants pre, post and six months after treatment. They found that the treatment group’s perceptions of their diabetes changed--they felt less threatened and had more feelings of control and acceptance. Furthermore, the adolescents in the treatment group felt as if there were less restrictions on their lifestyle than before. They also were more likely to be open about their feelings toward their diabetes, viewed other’s concerns as less problematic and more helpful. This research suggests that the group intervention led to an adaptive shift in illness perception.
OUTCOME
STUDY
Koerber,
A., Crawford, J., and O'Connell, K. (2003). The
effects of teaching dental students brief motivational interviewing for
smoking-cessation counseling: A pilot study. Journal of Dental Education, 67,
439-447.
Oral
health issues are particularly influenced by patient behaviors, including
smoking. It is therefore important to
train dentist to help their patients change these behaviors. This article
describes the use of brief motivational interviewing (BMI) in facilitating such
change and provides results from a pilot study designed to train dental
students. Twenty-two dental students
were randomly assigned to receive no training or training in BMI. Students were provided with confederate
patients and instructed to provide smoking interventions. BMI students were more likely to use BMI
techniques and their patients were more actively involved.
CONCEPTUAL
Konkle-Parker, D. (2001) A
motivational intervention to improve adherence to treatment of chronic disease.
Journal of the
This article describes and reviews an approach using motivational interviewing (MI) and the transtheoretical model (TTM) of change to increase adherence to medication regimens among individuals with HIV disease. The stages of change model is described and applied to factors related to medication adherence. Motivational interviewing strategies that can be used with this population are provided and specific examples are offered.
Kuchipudi, V., Hobein, K., Fleckinger, A., &
Iber, F. L. (1990). Failure
of a 2-hour motivational intervention to alter recurrent drinking behavior in
alcoholics with gastrointestinal disease. Journal of Studies on Alcohol,
51, 356-360.
Alcohol abuse is often the cause of gastrointestinal diseases, so one of the main goals in the treatment of these diseases is to control alcohol consumption. This study investigated the impact of a brief motivational intervention on the alcohol use of patients diagnosed with gastrointestinal disease who were currently drinking, and were not receiving alcoholism treatment. The intervention was delivered in 3 sessions to discuss the relationship of the patients' drinking to their disease, in a motivational approach that invoked the authority of the physician. Patients were also given information on different treatment alternatives available for them. There were no significant differences between those patients receiving the intervention and those who did. Patients who volunteered to talk about treatment and alcohol use did better at remaining sober than those who didn't. It was also found that those patients who remained in treatment for 2 to 3 appointments did significantly better than those who didn't, and those patients who completed the whole treatment, either inpatient or outpatient, reported higher sobriety than all the other participants. It was concluded that this intervention didn't work due to the patients' characteristics, which made them an especially difficult group to treat, due to their apparent unwillingness to seek and receive treatment. It was suggested that this was due to not having included an informed consent to participate in the study, suggesting that studies that use informed consents may find different results.
Abstract
by Patricia Juarez
CONCEPTUAL
Kushner, P. R.,
Levinson, W., & Miller, W. R. (1998). Motivational interviewing: What, when and
why. Patient Care, 32(14), 55-72.
Physicians
often have to advice their patients to modify their behavior with usually
limited success. It is often assumed that patients would follow the doctor's
advice just because it comes from an expert source, but unfortunately, this is
not usually the case. This occurs often because client's
don't participate in the decision to change and see the advice as a threat to
their freedom, or they may simply not be ready or truly motivated to change.
According to the theory of motivational interviewing (MI), motivation is not a
trait or a defense mechanism, but the likelihood that a person will do
something to feel or get better, and the product of the patient-physician
interaction. In order to promote behavior change, MI has four basic components:
Empathic listening, encourage patients to state their own reasons for change,
roll with resistance, and support self-efficacy. The theory of MI also assumes
that people are usually ambivalent to change their behavior, so one of the
goals of this approach is to help clients explore this conflict of pros and
cons. Another crucial factor that makes MI very useful is that it assesses
client's readiness for change and then selects an appropriate strategy to use.
This readiness for change is usually conceptualized in terms of stages people
move from one to another. These states are precontemplation,
contemplation, preparation, action, and maintenance. The average MI session
lasts from
Abstract by Patricia Juarez
CONCEPTUAL
Lawendowski, L. (1998) A motivational intervention for adolescent smokers. Preventative Medicine 27, A39-A46.
The author
reviews the definitions and applications of motivational interviewing (MI) and
motivational enhancement therapy (MET) with adolescent patients. Research evidence from UNM is discussed in
some detail and is argued to support the use of MI and MET with adolescents. It is noted that much work is needed to
develop a training protocol for nonspecialist use of
MI.
CONCEPTUAL
Lewis,
T. & Osborn, C. (2004). Solution-focused
counseling and motivational interviewing: A consideration of confluence. Journal of Counseling
and Development. Manuscript
accepted and scheduled for Winter 2004.
This paper gives a review of the similarities and differences of two counseling styles: solution-focused counseling (SFC) and motivational interviewing (MI). Based on empirical evidence, the authors propose that both approaches be considered concurrently. Some of the similarities between the two styles which promote this assertion include: non-pathological, salutatory focus; emphasis on the existence of multiple, intangible social realities, which afford the client several possibilities or solutions rather than only one; anchored in positive change; reframing of “resistance” as something gone awry between the counselor and client, not simply a client’s unwillingness to improve; based on cooperation between the counselor and client; the use of client strengths and resources; and brief therapy, therefore both are creating an inherent temporal sensitivity.
Lincourt,
P., Kuettel, T.J., & Bombardier, C.H. (2002). Motivational interviewing in a group
setting with mandated clients: A pilot study.
Addictive Behaviors, 27, 381-391.
This study aimed to facilitate the identification of treatment-related goals with clients who are court-mandated to enter treatment for substance-abuse treatment. A group-based motivational enhancement program was provided before standard treatment to 73 clients over a two-year period, while 94 chose or were unable to participate in the program. The program consisted of six sessions ran by group leaders trained in the strategies, theory, and application of motivational interviewing. This study found that there was a significant difference between the two groups: those who participated in motivational enhancement therapy were more likely to meet criteria for substance dependence, attend a higher number of their treatment sessions, and complete treatment (58% v. 32%). As a result of this being a nonrandomized controlled study, potential between-group variables that may have influenced the outcome were examined, and there still the same significant differences between the two groups. In conclusion, the authors believe that a motivational group before standard therapy may promote greater participation and the identification of treatment-specific goals in this particular population.
Abstract by Julie Steele
CONCEPTUAL
Ling, W.,
Farrell, M., & Ali, R. (2004). Cochrane systematic reviews: Time for an
introduction and appraisal. Drug and
Alcohol Review, 73, 217-218
The editorial states that more than
40 Cochrane systematic reviews have been completed in the area of drug and
alcohol research. These reviews provide
the most balanced and non-biased interpretation of currently published
literature, especially in areas where there are uncertainties or substantial
differences of opinion with respect to particular interventions.
Litt, J. (2002) How to provide effective smoking cessation advice. Australian Family Physician, 31,1087-1094.
The
author provides general practitioners with a plan to help patients quit smoking
in less than a minute without offending the patient. General Practitioners identify just over half the smokers in their
practice and counsel about one-third to quit.
Effectiveness can be improved by adopting a systematic approach to
identifying smoking status, more effective engagement of smokers by separating
information from the ‘moral imperative’, use of brief motivational interviewing
techniques and appropriate pharmacotherapy, and use of the QUIT line and other
smoking cessation resources.
OUTCOME STUDY
Long, C. G. & Hollin,
C. R. (1995). Assessment and management of eating disordered patients
who over-exercise: A four year follow up of six single
case studies. Journal of Mental Health, 4, 309-316.
There
is still debate on whether excessive exercise is a risk factor for the
development and maintenance of eating disorders, and this topic has been mostly
ignored in the area of anorexia nervosa. Excessive exercise has been found to
precede anorexia for some patients. It has also been found that it persists
even in recovered patients and it is suggested that it should be viewed as a
risk factor for relapse. The present study describes a four-year follow
up of six (5
woman and 1 men) anorexic clients where excessive exercise was one of the focus
of treatment. Therapists used a sympathetic style, referred to as motivational
interviewing, to treat these clients and to help them move from the
contemplation to the action and maintenance stages of change. The treatment
consisted of a discussion of objective feedback, self-monitoring of exercise,
exercise education, and a cognitive behavioral approach to treat the eating
disorder. Four participants showed a reduction in the symptoms of anorexia
nervosa and in psychological distress. Most relevant to the present
investigation, these four participants reported using exercise for social
reasons and for fitness, and not as a compulsion related to body image.
Abstract by Patricia Juarez
Longshore, D., Grills, C., & Annon, K. (1999). Effects of a culturally congruent intervention on cognitive factors related to drug-use recovery. Substance Use & Misuse, 34, 1223-1241.
African Americans are less likely to seek treatment for substance abuse problems and are less likely to believe they would benefit from treatment. This may be due to a lack of culturally congruent interventions that take into account the heritage and values of African Americans. This study developed a culturally congruent African American intervention based on motivational interviewing and dyadic techniques in which communalism and group processes were emphasized. Clients were recruited from social service and street settings and randomly assigned to a culturally congruent or control condition, both of which encourage clients to seek appropriate treatment. Clients who received the culturally congruent were significantly more involved in the intervention and more motivated to seek treatment.
Abstract by Jennifer Hettema
CONCEPTUAL
Ludman, E., Curry S. Meyerk, D. & Taplin, S.
(1999) Implementation of outreach telephone counseling to promote mammography
participation Health Education and Behavior 689-702.
To
increase mammography participation, the authors implemented a telephone
intervention using motivational interviewing (MI) that included the opportunity
to schedule a screening appointment.
Data from calls to 491 women is presented. A total of 83% of women accepted the
calls and 84% of women were either receptive or neutral in tone. Women who had previously had mammograms were
most likely to schedule a screening appointment. A
conceptually based telephone counseling approach such as the one described here
might be applicable for a wide variety of cancer screening and preventive
behaviors.
Marlatt,
G.A., Baer, J.S., Kivlahan, D.R., Dimeff,
L.A., Larimer, M.E., Quigley, L.A., Somers, J.M., & Williams, E. (1998). Screening and brief intervention for
high-risk college student drinkers: Results from a 2-year follow-up
assessment. Journal of Consulting and
Clinical Psychology, 66, 604-615.
This
research was designed to evaluate the efficacy of a brief motivational
intervention in reducing the harmful effects of heavy drinking among high-risk
college students. All of the students
recruited were accepted to the
Abstract by Julie Steele
CONCETUAL
McGuire, Terry (2003) Ways to help change behavior, The Pharmaceutical Journal, vol. 271 813-815.
The author explores how pharmacists in particular can help move people through the change process toward healthier living. He discusses the cycle of change: re-contemplation, contemplation, planning, action, and maintenance. The rationale behind motivational interviewing is presented and tied into the change cycle. Specific open-ended questions are included as examples of motivational interviewing in practice. Because of the short amount of time pharmacists spend with patients this approach could be invaluable.
Abstract by Jennifer Hettema
CONCEPTUAL
Mallin R. (2002) Smoking cessation: integration of behavioral and drug therapies. American Family Physician, 65, 1107-1114.
This
article describes the importance of promoting smoking cessation to smokers
visiting family physician clinics and efficacious steps involved in this process.
The first part of this process involves identifying smokers and assessing their
readiness to quit. The transtheoretical stages of change are described as well as
appropriate motivational interventions for each of these stages of change. Introduction and use of pharmacotherapy in
the preparation and action stage is discussed, including nicotine replacement
and bupropion.
Motivational Interviewing strategies for dealing with relapse are also
discussed.
Abstract by Jennifer Hettema
CASE
STUDY
Mann, R.E. & Rollnick, S. (1996).
Motivational interviewing with a sex offender who believed he was
innocent. Behavioural
and Cognitive Psychotherapy, 24, 127-134
This study utilizes motivational interviewing (MI) in the treatment of a convicted sex offender who did not believe he had committed an offense. Applying MI’s principles regarding denial and confrontation to sexual offenses, the authors administered a motivational interview to the sex offender, hoping that he would then agree to participate in the prison’s sex offender treatment program. Pre-treatment assessment indicated that the subject was had some ambivalent beliefs regarding the incident and that he was at a pre-contemplative stage of change. A MI intervention was then administered which utilized feedback of assessment results, reflection of self-motivational statements, affirmation, emphasis on de-labeling, and an emphasis on personal choice and control. The sex offender consequently joined the sexual offender treatment group and acknowledged that he had committed an offense.
CONCEPTUAL
Martino, S., Carroll, K., Kostas, D., Perkins, J.& Rounsaville, B. (2002).Dual diagnosis motivational
interviewing for substance-abusing patients with psychotic disorders.Journal
of Substance Abuse Treatment,23, 297-308.
,
Motivational interviewing (MI) is a brief treatment approach for helping patients develop
intrinsic motivation to change addictive behaviors. While initially developed to target primary
substance using populations, this article explores in detail recommended
modifications to MI to accommodate the special needs of substance abusing
patients who have psychotic disorders.
This approach is called dual diagnosis motivational interviewing
(DDMI). The initial pilot study (Martino
et al.,2000) showed some benefit of a one –session
motivational interview for dually diagnosed patients. The authors predict that a two-session and
carefully developed DDMI
may have the potential for
greater merit as a brief intervention.
Future reports will examine the feasibility and effectiveness of DDMI in a randomized
controlled trial. They recognize that
DDMI might best function as a complement to other approaches.
Martino, S., Carroll, K., O’Malley S. & Rounsaville, B. (2000) Motivational interviewing with psychiatrically ill substance abusing patients. The American Journal on Addictions 9, 88-91.
This study reviews the efficacy of a one-session preadmission motivational interview (MI) for 13 patients compared to a standard preadmission interview for 10 patients. These patients were entering into a partial hospitalization program. They were all substance abusing patients with DSM-IV mood and psychotic disorders. Results indicated that the group receiving MI preadmission interviews showed a greater number of days attended and less tardiness and early departures from treatment sessions. Motivational interviewing shows promise, according the authors and more study is needed.
Abstract
by Jennifer Hettema
CONCEPTUAL
Masterman, P.W. & Kelly, A.B (2003). Reaching adolescents who drink harmfully: Fitting interventions with developmental reality. Journal of Substance Abuse Treatment, 24, 347-355.
Alcohol use, especially binge drinking, is common among adolescents. This phenomenon is most commonly addressed through school-based intervention programs such as Drug Abuse Resistance Education (DARE), Project ALERT, and Life Skills Training, which have no demonstrated long term benefits, Programs which focus wider ranges of etiological risk factors, such as Project Northland, may delay onset of use among low risk participants. Meta-analyses seem to suggest that current prevention programs are largely ineffective, particularly among high-risk adolescents. The authors argue that research and interpretation of adolescent prevention efforts could be improved by a more thorough understanding of potential risk factors, which would allow us to view outcome as changes in trajectories of alcohol use, instead of absolute alcohol-related changes. Such an understanding would allow for interventions directed at specific drinking trajectories. Motivational interviewing (MI) may be one potential candidate as it allows for the accommodation individual risk factors and drinking trajectories in a flexible and personalized way.
McCambridge, J. & Strang, J.
(2004). The
efficacy of single-session motivational interviewing in reducing drug
consumption and perceptions of drug-related risk and harm among young
people: results from a multi-site
cluster randomized trial. Addictions,
99, 39-52.
This research aimed to
explore whether simply discussing alcohol, tobacco and illicit drug use in a
single session of Motivational Interviewing (MI) with young people would reduce
their use of these substances and/or the perception of the potential harms they
may cause. 200 people ages 16-20
participated in a cluster randomized trial in which they were assigned to
either MI (n=105) or non-intervention education-as-usual control condition
(n=95). These individuals were actively
using illicit drugs and were recruited from ten further education colleges
across inner
McCambridge, J. & Strang J. (2002) The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: results from a multi-site cluster randomized trial. Addiction, 99, 39-52.
In this study the efficacy of
motivational interviewing targeting multiple drug use for secondary purposes
was studied among 12-20 year old substance abusing young people attending further
education colleges in
CONCEPTUAL
Mc Carthy, P. & Cluss
P.(2002), Motivational interviewing in the
workplace. In D. Sandu
(Ed.): Counseling Employees: A Multifaceted Approach.
Motivational interviewing (MI) is a powerful style of brief counseling that assists clients in achieving a change in behavior. This chapter discusses the strategies of MI with accompanying fictitious client-counselor dialogues. Studies are reviewed which support the approach. The authors conclude by suggesting an additional use for MI for employees experiencing workplace substance abuse problems and those experiencing ambivalent thoughts and emotions triggered by impending employment changes.
CONCEPTUAL
Miller, C. & Johnson, J. (2001) Motivational Interviewing. Canadian Nurse, 97, 32-33.
Motivational interviewing (MI) is a technique that can be used to enhance positive health-behavior change by placing the client in the center of the change process. The authors review the stages of change and the basic theory and practices of MI and recommend MI to their fellow nurses.
CONCEPTUAL
Miller, W. R.
(1983) Motivational Interviewing with Problem Drinkers. Behavioural Psychotherapy, 11, 147-172.
In
the area of substance abuse, it has been traditionally believed that if
treatment
is successful, it is due to the characteristics of the therapist and the
approach itself. On the other hand, if a treatment approach is not successful
it is often attributed to a lack of client motivation, persistence or strength.
A personality characteristic that is often suggested to be a barrier in the
treatment of alcoholism is the client's "denial." However, denial
appears to be more often the product of the way counselors interact with clients.
The belief in this inner "denial" of the alcoholic patient has led
to a confrontational kind of therapy that only leads to increased resistance,
and
in turn to less success at motivating the patient to seek or remain in
treatment.
Motivational
Interviewing (MI) is a quite different approach. It uses reflective listening, operationalized by Carl Rogers as the skill of accurate
empathy, as its main tool to help clients recognize the problem and think about
possible solutions. Its main concern is to tip the balance between the
perceived positive consequences of alcohol consumption and its negative
consequences, towards the side of seeking help. MI discourages labeling, and
emphasizes the client's own perspectives on the negative consequences that alcohol
is having on a client's life. It also emphasizes the personal responsibility of
the client to decide whether or not he/she has a problem, how serious it is and
what to do about it. Similarly, MI gives the client credit for his/her
improvement and change by emphasizing the client's internal control of his/her
own behavior. MI further suggests eliciting dissonance in a client in order to
emphasize the discrepancy between his/her behavior and his/her beliefs,
attitudes, values, etc., therefore helping to increase the client's motivation
to change behavior. Motivational Interviewing complements a more general transtheoretical model of stages of change, proposed by Prochaska and Diclemente, which
includes the person's motivation for change in the first phases of the process
as part of a cycle of change. MI complements this model by helping the client
move from the precontemplation or contemplation stage
to action.
Abstract by Patricia Juarez
CONCPETUAL
Miller, W. R., & Jackson,
K. A. (1985). "Not listening" and
"Listening" chapters. In
The
purpose of these chapters is to teach pastors quality listening skills. They
propose a whole new way of listening which may be considered a new way of
thinking and relating to other people. The first chapter describes what not
listening is in order to set the way to describe what good listening is indeed.
Not listening involves signs of lack of interest, a lot of talking and interruption
by the listener, signs of boredom, and a lot of fidgeting. Other verbal
examples of "not listening" include providing a lot of own opinions
and evaluations, or any other way to prevent people from thoroughly expressing
their thoughts. A list of 12 common obstacles to good listening and examples
are described in detail. Listening, on the other hand, means devoting all
attention to the speaker, refraining from giving own opinions, and engaging in
active listening (reflecting what the person is saying, feeling and thinking).
Therefore reflective listening gives to the client an accurate reflection of
his/her own thoughts and feelings. The steps to provide this type of listening
include acceptance (listening without judging), learning to think reflectively
(alternative interpretations), providing reflective statements rather than
questions (a guess about the speaker's meaning), giving deep reflections
(rephrase, paraphrase, elaborate), and being alert for feedback from the
client. The chapter also presents some points to improve the basic skills of
reflective listening, such as understating feelings, reflecting both sides of
a
conflict, and using appropriate analogies. Finally, the chapter describes
situations in which reflection may not be advisable, or may be all it
takes.
Abstract by Patricia Juarez
LITERATURE
REVIEW
Miller W. R. (1985). Motivation for
Treatment: A Review with special Emphasis on Alcoholism. Psychological Bulletin, 98, pp. 84-107.
The
lack of client motivation has often been regarded as the cause of treatment
failure,
and it is usually seen as a result of inner maladaptive defense mechanisms of
the client. This has been especially so in the area of alcoholism, where the
primary defense mechanism is reputed to be the client's "denial."
Therapists often base their perceptions of clients' poor motivation on lack of
acceptance of the problem, resistance to accept "alcoholic" label,
lack of desire to seek help, lack of distress and lack of compliance with the
treatment. A more adaptive approach is to think of motivation as the
probability of a desired behavior. Investigating the processes that influence
a
person to engage in behaviors leading to recovery should lead to a better
appreciation of a client's motivation and to better treatment approaches.
Motivational interventions attempt to increase the probability of engaging
these behaviors. Some motivational interventions that have been successful in
evoking behavior change include giving advice, providing feedback, goal
setting, role playing, modeling, maintaining contact with client, altering
external contingencies, providing choice with a variety of alternatives of
goals and change strategies, and decreasing attractiveness of the problem
behavior. Other less specific characteristics that also influence the client's
motivation to enter treatment and comply with change efforts include
characteristics of the client (distress, maintenance of high self-esteem,
internal locus of control, severity of the addiction problem and conceptual level
as a measure of interpersonal development), characteristics of the environment
(waiting time, travel distance and social support) and therapeutic
characteristics (hostility, expectancy and empathy). Belief in the trait model
of motivation has often led to the use of confrontational therapeutic
techniques, which have not shown high rates of success. When motivation is seen
as a probability of behavior it may lead to the development of more successful
treatment interventions, designed to increase the client's motivation of
engaging in recovery related behaviors.
Abstract by Patricia Juarez
LITERATURE
REVIEW
Miller, W. R. (1987). Techniques
to modify hazardous drinking. In M. Galanter
(Ed.) Recent Developments in alcoholism, 5, Memory Deficits, Sociology of
treatment, Ion channels, Early problem drinking. Plenum
Press.
This
chapter presents a summary of past and recent research on the effectiveness of
different treatments and interventions for early alcohol abuse. The type of
intervention described in this chapter focuses mainly controlled or moderate
drinking. The overall goal is mainly to decrease alcohol use to a level in
which it no longer causes problems nor posses
significant risks for the individual. The most effective procedure that emerged
in the research of the early 70's, was Self-controlled
training, which has been extensively evaluated and investigated in the present.
This type of interventions commonly include aspects such as goal setting,
self-monitoring, reduction strategies, self-reinforcement, functional analysis,
and alternatives to drinking. The chapter describes the current research on
Behavioral Self-controlled Training (BSCT) in detail. In general, it is
suggested that BCST is most effective at achieving moderate drinking for less
severely impaired and dependent drinkers, and that abstinence is more likely
to be accomplished by more severe and problematic drinkers. This research has
now
progressed towards the investigation and understanding of motivation for change
and its implications for early interventions. This idea has led to the
development of interventions attempting to increase this motivation for change
(e.g. Drinker's Check-up), which have been shown to be as effective at reducing
drinking behavior as treatments using BSCT
Abstract by Patricia Juarez
CONCEPTUAL
Miller, W. R. (1987). Motivation
and Treatment Goals. Drugs and
Society, 1, 133-151.
The goals
that therapists set for their clients may not be the same that the clients have
for themselves. This can result in client reluctance to comply with these
goals. Research indicates that personal goals are an important factor in
motivation for change; yet there are very few treatment programs in which the
clients are free to choose from an array of alternatives what think is best for
them. Treatment failure is often attributed to the client's lack of motivation
or to his/her noncompliance with the goals set for them. It is suggested that
clients should be matched with the best treatment goal chosen from a set of
alternatives (e.g. abstinence, controlled drinking) in order to increase
clients' early entry into treatment, compliance to treatment, treatment
outcome, prevention through early intervention, service for a wider range of
the population, and to decrease the overuse and costs of health-care. Different
treatment goals such as abstinence and controlled drinking may be successful
for particular individuals, pursuant to an overall goal of reducing problems
associated with alcohol abuse.
Abstract by Patricia Juarez
Miller, W. R., Sovereign, R. G., &
Krege, B. (1988). Motivational
Interviewing with Problem Drinkers: II. The Drinker's Check
up as a Preventive Intervention. Behavioral Psychotherapy, 16,
251-268.
The
importance of motivation for change in the prevention and treatment of alcohol
abuse is widely recognized, but it is still often believed that treatment
failure is due to the lack of clients' personal motivation. Miller (1983)
introduced an approach called motivational interviewing (MI), which
de-emphasizes labeling, encourages individual responsibility and increases the
client's dissonance between ideal goal and present behavior. MI emphasizes a
combination of discrepancy and self-efficacy in order to better motivate people
for change. The Drinker's Check-up (DCU) is a set of measures designed to help
the person see how alcohol consumption is negatively affecting his or her life,
thus increasing the awareness of risk associated with alcohol consumption. The
DCU can be administered in settings such as health screening, treatment
selection and matching, self-assessment and research. In order to evaluate the
usefulness of the DCU, it was administered to 42 people in this first
evaluation of the efficacy of MI. Participants showed significant reduction in
alcohol use at the 6 week and 18 month follow up. The DCU intervention did not
significantly decrease symptoms and problems related to alcohol use. Therefore,
it is recommended that the DCU should be used to motivate and prepare the
client to seek treatment, and it should also be used as an initial assessment,
part of the whole intervention process of motivation and treatment.
Abstract by Patricia Juarez
LITERATURE
REVIEW
Miller, W. R., & Sovereign,
R. G. (1989). The Check-up: A model for early intervention
in addictive behaviors. In T. Loberg, W. R. Miller,
P. E. Nathan, & G. A. Marlatt (Eds.), Addictive behaviors: Prevention and early
intervention (pp. 219-213).
It
is
commonly believed that alcoholics show specific internal and enduring
personality characteristics such as lack of motivation to change, and the use
of defense mechanisms such as denial, projection and rationalization. These "personal and stable" characteristics are believed to prevent
alcoholics from recognizing their problem and from trying to do something about
it. These beliefs have usually led to the use of confrontational and aggressive
strategies in order to break through the client's defense mechanisms. However,
research has shown that this view of motivation may not be accurate. There is
no uniform "alcoholic personality." Furthermore, research has shown
that the outcomes of therapy are often related to the characteristics of the
therapist and to other external factors rather than to clients' personality
characteristics. Brief interventions (1-3 sessions) can be very effective at
reducing alcohol use and related problems. Some of the characteristics that
make these interventions successful include feedback, emphasis on personal
responsibility, advice, menu of alternatives, and emphasis on self-efficacy,
which together have been referred to as motivational interviewing. The
Drinkers' Check up (DCU) was developed to address the issue of how to attract
people to enter this kind of intervention. The DCU intends to remove common
barriers to seeking help, such as being labeled or diagnosed, rejection of a
need for "treatment," fear of losing confidentiality, or cost. It
consists of a 3-hour assessment followed by a 1-hour feedback session (an oral
and written personal profile and a blood concentration table). The feedback
session is conducted in a motivational interviewing style. Newspaper
announcements of the DCU have attracted people who would be unwilling to enter "treatment," but
who are concerned with health risks and with other alcohol-related problems.
In an initial evaluation of the effects of the DCU, it was found that
it decreased alcohol use and increased future treatment involvement, as
compared to a control group that was put on a waiting list. Furthermore, when
therapist style was considered, a client-centered style (motivational
interviewing approach) elicited more positive responses, less resistance, more
motivation to change, and therefore a decrease in alcohol use in the long
term.
Abstract by Patricia Juarez
BOOK
Miller, W. & Rollnick.,
S. (Eds.) (1991). Motivational Interviewing: Preparing people to change
addictive behavior.
This
300+ page text is available in both hardback and paperback and remains
the most
thorough presentation of MI to date. The text uses a practical tone and
gives many clinical examples. The book is broken into three parts:
Background, Practice, and Clinical Applications (in various settings and with various
populations). Besides a thorough overview, the text offers advice on
avoiding typical problems that develop using the approach and on handling other
typical and difficult situations, such as working with spouses and coerced
clients, dealing with time shortages, and helping clients whose lives are in
chaos and who often get sidetracked during sessions. Other topics
addresses in co-authored chapters include MI and the stages of change; brief
MI
by the nonspecialist; working with heroin-dependent
and severely alcohol dependent clients; working with couples, adolescents, and
sex offenders; using MI to reduce HIV risk; and incorporating maintenance of
change issues into MI treatment.
You may
order the book here: http://views.vcu.edu/vattc/books.html#tx
CONCEPTUAL
Miller, W. R. (1993). What I would most like
to know: What drives change? Addiction,
88, 1479-1480.
This
article is an hypothetical "letter to God" asking
what are the mechanisms of change in addictive behaviors. There are several factors
that have been proposed as the causes of addiction
(determinant, predisposing, precipitating and reinforcing factors). Similarly,
it has been suggested that relapse is primarily caused by precipitating
factors. The author is most concerned, however with the fact that too little
investigation has been devoted to studying the causes of change in addiction,
including its precipitating causes (what occurs before change), predisposing
factors (foundation for change), perpetuating causes (what maintains change),
and primary causes (necessary and sufficient conditions for change).
Furthermore, it would be useful to know how these factors interact with each
other to produce behavior change, and how is it that some people seem to
experience drastic and permanent transformations. The article is one in a
series of invited short pieces in which senior researchers indicate what they
would most like to know.
Abstract by Patricia Juarez
OUTCOME STUDY,
PROCESS STUDY
Miller, W. R., Benefield, R. G., & Tonigan, S. (1993). Enhancing
motivation in problem drinking: A controlled comparison of two therapist
styles. Journal of Consulting and Clinical Psychology, 61,
455-461.
It is widely acknowledged that one
of the largest concerns in health psychology, especially in the area of
addictions, is the lack of motivation to seek and remain in treatment. Often
this lack of motivation is attributed to personal, enduring characteristics of
the clients, while substantive research has shown that motivation can be
increased through brief motivational interventions. The present investigation
studied the effects of therapists' style on 42 alcohol abusers, using a
2-session motivational check-up. Participants were randomly assigned to one of
three groups: 1) immediate check-up with directive confrontational feedback, 2)
immediate check-up with client-centered feedback, or 3) delayed check-up. The
intervention significantly reduced drinking in the 6-week follow up, and this
change was maintained over a yearof follow-up.
Participants assigned to the immediate check-up conditions showed a significant
reduction in alcohol use compared to those participants in the control group.
Similarly, therapists using a directive-confrontational style elicited more
resistance from clients and therefore produced less positive results at the 1
year follow-up, such that those clients receiving this kind of counseling drank
more than other participants.
Abstract by Patricia Juarez
OTHER EMPIRICAL STUDY
Miller, W. R., & C'deBaca, J. (1994). Quantum
change: Toward a psychology of transformation. In T. Heatherton & J.
Weinberger (Eds.), Can personality change? (pp.252-280).
One
of psychology's oldest interest are sudden, profound
and radical changes of behavior, which have been referred to as quantum
changes. It is suggested that this phenomenon is hard to investigate due to its
often private and unreported occurrences, therefore how, when and why does it
occurs remains a puzzling question for psychology. This article presents a
scientific study of quantum change. 52 participants were asked aspects about
their transcendent experiences, further details about these experiences, their
value structure, life experiences before and after the
change, religious background and beliefs. Furthermore, they completed three
personality measures. Participants were interviewed in a reflective listening
style. The common characteristics of quantum change that were observed among
the sample were: sudden onset, surprising, emanating from an external source
or
event, relatively brief, previous emotional distress, previous negative life
experiences, previous spirituality and/or strong religious beliefs, related
expectations to the experience, life improvement, confidence in the permanence
of change, feelings of liberation after the experience, positive feelings and
happiness, a new kind of meaning and perception, and a shift in value
priorities. These characteristics suggest that quantum change may not be part
of a normal continuum of behavior change, but may refer to a unique phenomenon.
Four mechanisms are suggested to explain this unique process of change:
awakening of self-regulatory processes, a shift in perception, value and
attitude conflicts, and a transcendental experience. In conclusion, it is
important to recognize that behavior change can occur in ways that don't fit
our current gradual theories of personality change.
Abstract by Patricia Juarez
LITERATURE REVIEW
Miller, W. R., & Sanchez,
V. C. (1994). Motivating young adults for treatment and
lifestyle change. In G. Howard and P. E. Nathan (Eds.),
Alcohol use and misuse by young adults (pp. 55-81). Notre Dame, IN:
Motivation
for change has often been viewed as a stable personality characteristic. More
recently however, research has suggested that motivation is part of a process
of stages of change, which go from precontemplation to
maintenance of behavior. Furthermore, motivation is also viewed as a product
of interpersonal relations and environmental variables rather than as a stable
characteristic of the individual. Of similar importance, significant support
has been found for the effectiveness of relatively brief motivational
interventions, over no treatment and long-term treatment approaches. This type
of intervention include elements such as giving feedback, emphasis on personal
responsibility, giving advice, providing a menu of alternatives and goals,
showing empathetic listening and emphasis on self-efficacy. Other factors that
have been found to influence people's motivation for change, and that are
approached by brief motivational interventions are how risky is the target
behavior perceived, and the individual's perceived self-efficacy to change this
behavior. Another crucial recent development is the change in the conception
of
alcoholism, where rather than being seen as a disease, it is now viewed more
in
terms of a complex and interactive public health model. The implications of
these findings in the development of prevention interventions that include
these components are discussed in detail.
Abstract by Patricia Juarez
CONCEPTUAL
Miller, W. R.,
Jackson, K. A., & Karr, K. W. (1994). Alcohol problems: There's a lot you can do
in two or three sessions. EAP Digest, 14, 18-21, 35-36.
Employee
assistance programs (EAP) to help employees have commonly operated on
time-limited intervention model, which may consists from two to eight sessions.
For this reason, it is often the case that when the presenting problem is
alcoholism, it is often just detected and then referred to usually costly
in-patient or residential programs. Recent developments in the area of
alcoholism treatment suggest first that there is a broad range of different
alcohol problems, which suggests that one of approach to treatment may not be
the most appropriate for all alcohol problems. Second, research has shown that
the intensity of treatment (in-patient vs. out-patient, long-term vs.
short-term) does not determine its effectiveness. Third, it has been found then
that brief interventions can be very effective at changing clients' drinking.
The components that make this kind of brief interventions effective include
providing feedback, emphasizing personal responsibility, giving advice,
providing a menu of alternatives, showing empathic understanding, and
emphasizing self-efficacy. The basic procedure for brief motivational
interventions is outlined and the implications of these findings for EAP
professionals are discussed.
Abstract by Patricia Juarez
CONCEPTUAL
Miller, W. R. (1994). Motivational
Interviewing: III. On the ethics of Motivational
Intervention. Behavioral and Cognitive Psychotherapy, 22, 111-123.
This
article discusses the ethical implications associated with Motivational interventions.
Motivational interviewing (MI) is a therapeutic technique designed to motivate
people to change health behaviors. One of the most important barriers for
change that has been typically identified is the person's "denial,"
which according to recent research can refer to conscious lying, normal
self-protective biases, lack of awareness, ambivalence or resistance, rather
than as a permanent personality characteristic of the clients. The first
ethical question that emerges is under what conditions can a therapist work
with an unmotivated client and how? A continuum is suggested in which the
therapist goes from passive to more coercive techniques, depending on the
client's level of readiness for change and the severity of the problem. The
basic goal of motivational interventions is to elicit dissonance between the
present behavior, and future goals and values of the client. Another ethical
concern that has been identified is whether or not MI is a
"manipulative" technique in which clients may seem to be made to
change behaviors when they were not intending to, and under processes that are
not easily perceived. The basic purpose of MI is to elicit cognitive dissonance
by having the person describe how his behavior is interfering with the
attainment of other goals that seem important for her/him, so that the
motivation for change comes from within the patient and not imposed by the
therapist or the technique itself.
Abstract by Patricia Juarez
MANUAL
Miller, W.R., Zweben, A., DiClemente, C.C., & Rychtarik, R.G. (1995). Motivational
Enhancement Therapy manual: A clinical research guide for therapists
treating individuals with alcohol abuse and dependence. NIH/NIAAA: Rockville, MD.
This
121 page clinical manual describes the MET procedures used in “Project
MATCH,”
which sought to determine whether subgroups of substance abusers respond
differently to 12-Step Facilitation Therapy, Cognitive-Behavioral Coping Skills
Therapy, and Motivational Enhancement Therapy. In this study, MET was
used in a structured 4-session, individual format and was preceded by
approximately 6-7 hours of intensive biopsychosocial assessment. The first two sessions focus on structured feedback from the
initial assessment, future plans, and motivation for change. The final two
sessions at the midpoint and end treatment provide opportunities for the
therapist to reinforce progress, encourage reassessment, and provide an
objective perspective on the process of change. The sessions were
delivered in the following format: Session 1 at week 1 of the project, Session
2 at Week 2, Session 3 at Week 6, and Session 4 at Week 12.
Visit the
NIAAA web site to learn more about Project MATCH or to obtain this treatment
manual:
http://silk.nih.gov/silk/niaaa1/publication/match.htm
CONCEPTUAL
Miller, W. R. (1995). Increasing
motivation for change. In R. K. Hester & W. R. Miller (Eds.),
Handbook of alcoholism treatment approaches: Effective alternatives (2nd ed.,
pp. 89-104).
Until
recently, motivation was often seen as a personal characteristic of the client.
Similarly, lack of motivation was seen as resulting from defense mechanisms
characteristic of alcoholics. Now it has become more widely accepted that
external environmental and interpersonal factors play a more crucial role in
peoples' motivation for change, and the idea of the "alcoholic
personality" has gradually lost support in the research community.
Therefore, motivation is now conceptualized as involving the recognition of a
problem, a search for a way to change, and implementing and maintaining that
change. This definition suggests a process with different and clearly defined
stages of change. In order to increase peoples' motivation for change, several
strategies have proven successful, which can be conceptualized with the acronym
FRAMES. These aspects refer to providing feedback, emphasis on personal
responsibility, giving advice, suggesting a menu of alternatives, showing
empathic listening, and emphasis on self-efficacy. These elements have lead to
the development of an intervention referred to as "motivational
interviewing," which is basically a nonconfrontational
approach to therapy that emphasizes cognitive dissonance between the present
behavior and the future goals and values of the client. Its main purpose is to help
the client move from precontemplation or
contemplation, to determination and action by emphasizing the clients' personal
responsibility in making the choices, and using an empathic therapeutic style
that avoids argumentation. Usually, the intervention begins with an assessment
(Drinker's Check up), which can be used to give feedback to the client and can
even serve as a sole intervention session. Other important aspects of
motivational interventions include the removal of barriers, the management of
external contingencies, family involvement, some more coercive strategies, and
therapist's persistence. All these characteristics and elements of this type
of
brief motivational interventions have proven to be effective at modifying
drinking behavior in research investigations on their impact, making it a
promising breakthrough in the area of addiction treatment.
Abstract by Patricia Juarez
CONCEPTUAL
Miller, W. R. (1995). The ethics of
motivational interviewing revisited. Behavioral and Cognitive Psychotherapy,
23, 345-348.
This
article is a response to two commentaries on a previous article on the ethics
of motivational interviewing (MI). First it suggests that the ethical
principles that apply to MI also apply to other kinds of psychotherapy, because
of its goals for therapy. However, it is argued that the issue of informed
consent does not apply in the area of psychotherapy, but rather it is an
implied form of consent from the client who is seeking treatment. It is also
suggested that the purpose of all psychotherapies is to influence and change
behavior and that because of these goals, MI and other similar kinds of
psychotherapy should not be seen as unethical. The previous article to which
this present article alludes was written in response to some concerns that
researchers and therapists were having about MI, and not as an attempt to
defend MI from attacks or criticisms. The author claims that one of the most
important and current concerns in MI is to investigate
the conditions that promote long-term change and under what circumstances
should it be applied. Therefore he does not excludes
the posibility that other approaches to psychotherapy
(e.g. Psychoanalysis) may provide significant contributions to, and may benefit
from the MI approach.
Abstract by Patricia Juarez
LITERATURE
REVIEW
Miller, W. R. (1996). Motivational
interviewing: Research, practice and puzzles. Addictive Behaviors, 21, 835-842.
Brief
interventions that include some type of feedback, emphasis on personal
responsibility, advice, a menu of alternatives, empathy, and emphasis on
self-efficacy have been shown to be effective for the treatment of drinking
problems. This success has promoted questions and research on the process of
motivational interviewing (MI) and on the factors that make it work. MI is a
client centered therapeutic approach designed to motivated people to change
problem behaviors by promoting the reduction of ambivalence. The present
article presents a review of the research that led to the development of this
approach. It further presents the current evidence that support the
effectiveness of MI at reducing substance abuse. Even though MI has been shown
to be effective, the mechanisms of change that it promotes, and why is it that
it works, are still puzzling.
Abstract by Patricia Juarez
CONCEPTUAL
Miller, W. R., & Bennett,
M. E. (1996). Treating alcohol problems
in the context of other drug abuse. Alcohol, Health & Research
Work, 20, p.118-123.
It is
commonly found that people who abuse alcohol tend to also abuse other drugs.
This polydrug use may increase the individual's risk
for relapse and for more serious alcohol and other drug related problems. Polydrug users in treatment for alcohol problems tend to
experience less change in their drinking, which may be due to particular
personality characteristics. For this reason, the treatment of only alcohol
abuse while relegating other drug use is highly discouraged,
and it is suggested that a more comprehensive approach to treatment be taken in
these cases. This article discusses the implications of polydrug use
for the treatment of alcohol related disorders, in areas such as assessment,
motivation, treatment design, and outcome evaluation, which should
each be approached in terms of each drug used by the person. Such an approach
will provide a better understanding of the interrelationship of drinking, drug
use, and the psychosocial context in which these drugs are used. Therefore more
comprehensive treatment approaches will be developed, which will have a more
general positive effect on the clients' lives.
Abstract by Patricia Juarez
INSTRUMENT
DEVELOPMENT STUDY
Miller, W. R., & Tonigan, J. S. (1996). Assessing
drinkers' motivation to change: The Stages of Change Readiness and Treatment Eagerness
Scale (SOCRATES). Psychology of addictivve
behaviors, 10, 81-89.
Motivation
for treatment has traditionally been regarded as a personal characteristic of
the clients, and it is considered to be a prerequisite for treatment. On the
contrary, motivation for change is also seen as dynamic states varying on a
continuum, and that are influenced by several factors in the environment. Based
on this idea, a transtheoretical model describing a
sequence of stages people go through while changing a behavior, was developed
by Prochasta and DiClemente
(1982, 1986). The Stages of Change Readiness and Treatment Eagerness Scale
(SOCRATES) is a questionnaire designed to measure motivation to change in
problem drinkers, corresponding these stages of
change. The purpose of the present investigation was to test the reliability of
this measure using data from 1672 participants from a multisite
clinical study and from a test-retest study (N = 82). Factor analysis yielded 3
relatively independent and stable factors: Recognition, Ambivalence, and taking
steps. It was found that scores on the Recognition factor were moderately
correlated to intensity of alcohol consumption and related problems. Similar
scale scores were found for shorter versions of the questionnaire (a 19-item
and a 39 item scales).
Abstract by Patricia Juarez
LITERATURE
REVIEW
Miller, W. R.,
Andrews, N. R., Wilbourne, P., & Bennett, M. E.
(1998). A wealth of alternatives: Effective treatments for alcohol
problems. In W. R. Miller & N. Heather (Eds.), Treating addictive
behaviors: Processes of change (2nd ed., pp. 121-132).
The
treatment for alcohol and substance abuse has been relatively reluctant to
respond to new scientific developments and results, creating a gap between research
and practice. The present chapter presents a summary of the research on alcohol
abuse treatment. It specifically focuses on a project called "Mesa
Grande", which is an attempt to review and summarize the methodologies and
results of controlled trials of treatments for alcohol problems. Each study
reviewed was rated in terms of its methodological quality and outcome, giving a
rating of the study's overall efficacy. It was found, that treatments differ
significantly on their effectiveness. The two treatment approaches found to
have the greatest positive impact were brief interventions and MET. When
combined, these two approaches attempt to elicit the client's motivation for
change, and they generally include six basic components (feedback, emphasis on
client's responsibility, advice, menu of alternatives for change, empathic
listening, and building self-efficacy). Another strategy found to be very
effective was the teaching of general coping, social and/or self-control
skills. Community reinforcement approach was also found to be a very effective
therapeutic technique. Its main purpose is to change the client's social
environment by clients can learn to receive positive reinforcement without
alcohol. On the other hand, treatments involving medications, and those
referred to as "family therapy" have given generally modest or
puzzling results due to the lack of controlled trials or definitional problems.
The treatment approaches that were found to result in either no or detrimental
impact on drinking were educational approaches, psychodynamic techniques,
confrontational approaches, undifferentiated types of individual or group
therapy, relaxation and stress management training, and residential treatments.
Three other crucial findings of the "Mesa Grande" project were first
that therapist styles have significant effects on clients, such that therapist
empathy has significant positive and long term effects on drinking behavior.
Another crucial finding was that when therapists demonstrate genuine and active
interests on their clients, they show significantly better results. Finally,
one of the best predictors of change was found to be just doing
"something" toward change and adhering to treatment.
Abstract by Patricia Juarez
CONCEPTUAL
Miller, W. R. (1998). Why do people change
addictive behavior? The 1996 H. David Archibald Lecture. Addiction, 93,
163-172.
It
is widely recognized that addictions are established due to the pleasant
effects
of the addictive agent. But still some questions remain: Why not all people
become addictive? And what are the processes of recovery from addictions? The
most common answer to the second question tends to be that it is through some
kind of treatment, but this answer only elicits more questions. Some of these
questions are: what aspects of the "treatment" process promote the
most behavior change? Which therapist characteristics elicit more positive
outcomes? Why is it that some people change outside of the context of
treatment? Substantial research addressing these questions
suggest that treatment doesn't seem to be neither a necessary nor a
sufficient condition for change. Therefore, change must be explained through
other more natural models and factors, such as different stages of change,
self-efficacy, ambivalence, discrepancy, and a shift in meaning. Final remarks
for integration of these factors, and future directions for research, are
discussed in detail.
Abstract by Patricia Juarez
CONCEPTUAL
Miller, W. R.
(1998) Enhancing motivation to change. In W. R. Miller & N. Heather (Eds), Treating Addictive Behaviors: Processes of Change
(2nd ed., pp.; 121-132).
It is now
widely acknowledged that motivation is a crucial component of behavior change,
especially so in the area of addictive behaviors. People with problems of
addiction often recognize the risks involved but nevertheless, they continue
engaging in those behaviors. It is therefore suggested that addiction problems
could be best approached from the concept of motivation, defined as the
probability of behavior to do something better. Therefore the question is how
to help clients feel motivated to do something to improve their situation. The
purpose of this chapter is to summarize research contributions to the
enhancement of client motivation, in three basic topics: therapeutic style,
motivational techniques, and the broader context of behavior change. A
motivational therapeutic style involves the understanding of ambivalence,
avoidance of the confrontational-denial trap, a rejection of the authoritarian
approach, understanding of the natural processes of change, recognition of the
locus of change within the client, transmit a belief
in the possibility of change to clients, empathic listening, and a supportive
attitude towards the client. The motivational techniques include facilitating
and supporting client compliance, developing discrepancy, and providing a menu
of alternatives for change. Finally, in the broader context of change, one has
to also consider alternative reinforcers for the
client, which may imply working with significant others and modifying the
social environment. In summary, the purpose of motivational interviewing is to
help people see that their addiction is endangering that which they value most.
Abstract by Patricia Juarez
LITERATURE REVIEW
Miller, W. R., Andrews, N. R., Wilbourne, P., & Bennett, M. E. (1998). A wealth of
alternatives: Effective treatments for alcohol problems. In W. R. Miller & N.
Heather (Eds.), Treating addictive behaviors: Processes of change (2nd ed., pp.
121-132).
The
treatment for alcohol and substance abuse has been relatively reluctant to
respond to new scientific developments and results, creating a gap between
research and practice. The present chapter presents a summary of the research
on alcohol abuse treatment. It specifically focuses on a project called "Mesa Grande", which is an attempt to review and summarize the
methodologies and results of controlled trials of treatments for alcohol problems.
Each study reviewed was rated in terms of its methodological quality and
outcome, giving a rating of the study's overall efficacy. It was found, that
treatments differ significantly on their effectiveness. The two treatment
approaches found to have the greatest positive impact were brief interventions
and MET. When combined, these two approaches attempt to elicit the client's
motivation for change, and they generally include six basic components
(feedback, emphasis on client's responsibility, advice, menu of alternatives
for change, empathic listening, and building self-efficacy). Another strategy
found to be very effective was the teaching of general coping, social and/or
self-control skills. Community reinforcement approach was also found to be a
very effective therapeutic technique. Its main purpose is to change the
client's social environment by clients can learn to receive positive
reinforcement without alcohol. On the other hand, treatments involving
medications, and those referred to as "family therapy" have given
generally modest or puzzling results due to the lack of controlled trials or
definitional problems. The treatment approaches that were found to result in
either no or detrimental impact on drinking were educational approaches,
psychodynamic techniques, confrontational approaches, undifferentiated types of
individual or group therapy, relaxation and stress management training, and
residential treatments. Three other crucial findings of the "Mesa
Grande" project were first that therapist styles have significant effects
on clients, such that therapist empathy has significant positive and long term
effects on drinking behavior. Another crucial finding was that when therapists
demonstrate genuine and active interests on their clients, they show significantly
better results. Finally, one of the best predictors of change was found to be
just doing "something" toward change and adhering to treatment.
Abstract by Patricia Juarez
TRAINING STUDY
Miller, W. R., & Mount, K. A. (in press). A small study
of training in motivational interviewing: Does one workshop change clinician
and client behavior? Behavioural and Cognitive Psychotherapy.
In
teaching motivational interviewing, as well as many other approaches,
professional training often relies upon a one-time clinical workshop. Little is
known, however, about whether such workshops actually change practice behavior.
We trained 22 counselors in a 2-day workshop, of whom 15 provided us with taped
practice samples before and immediately after training, and again 4 months
later. We developed a structured Motivational Interviewing Skill Code (MISC)
for recording counselor and client behavior in these sessions. On self-report
questionnaires, practitioners reported large increases in their motivational
interviewing skills. Coding of the practice sample tapes indicated modest but
statistically significant changes in practice samples immediately after
training, which were largely retained 4 months later.
Certain client responses that are predictive if better
outcomes, however, showed no change. We conclude that although practice
behavior was modified to a modest extent, the effect of a one-time workshop was
not sufficient to make any difference in client response. In essence, we added
a few MI-consistent behaviors to an existing counseling style, without reducing
other responses associated with less favorable outcomes. Training in MI may
therefore need to focus not only on shaping up MI-consistent responses, but
also on suppressing MI-inconsistent counseling habits. Abstract by Bill
Miller
Monti,
P., Colby, S., Barnett, N., Spirito, A., Rohsenow, D,, Myers, M., Woolard,
R. & Lewander,
W. (1999) Brief intervention for harm
reduction with alcohol-positive older adolescents in a hospital emergency
department, Journal of Consultin and Clinical
Psychology, vol. 67, no. 6, 989-994.
18-24
year olds have the highest rates of alcohol consumption and represent the
largest percentage of problem drinkers, according to the U.S. Dept. of Health
and Human Services in 1997. This study
evaluated the use of a brief motivational interview (MI) to reduce
alcohol-related consequences and use among adolescents treated in an emergency
room.(ER) following an alcohol-related event. 94
patients, ages 18 and 19, were split into two groups: MI or standard care (SC).
SC consisted of a handout on avoiding drinking and driving and a list of local
treatment agencies, Assessment and intervention were conducted in the emergency
room itself. Follow-up was scheduled at
three months and six months. Results showed that patients who received MI had
significantly lower incidence of drinking and driving, traffic violations,
alcohol-related injuries, and alcohol-related problems, Both groups showed reduced alcohol
consumption.
CONCEPTUAL
Moyers, T.B. (2001). Motivational interviewing.
In J.L. Sorenson, R.A. Rawson, J. Guydish, & J.A. Zweben (Eds.): Drug Abuse Treatment through
Collaboration (pp. 139-150).
This general overview of Motivational Interviewing (MI) first discussed the underlying assumption of MI, which is a client-centered approach to facilitating behavior change by helping clients explore ambivalence about change in a non-confrontational manner. Four principles are introduced to aid therapists in engaging in MI, including expressing empathy, developing a discrepancy, rolling with resistance, and supporting self-efficacy. Clinical vignettes are offered to demonstrate these concepts. In addition, research on the efficacy of MI in the treatment of substance use is summarized, and discussion of the complexities involved in disseminating this research is offered.
CONCEPTUAL
Moyers, T.B. & Rollnick, S. (2002). A motivational interviewing perspective on resistance in psychotherapy, 58, 185-193.
While resistance has been traditionally viewed as a solely client characteristic, this article discusses resistance within the framework of motivational interviewing (MI). From this perspective, resistance is viewed as a product of the interaction between therapist and client. While the client may enter the therapeutic relationship with some level of resistance, this inevitably interacts with therapist behaviors, such as confrontation, which may increase, or acceptance, which may decrease, resistance level. MI techniques, such as rolling with resistance, reflective responding, strategic responding, and an appropriate level of therapist investment in client goals seem to be therapeutic behaviors which facilitate reductions in resistance. Several case vignettes, in which these techniques are used to successfully reduce resistance are offered.
Abstract by Jennifer Hettema
CONCEPTUAL
Moyers, T., Martin, T., Catley, D., Harris, K.J., & Ahluwalia,
J.S. (2003). Assessing the integrity of motivational interviewing interventions:
Reliability of the motivational interviewing skills code. Behavioural and
Cognitive Psychotherapy, 31, 177-184.
Motivational interviewing (MI) has been demonstrated to be an effective prelude to other treatments and an effective treatment on its own. However, as is often the case with treatment outcome research, the actual treatments that are provided under the label of MI vary dramatically. In response to this, a Motivational Interviewing Skills Code (MISC) was developed to quantify MI components during therapy. The integrity and reliability of this instrument was investigated in this study. 86 audiotapes from an effectiveness study of MI and buprprion were coded using the MISC by upper level psychology graduate students. Global measures of therapist, client, and interactions variables and behavior counts were double coded for a twenty minute sample of each tape. Reliability coefficients indicated that, while most global rating intraclass correlation coefficients tended to be in the good to excellent range, while less than half of the behavior count reliability levels were in this range. Collapsing scores to determine overall clinician adherence were more acceptable.
Abstract by Jennifer Hettema
Nochajski, T.H., Stasiewicz, P.R., & Gonzales, S. (XXXX). Use of Motivational Interviewing to Engage and Retain DWI Offenders in Treatment. On internet can’t find source.
DWI offenders are at a high risk for recidivism and often fail to seek and complete treatment. In this study, 25 DWI offenders were assessed and given feedback in a motivational interviewing (MI) style. All participants were then encouraged to attend harm reduction treatment. Twenty-two of the participants attended treatment and number of treatment sessions attended was quite high. Among those who attended treatment, no recidivism had occurred at approximately two-year follow-up.
PROCESS STUDY
Nye, E. C., Agostinelli,
G., & Smith, J. E. (1999). Enhancing
alcohol problem recognition: A self-regulation model for the effects of
self-focusing and normative information. Journal of Studies on Alcohol,
60, 658-693.
This
study investigated the individual and joint effects of self-monitoring and
self-evaluation processes in the problem recognition of heavy drinking college
students. These two processes have been suggested to lead to a discrepancy
between present behavior and some other goal or standard, which in turns leads
to problem recognition. 72 heavy drinkers were randomly assigned to one of 4
conditions: self-focusing information plus normative information, self-focusing
information alone, normative information alone, and control. It was found that
when either of the two types of information was presented alone, they elicited
the most negative evaluations of one's drinking, and the largest problem
recognition or least denial, as measured by a decisional balance measure (DBM)
the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) and by
verbal self-reports on immediate reactions to the information. On the other
hand, it was found that presenting both kinds of information together decreased
problem recognition and failed to decrease the positive evaluations of one's
drinking. This last finding was suggested to be due to a defensive/denial
reaction to the information, which is commonly observed in confrontational
approaches for alcohol abuse. These last effects appeared to be moderated by "self-deception",
so that the most self-deceptive participants tended to react more defensively
and to evaluate alcohol use more favorably. Of
similar importance, participants who received self-focusing information alone
reacted the least defensively, and showed the most problem recognition across
all dependent measures.
Abstract by Patricia Juarez
MANUAL
Obert, J. L., Rawson,
R. A., Miotto, K. (1997). Substance Abuse Treatment
for "Hazardous Users": An Early Intervention Journal of Psychoactive
Drugs, July-September 1997, Vol. 29(3).
A
six-session cognitive behavioral protocol has been developed for substance
abusers who meet the description "hazardous users." This category
includes individuals evidencing mild to moderate use of alcohol or other drugs,
whose lifestyles are minimally disrupted, or who are displaying signs of
problem use or abuse, but are unwilling to enter intensive treatment. The
treatment model in non-confrontational and is designed to motivate the
individual to recognize the problems associated with his or her substance use
and initiate treatment-seeking behavior. The intervention may be particularly
useful in situations where employees have tested positive for substances but
deny having a problem, where friends or family members report help is needed
but the individual denies any problem, or where an alcohol or other drug
problem is clearly evidenced but the individual doesn't acknowledge a problem.
A positive outcome is indicated by the client taking action which is consistent
with an increased awareness of the problem as conceptualized by Prochaska and DiClemente (1982).
This model is an alternative to the traditional confrontational models of "breaking through denial." The
philosophies employed by William Miller and associates and by the Matrix treatment
models form the basis of the
intervention.
CONCEPTUAL
O’Leary, T.A., Brown, S., Colby, S.M., Cronce, J.M., D’Amico, J.D., Fader, J.S., Geisner, I.M., Larimer, M.E., Maggs, J.L., McCrady, B., Palmer, R.S., Schluneberg, J., & Monti, P.M. (2002). Treating adolescents together or individually? Issues in adolescent substance abuse interventions. Alcoholism: Clinical and Experimental Research, 26, 890-899.
This article is a summary of a
symposium, led by Peter Monti and Tracey O’Leary, at
the 2001 Research Society on Alcoholism meeting in
Abstract by Jennifer Hettema
PROCESS
STUDY
Patterson, G. A., & Forgatch, M. S.
(1985). Therapist behavior as a determinant for client non compliance: A
paradox for the behavior modifier. Journal of Consulting and Clinical
Psychology, 53, 846-851.
It has been observed that some therapeutic conditions designed to help clients often have quite the opposite effect. The present two studies were conducted to investigate the impact of therapists' behaviors on the noncompliance of patients. Client noncompliance was suggested to be determined both by personal and social factors, and by therapists' attempts to intervene. Client noncompliance was analyzed via observable behaviors during psychotherapy, and by client compliance to the treatment, which together would be expected to predict treatment results. Videos of parent training sessions where analyzed and coded for therapists' behaviors in both studies. In the first study, it was found that therapists' attempts to teach and confront were associated with higher client noncompliance, whereas efforts to support or facilitate were associated with lower client noncompliance. The second study provided further support for these findings, such that client noncompliance increased when therapists showed directive behaviors (i.e. teach and confront), whereas client noncompliance decreased as these behaviors also decreased. It was further suggested that client noncompliance may also influence the behavior of the therapist, so that the client may even be evaluated in a negative way, creating a self-perpetuating spiral.
Abstract by Patricia Juarez
PROCESS
STUDY
Peterson, T. R., Waldron, H. B., & Miller,
W. R. (1996) A sequential analysis of client and therapist behaviors
during motivational enhancement therapy for problem drinking.
Recent
advancements in the treatment can be suggested to be based on careful analysis
of processes that occur during therapy. A recent therapeutic style designed to
motivate people to change behaviors, called motivational enhancement therapy
(MET), is a brief intervention specifically designed to treat addictive
behaviors and problem drinking which might prove useful as a test for these
therapeutic processes. In the present investigation, 22 therapeutic sessions
were taped for 30 minutes in which clients were employing the MET techniques.
These tapes were later coded with a behavioral coding system, and analyzed in
order to observe the therapists' behaviors and see how these related to therapy
outcome and clients' reactions and cooperation during therapy. The intervention
consisted of 4 sessions where the goal was to help clients move towards higher
stages of change and behavior change commitment. The basic components of this
type of therapy are the development of clients' discrepancy between present
behavior and future goals, reduction of ambivalence, reduction of client
resistance, use of empathic listening, and the reinforcement of self-motivation
statements from the clients. After conducting a sequential analysis of the
therapist-client interactions, it was found that the more support the therapist
demonstrated towards the client, the more cooperation and the less resistance
was showed by the client. Furthermore, it was observed that the more
confrontation the therapist employed, the more resistance and less cooperation was elicited from the client.
Abstract by Patricia Juarez
OUTCOME
STUDY
Picciano, J. F., Roffman, R.A.,
This
study targeted men who have sex with men (MSM) and specifically, those men who
were currently engaging in unsafe sex practices in the
OUTCOME
STUDY
Project CHOICES Intervention Research Group. Reducing
the risk of alcohol-exposed pregnancies: A study of a motivational intervention
in community settings. Pediatrics, 111, 1131-1135.
Women drinking at high levels and practicing poor contraception are at risk for alcohol exposed pregnancies and having babies with fetal alcohol syndrome. In this pilot study, women attending six community-based settings, including jails, drug and alcohol treatment centers, and primary care practices, were screened for at risk drinking and poor contraception use. 190 eligible women then received an intervention consisting of four sessions of motivation interviewing and one session of contraception counseling. At a six month follow-up point, 68.5% of the women were no longer at an increased risk of having an alcohol exposed pregnancy, either because they reduced their alcohol intake below risk levels, or they began using effective contraception. 12.6% reduced drinking only, while 23.1% decreased their risk for pregnancy. 32.9% improved on both risk factors.
Abstract by Jennifer Hettema
OUTCOME STUDY
Project MATCH Research Group (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH post-treatment drinking outcomes. Journal of Studies on Alcohol, 58, 7-29.
This article discusses the one-year outcomes of clients in Project MATCH a multi-site study comparing Twelve-Step Facilitation (TSF), Motivational Enhancement Therapy (MET), and Cognitive-Behavioral Therapy (CBT) among outpatient and aftercare clients. Similar improvements in drinking outcomes were observed among all the treatments and few differences among treatments were observed. Clients were thoroughly assessed prior to treatment to determine the existence of any potential matching characteristics which could be used to predict differential response to treatment based on pre-treatment variable. Only on matching hypothesis was confirmed, with individual slow in psychiatric severity having more abstinent days in TSF compared to CBT.
OUTCOME STUDY
Project MATCH Research Group (1997). Project
MATCH secondary a priori hypotheses. Addiction, 92, 1671-1698.
The
purpose of the present investigation was to see if clients would benefit
more from three different
kinds of treatment if they were matched to one of them on the basis of 11
client characteristics. This report also discussed the implications of the
project's results and of they hypothesis that were previously reported.
Participants were either receiving outpatient therapy or aftercare therapy
after inpatient treatment or hospitalization. Participants from these two
settings were randomly assigned to either Cognitive Behavioral Coping Skills
Therapy (CBT), Motivational Enhancement Therapy (MET), or to Twelve-Step
Facilitation Therapy (TSF). The three conditions were all 12-week,
manual-guided, individual treatments. All participants were monitored for 15
months, which included a 1 year follow-up assessment after the treatment
intervention. 17 previously specified contrasts were conducted in terms of
client attributes. It was found that those outpatient participants who reported
high levels of anger and received MET reported drinking less than those who
received CBT. The aftercare clients who reported high levels of alcohol
dependence showed more positive results in their drinking when they received
TSF; while those who were low on alcohol dependence were more benefited by CBT.
It is suggested that these two client characteristics be taken into account as
useful matching attributes for these treatments.
Abstract by Patricia Juarez
This study examined therapist differences in administering three different psychosocial treatments for alcohol problems within a multisite (N = 1726) randomized trial. Therapist (N = 80) were specifically trained to conduct twelve-step facilitation (TSF), cognitive-behavioral skills training (CBT), or motivational enhancement therapy (MET). The following questions were explored: How did therapist characteristics vary across the three treatments? Did the therapist vary in their effectiveness in treating alcohol problems within treatments? What therapist characteristics were associated with better retention and outcome in alcohol treatment? TSF therapists were significantly older (7 years) than CBT, but not significantly older than MET. TSF had significantly fewer years of formal education than both CBT and MET. TSF were 6 times more likely to have had a history of alcohol problems than both CBT and MET, and 95% reported having a problem drinker or alcoholic in their immediate family, compared with 52% in CBT and 62% in MET. TSF therapist were also more likely to support a disease model of alcoholism and were less likely to endorse psychosocial views of alcoholism. TSF therapist were also found to have a higher rate of spiritual/religious practices than that of CBT and MET. No therapist effectiveness in treatment retention was found to differ between TSF, CBT, and MET. Significant therapist effects were found in client satisfaction and drinking outcomes. Therapist attributes did predict client outcome. TSF therapist with fewer years of education, experience, and with a higher need for aggression and lower scores on both masculinity and femininity had more favorable outcomes during aftercare treatment. MET therapist in aftercare sites with a lower need for aggression and higher need for nurturance was partially correlated to client abstinence. No CBT therapist attributes were predictive of client outcomes. Therapist with unusually poor outcomes accounted for most of the observed effects.
Abstract by Julie Steele
This study examined therapist differences in administering three different psychosocial treatments for alcohol problems within a multisite (N = 1726) randomized trial. Therapist (N = 80) were specifically trained to conduct twelve-step facilitation (TSF), cognitive-behavioral skills training (CBT), or motivational enhancement therapy (MET). The following questions were explored: How did therapist characteristics vary across the three treatments? Did the therapist vary in their effectiveness in treating alcohol problems within treatments? What therapist characteristics were associated with better retention and outcome in alcohol treatment? TSF therapists were significantly older (7 years) than CBT, but not significantly older than MET. TSF had significantly fewer years of formal education than both CBT and MET. TSF were 6 times more likely to have had a history of alcohol problems than both CBT and MET, and 95% reported having a problem drinker or alcoholic in their immediate family, compared with 52% in CBT and 62% in MET. TSF therapist were also more likely to support a disease model of alcoholism and were less likely to endorse psychosocial views of alcoholism. TSF therapist were also found to have a higher rate of spiritual/religious practices than that of CBT and MET. No therapist effectiveness in treatment retention was found to differ between TSF, CBT, and MET. Significant therapist effects were found in client satisfaction and drinking outcomes. Therapist attributes did predict client outcome. TSF therapist with fewer years of education, experience, and with a higher need for aggression and lower scores on both masculinity and femininity had more favorable outcomes during aftercare treatment. MET therapist in aftercare sites with a lower need for aggression and higher need for nurturance was partially correlated to client abstinence. No CBT therapist attributes were predictive of client outcomes. Therapist with unusually poor outcomes accounted for most of the observed effects.
Abstract
by Julie Steele
This study examined therapist differences in administering three different psychosocial treatments for alcohol problems within a multisite (N = 1726) randomized trial. Therapist (N = 80) were specifically trained to conduct twelve-step facilitation (TSF), cognitive-behavioral skills training (CBT), or motivational enhancement therapy (MET). The following questions were explored: How did therapist characteristics vary across the three treatments? Did the therapist vary in their effectiveness in treating alcohol problems within treatments? What therapist characteristics were associated with better retention and outcome in alcohol treatment? TSF therapists were significantly older (7 years) than CBT, but not significantly older than MET. TSF had significantly fewer years of formal education than both CBT and MET. TSF were 6 times more likely to have had a history of alcohol problems than both CBT and MET, and 95% reported having a problem drinker or alcoholic in their immediate family, compared with 52% in CBT and 62% in MET. TSF therapist were also more likely to support a disease model of alcoholism and were less likely to endorse psychosocial views of alcoholism. TSF therapist were also found to have a higher rate of spiritual/religious practices than that of CBT and MET. No therapist effectiveness in treatment retention was found to differ between TSF, CBT, and MET. Significant therapist effects were found in client satisfaction and drinking outcomes. Therapist attributes did predict client outcome. TSF therapist with fewer years of education, experience, and with a higher need for aggression and lower scores on both masculinity and femininity had more favorable outcomes during aftercare treatment. MET therapist in aftercare sites with a lower need for aggression and higher need for nurturance was partially correlated to client abstinence. No CBT therapist attributes were predictive of client outcomes. Therapist with unusually poor outcomes accounted for most of the observed effects.
Abstract
by Julie Steele
CONCEPTUAL
Quick, R. (2003). Changing community behaviour:
experience from three African countries.
International Journal of Environmental Health
Research, 13, S115-S121.