MOTIVATIONAL INTERVIEWING

Motivational Interviewing and Substance Abuse Treatment



Motivational Interviewing and Substance Abuse Treatment

Introduction

More than 76 million people worldwide have alcohol problems, and another 15 million have drug problems. Motivational interviewing (MI) is a psychological treatment that aims to help people cut down or stop using drugs and alcohol. The drug abuser and counselor typically meet between one and four times for about one hour each time. The counselor expresses that he or she understands how the clients feel about their problem and supports the clients in making their own decisions. He or she does not try to convince the client to change anything, but discusses with the client possible consequences of changing or staying the same. Finally, they discuss the clients' goals and where they are today relative to these goals.

Literature Review

Motivational interviewing (MI), a treatment strategy developed to enhance motivation for change has strong empirical support in trials with a number of substance-using populations, particularly problem drinkers. MI's burgeoning empirical base and its short-term nature, coupled with the pressures exerted by the treatment system and third party payors to reduce costs and improve client retention and treatment outcomes, have led to MI's being broadly applied in a range of substance abuse treatment settings (Babor et al, 2000).

However, there remain a number of important and largely unaddressed issues regarding MI's efficacy in non-research community settings and among diverse populations of substance users. First, although the bulk of studies evaluating MI with drug-using populations have suggested that MI is more effective than no treatment or comparison approaches, several well-conducted studies evaluating MI with comparatively large samples of drug-using individuals have yielded few significant differences between MI and standard care comparison conditions. Second, because the bulk of studies evaluating MI with drug users have evaluated the efficacy of adding an additional MI session to standard treatment, there are relatively few data on the effectiveness of MI under the conditions in which it is most likely to be applied in clinical practice, that is, integrating MI techniques into standard treatment approaches (Delboca, 2002).

Third, there are also comparatively little data on the effectiveness of MI in clinical practice and how best to disseminate MI to the clinical community. Only a handful of studies have evaluated the ability of 'real world' clinicians in community-based settings to learn and implement MI effectively. Delboca, (2002) reported on an uncontrolled evaluation of the impact of a 2-day clinical training workshop on 44 participants' knowledge and practice of MI. Participants' knowledge of MI (assessed through a 15-item multiple choice test) increased after attending the workshop, as did their articulation of statements reflecting techniques of MI in response to written vignettes. Subsequent training trials have suggested a single workshop may be associated with some change in clinician behavior, but these changes may not be substantial enough to strongly affect patient response and that coaching and feedback appear to be essential for effective implementation of MI. Finally, comparatively few studies have addressed critical internal validity issues in the effectiveness of ...