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Schwenker R, Dietrich CE, Hirpa S, Nothacker M, Smedslund G, Frese T, Unverzagt S. Motivational interviewing for substance use reduction. Cochrane Database Syst Rev 2023; 12:CD008063. [PMID: 38084817 PMCID: PMC10714668 DOI: 10.1002/14651858.cd008063.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Substance use is a global issue, with around 30 to 35 million individuals estimated to have a substance-use disorder. Motivational interviewing (MI) is a client-centred method that aims to strengthen a person's motivation and commitment to a specific goal by exploring their reasons for change and resolving ambivalence, in an atmosphere of acceptance and compassion. This review updates the 2011 version by Smedslund and colleagues. OBJECTIVES To assess the effectiveness of motivational interviewing for substance use on the extent of substance use, readiness to change, and retention in treatment. SEARCH METHODS We searched 18 electronic databases, six websites, four mailing lists, and the reference lists of included studies and reviews. The last search dates were in February 2021 and November 2022. SELECTION CRITERIA We included randomised controlled trials with individuals using drugs, alcohol, or both. Interventions were MI or motivational enhancement therapy (MET), delivered individually and face to face. Eligible control interventions were no intervention, treatment as usual, assessment and feedback, or other active intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, and assessed the certainty of evidence with GRADE. We conducted meta-analyses for the three outcomes (extent of substance use, readiness to change, retention in treatment) at four time points (post-intervention, short-, medium-, and long-term follow-up). MAIN RESULTS We included 93 studies with 22,776 participants. MI was delivered in one to nine sessions. Session durations varied, from as little as 10 minutes to as long as 148 minutes per session, across included studies. Study settings included inpatient and outpatient clinics, universities, army recruitment centres, veterans' health centres, and prisons. We judged 69 studies to be at high risk of bias in at least one domain and 24 studies to be at low or unclear risk. Comparing MI to no intervention revealed a small to moderate effect of MI in substance use post-intervention (standardised mean difference (SMD) 0.48, 95% confidence interval (CI) 0.07 to 0.89; I2 = 75%; 6 studies, 471 participants; low-certainty evidence). The effect was weaker at short-term follow-up (SMD 0.20, 95% CI 0.12 to 0.28; 19 studies, 3351 participants; very low-certainty evidence). This comparison revealed a difference in favour of MI at medium-term follow-up (SMD 0.12, 95% CI 0.05 to 0.20; 16 studies, 3137 participants; low-certainty evidence) and no difference at long-term follow-up (SMD 0.12, 95% CI -0.00 to 0.25; 9 studies, 1525 participants; very low-certainty evidence). There was no difference in readiness to change (SMD 0.05, 95% CI -0.11 to 0.22; 5 studies, 1495 participants; very low-certainty evidence). Retention in treatment was slightly higher with MI (SMD 0.26, 95% CI -0.00 to 0.52; 2 studies, 427 participants; very low-certainty evidence). Comparing MI to treatment as usual revealed a very small negative effect in substance use post-intervention (SMD -0.14, 95% CI -0.27 to -0.02; 5 studies, 976 participants; very low-certainty evidence). There was no difference at short-term follow-up (SMD 0.07, 95% CI -0.03 to 0.17; 14 studies, 3066 participants), a very small benefit of MI at medium-term follow-up (SMD 0.12, 95% CI 0.02 to 0.22; 9 studies, 1624 participants), and no difference at long-term follow-up (SMD 0.06, 95% CI -0.05 to 0.17; 8 studies, 1449 participants), all with low-certainty evidence. There was no difference in readiness to change (SMD 0.06, 95% CI -0.27 to 0.39; 2 studies, 150 participants) and retention in treatment (SMD -0.09, 95% CI -0.34 to 0.16; 5 studies, 1295 participants), both with very low-certainty evidence. Comparing MI to assessment and feedback revealed no difference in substance use at short-term follow-up (SMD 0.09, 95% CI -0.05 to 0.23; 7 studies, 854 participants; low-certainty evidence). A small benefit for MI was shown at medium-term (SMD 0.24, 95% CI 0.08 to 0.40; 6 studies, 688 participants) and long-term follow-up (SMD 0.24, 95% CI 0.07 to 0.41; 3 studies, 448 participants), both with moderate-certainty evidence. None of the studies in this comparison measured substance use at the post-intervention time point, readiness to change, and retention in treatment. Comparing MI to another active intervention revealed no difference in substance use at any follow-up time point, all with low-certainty evidence: post-intervention (SMD 0.07, 95% CI -0.15 to 0.29; 3 studies, 338 participants); short-term (SMD 0.05, 95% CI -0.03 to 0.13; 18 studies, 2795 participants); medium-term (SMD 0.08, 95% CI -0.01 to 0.17; 15 studies, 2352 participants); and long-term follow-up (SMD 0.03, 95% CI -0.07 to 0.13; 10 studies, 1908 participants). There was no difference in readiness to change (SMD 0.15, 95% CI -0.00 to 0.30; 5 studies, 988 participants; low-certainty evidence) and retention in treatment (SMD -0.04, 95% CI -0.23 to 0.14; 12 studies, 1945 participants; moderate-certainty evidence). We downgraded the certainty of evidence due to inconsistency, study limitations, publication bias, and imprecision. AUTHORS' CONCLUSIONS Motivational interviewing may reduce substance use compared with no intervention up to a short follow-up period. MI probably reduces substance use slightly compared with assessment and feedback over medium- and long-term periods. MI may make little to no difference to substance use compared to treatment as usual and another active intervention. It is unclear if MI has an effect on readiness to change and retention in treatment. The studies included in this review were heterogeneous in many respects, including the characteristics of participants, substance(s) used, and interventions. Given the widespread use of MI and the many studies examining MI, it is very important that counsellors adhere to and report quality conditions so that only studies in which the intervention implemented was actually MI are included in evidence syntheses and systematic reviews. Overall, we have moderate to no confidence in the evidence, which forces us to be careful about our conclusions. Consequently, future studies are likely to change the findings and conclusions of this review.
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Affiliation(s)
- Rosemarie Schwenker
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Carla Emilia Dietrich
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Selamawit Hirpa
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany, Berlin, c/o Philipps University Marburg, Berlin & Marburg, Germany
| | | | - Thomas Frese
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
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Abstract
This review traces the development of motivational interviewing (MI) from its happenstance beginnings and the first description published in this journal in 1983, to its continuing evolution as a method that is now in widespread practice in many professions, nations and languages. The efficacy of MI has been documented in hundreds of controlled clinical trials, and extensive process research sheds light on why and how it works. Developing proficiency in MI is facilitated by feedback and coaching based on observed practice after initial training. The author reflects on parallels between MI core processes and the characteristics found in 70 years of psychotherapy research to distinguish more effective therapists. This suggests that MI offers an evidence-based therapeutic style for delivering other treatments more effectively. The most common use of MI now is indeed in combination with other treatment methods such as cognitive behaviour therapies.
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Affiliation(s)
- William R Miller
- Department of Psychology, The University of New Mexico, Albuquerque, NM, USA
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3
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Merrin GJ, Low S. Who Benefits from Universal SEL Programming?: Assessment of Second Step© Using a Growth Mixture Modeling Approach. SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-022-09542-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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4
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Scheer JR, Batchelder AW, Bochicchio LA, Kidd JD, Hughes TL. Alcohol use, behavioral and mental health help-seeking, and treatment satisfaction among sexual minority women. Alcohol Clin Exp Res 2022; 46:641-656. [PMID: 35318685 PMCID: PMC9018513 DOI: 10.1111/acer.14789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/23/2022] [Accepted: 01/31/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Sexual minority women (SMW) report higher rates of heavy episodic drinking (HED) and adverse alcohol-related outcomes, including poor mental health, than heterosexual women. These disparities indicate a greater need for behavioral and mental health treatment for SMW. This study examined associations among alcohol outcomes, behavioral and mental health help-seeking, and treatment satisfaction among SMW by age, sexual identity, race/ethnicity, and income. METHODS Participants included a community sample of 695 SMW (Mage = 40.0, SD = 14.1; 74.1% lesbian, 25.9% bisexual; 37.6% White, 35.8% Black, 23.2% Latinx; 26.3% annual income $14,999 or less). We used bivariate analyses to characterize the sample's demographic characteristics and multivariable logistic regression analyses to examine associations among variables. RESULTS SMW subgroups based on age, race/ethnicity, and annual income differed in alcohol outcomes (i.e., HED, DSM-IV alcohol dependence, alcohol-related problem consequences, alcohol problem recognition, and motivation to reduce drinking); help-seeking; and treatment satisfaction. SMW who engaged in help-seeking for alcohol-related concerns were more likely than those who did not to meet criteria for DSM-IV alcohol dependence (adjusted odds ratio [aOR] = 7.13; 95% CI = 2.77; 18.36), endorse alcohol-related problem consequences (aOR = 11.44; 95% CI = 3.88; 33.71), recognize problematic drinking (aOR = 14.56; 95% CI = 3.37; 62.97), and report motivation to reduce drinking (aOR = 5.26; 95% CI = 1.74; 15.88). SMW's alcohol outcomes did not differ based on their satisfaction with treatment or with providers. CONCLUSIONS This study's findings confirm SMW's elevated risk for HED and other alcohol-related outcomes and underscore the importance of identity-affirmative and accessible behavioral and mental health treatment for young, Black, and low-income SMW. Clinicians and intervention scientists should develop or enhance existing brief behavioral and mental health treatments for SMW engaging in HED who may not recognize that their drinking is problematic or who are not motivated to reduce drinking.
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Affiliation(s)
| | - Abigail W. Batchelder
- Harvard Medical School, Harvard University, Boston, MA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | - Lauren A. Bochicchio
- School of Nursing and Department of Psychiatry, Columbia University, New York, NY
| | - Jeremy D. Kidd
- Columbia University Irving Medical Center, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Tonda L. Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, NY
- Columbia University Irving Medical Center, New York, NY
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5
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Deutsch AR, Lustfield R, Hanson JD. Where there's a will, there's a way? Strategies to reduce or abstain from alcohol use developed by Northern Plains American Indian women participating in a brief, alcohol-exposed pregnancy preconceptual intervention. Alcohol Clin Exp Res 2021; 45:2383-2395. [PMID: 34585745 DOI: 10.1111/acer.14721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol-exposed pregnancy (AEP) is an ongoing concern, especially within low-resource, high-risk areas such as rural American Indian/Alaska Native (AIAN) communities. Brief, preconceptual AEP-reduction interventions are popular in such areas but have a small impact on alcohol use. Developing a strategic alcohol change plan is a key program component; however, there is little research on strategy selection, especially within contexts that positively or negatively impact selection (e.g., cultural strengths, trauma, collective efficacy within AIAN communities). This study qualitatively analyzed strategies chosen to reduce alcohol use by AIAN women participating in a culturally tailored, brief, preconceptual AEP-reduction intervention. METHODS One hundred-sixty Northern Plains AIAN women who were participating in a brief AEP-reduction program developed a plan to accomplish an alcohol reduction/abstention goal at the first and last program sessions. The plan included choosing 1 or more strategies to (1) achieve the goal, (2) mitigate barriers, and (3) use cultural strengths. Qualitative analysis of the data involved thematic open and structured coding of all 3 strategies separately. We also examined how many different themes (different individual strategies) participants reported for each strategy component. RESULTS Most participants reported only 1 strategy (theme) for each of the 3 components. Common goal-achieving and barrier-mitigation strategies included positive social supports and avoiding negative or alcohol-involved social environments. Other strategies involved circular logic (e.g., the strategy to reduce drinking was to drink less). Both traditional and western cultural strengths were reported as important resources, although many participants had no cultural resource strategy. CONCLUSION Programs aimed at reducing AEPs may need to provide participants more support to develop strong strategies to reduce alcohol use when implemented within areas with high levels of trauma and contextual barriers that can impact strategy selection. Such support could include ways to improve health on both interpersonal and community levels.
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Affiliation(s)
- Arielle R Deutsch
- Avera Research Institute, Sioux Falls, South Dakota, USA.,School of Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Rebecca Lustfield
- Avera Research Institute, Sioux Falls, South Dakota, USA.,School of Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Jessica D Hanson
- Department of Applied Human Sciences, University of Minnesota Duluth, Duluth, Minnesota, USA
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Kuhlemeier A, Desai Y, Tonigan A, Witkiewitz K, Jaki T, Hsiao YY, Chang C, Van Horn ML. Applying methods for personalized medicine to the treatment of alcohol use disorder. J Consult Clin Psychol 2021; 89:288-300. [PMID: 34014691 PMCID: PMC8284918 DOI: 10.1037/ccp0000634] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Numerous behavioral treatments for alcohol use disorder (AUD) are effective, but there are substantial individual differences in treatment response. This study examines the potential use of new methods for personalized medicine to test for individual differences in the effects of cognitive behavioral therapy (CBT) versus motivational enhancement therapy (MET) and to provide predictions of which will work best for individuals with AUD. We highlight both the potential contribution and the limitations of these methods. METHOD We performed secondary analyses of abstinence among 1,144 participants with AUD participating in either outpatient or aftercare treatment who were randomized to receive either CBT or MET in Project MATCH. We first obtained predicted individual treatment effects (PITEs), as a function of 19 baseline client characteristics identified a priori by MATCH investigators. Then, we tested for the significance of individual differences and examined the predicted individual differences in abstinence 1 year following treatment. Predictive intervals were estimated for each individual to determine if they were 80% more likely to achieve abstinence in one treatment versus the other. RESULTS Results indicated that individual differences in the likelihood of abstinence at 1 year following treatment were significant for those in the outpatient sample, but not for those in the aftercare sample. Individual predictive intervals showed that 37% had a better chance of abstinence with CBT than MET, and 16% had a better chance of abstinence with MET. Obtaining predictions for a new individual is demonstrated. CONCLUSIONS Personalized medicine methods, and PITE in particular, have the potential to identify individuals most likely to benefit from one versus another intervention. New personalized medicine methods play an important role in putting together differential effects due to previously identified variables into one prediction designed to be useful to clinicians and clients choosing between treatment options. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Alena Kuhlemeier
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico
| | - Yasin Desai
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Alexandra Tonigan
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, New Mexico
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Thomas Jaki
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Yu-Yu Hsiao
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, New Mexico
| | - Chi Chang
- Office of Medical Education Research and Development & Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - M. Lee Van Horn
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, New Mexico
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7
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Abstract
The current article provides a brief summary of biopsychosocial gender differences in alcohol use disorder (AUD), then reviews existing literature on gender differences in treatment access, retention, outcomes, and longer-term recovery. Among psychotherapies for AUD, there is support for the efficacy of providing female-specific treatment, and for female-only treatment settings but only when female-specific treatment is included. However, despite mandates from the National Institutes of Health to do so, there is little work thus far that directly compares genders on outcomes of specific psychotherapies or pharmacotherapies for AUD. Although existing research has mixed findings on sex and gender differences in overall outcomes, there are more consistent findings suggesting different mechanisms of behavior change among men and women in AUD treatment and long-term recovery. Thus, more work is needed that attends to gender and sex differences, including planning studies that are structured to examine not only gender-differentiated outcomes in treatment response, but equally important, differences in treatment access and attendance as well as differences in mechanisms of change in drinking behavior.
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Affiliation(s)
- Cathryn Glanton Holzhauer
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Research and Education, VA Central Western Massachusetts, Leeds, Massachusetts
| | - Michael Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,VA South Central Mental Illness Research, Education, and Clinical Center and Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
| | - Elizabeth E Epstein
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
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8
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Cummins DM, Tobian R. Motivational Enhancement Therapy for Veterans with Chronic Pain and Substance Use. HEALTH & SOCIAL WORK 2018; 43:269-273. [PMID: 30215705 DOI: 10.1093/hsw/hly026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 08/02/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Diane M Cummins
- Diane M. Cummins, LSW, is community outreach social worker and Raquel Tobian, LSW, LICDC, is recovery services social worker, Chalmers P. Wylie VA Ambulatory Care Center, Veterans Health Administration
| | - Raquel Tobian
- Diane M. Cummins, LSW, is community outreach social worker and Raquel Tobian, LSW, LICDC, is recovery services social worker, Chalmers P. Wylie VA Ambulatory Care Center, Veterans Health Administration
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9
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L’addictologie de liaison : outils et spécificités. Encephale 2018; 44:354-362. [DOI: 10.1016/j.encep.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
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10
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Exploration of treatment matching of problem drinker characteristics to motivational interviewing and non-directive client-centered psychotherapy. J Subst Abuse Treat 2018; 86:9-16. [PMID: 29415857 DOI: 10.1016/j.jsat.2017.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/21/2017] [Accepted: 12/08/2017] [Indexed: 11/20/2022]
Abstract
Motivational Interviewing (MI) is a known effective intervention for alcohol use disorder (AUD). MI's mechanisms of action remain inconsistently substantiated, and research in this area has been reliant on identifying relationships through strength of association rather than experimental manipulation of active ingredients. In two previous studies, a pilot and a larger replication study, we disaggregated MI into its hypothesized active ingredients by creating three conditions: MI, Spirit Only MI (SOMI, in which evocation of change talk was proscribed), and a non-therapy condition (NTC). Results from both studies yielded equivalent findings across all three conditions. In the current analyses, data from both studies were combined to test five participant characteristics as moderators of MI's component parts: 1) severity of baseline drinking, 2) severe AUD (met 6 or more criteria), 3) baseline self-efficacy to moderate drinking, 4) mean daily confidence to resist heavy drinking in the week prior to treatment initiation, and 5) depression. There were no significant findings related to baseline drinking, severe AUD, or baseline self-efficacy. Confidence yielded a significant interaction effect. When participants had high baseline confidence, drinking for those in MI increased compared to those in SOMI. Depression also yielded a significant moderating effect such that in the context of higher depressive symptoms, receipt of either therapy reduced drinking relative to NTC. Results are discussed in light of existing literature on MOBC with MI and the potential role exploring ambivalence may play for participants with particular characteristics.
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Nielsen AS, Nielsen B. Improving Outpatient Alcohol Treatment Systems: Integrating Focus on Motivation and Actuarial Matching. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1424592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Bent Nielsen
- Department of Psychiatry, Odense University Hospital, Odense C, Denmark
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12
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Morgenstern J, Kuerbis A, Houser J, Levak S, Amrhein P, Shao S, McKay JR. Dismantling motivational interviewing: Effects on initiation of behavior change among problem drinkers seeking treatment. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:751-762. [PMID: 28956934 DOI: 10.1037/adb0000317] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Motivational interviewing (MI) is an efficacious treatment for alcohol use disorders. MI is thought to enhance motivation via a combination of 2 therapeutic strategies or active ingredients: 1 relational and 1 directional. The primary aim of this study was to examine MI's hypothesized active ingredients using a dismantling design. Problem drinkers (N = 139) seeking treatment were randomized to 1 of 3 conditions: MI, relational MI without the directional elements labeled spirit-only MI (SOMI), or a nontherapy control condition and followed for 8 weeks. Those assigned to MI or SOMI received 4 sessions of treatment over 8 weeks. All participants significantly reduced their drinking by Week 8, but reductions were equivalent across conditions. The hypothesis that baseline motivation would significantly moderate condition effects on outcome was generally not supported. Failure to find support for MI's hypothesized active ingredients is discussed in the context of the strengths and limitations of the study design. (PsycINFO Database Record
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Affiliation(s)
| | - Alexis Kuerbis
- Silberman School of Social Work, Hunter College, City University of New York
| | | | | | - Paul Amrhein
- Psychology Department, Montclair State University
| | | | - James R McKay
- Department of Psychiatry, Pennsylvania Treatment Research Institute Center on the Continuum of Care in the Addictions, University of Pennsylvania
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13
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D'Souza PC, Mathai PJ. Motivation to change and factors influencing motivation in alcohol dependence syndrome in a tertiary care hospital. Indian J Psychiatry 2017; 59:183-188. [PMID: 28827865 PMCID: PMC5547859 DOI: 10.4103/psychiatry.indianjpsychiatry_262_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Motivation plays an important role in the treatment of alcohol dependence syndrome (ADS) by influencing the patient to seek and comply with treatment as well as make successful long term changes. AIM The aim of this study is to study the motivation for change in inpatients with ADS. SETTINGS AND DESIGN One hundred consecutive patients admitted for the treatment of ADS in a medical college hospital were evaluated. MATERIALS AND METHODS The International Classification of Disease 10th Revision - AM symptom checklist for mental disorders screener and appropriate modules were used to establish ADS. The assessment of motivation was done using the University of Rhode Island Change Assessment scale at baseline and after 2 weeks of admission. The Severity of Alcohol Dependence Questionnaire and Kuppuswamy's scale for socioeconomic status were used. STATISTICAL ANALYSIS Paired and unpaired t-test, Fisher's exact test, and Wilcoxon signed-rank test were used to analyze data. RESULTS The assessment of motivation showed 60% of patients in precontemplation (PC) stage at baseline, compared to 34% of the patients in PC, 57% in contemplation, and 9% in action stage after 2 weeks of inpatient stay. A highly significant change was seen in the levels of motivation toward contemplation and action stage after 2 weeks of inpatient stay (Z = 5.745, P < 0.001). Motivation to change had a significant association with complications of alcohol use, medical comorbidity, onset and severity of alcohol dependence, socioeconomic status, religion, and mode of referral. CONCLUSIONS The study concludes that certain patients with ADS may have low pretreatment levels of motivation, with significant improvement in the motivation levels after a short duration of inpatient treatment.
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Affiliation(s)
- Prima Cheryl D'Souza
- Department of Psychiatry, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - P John Mathai
- Department of Psychiatry, Father Muller Medical College, Rajiv Gandhi University of Health Sciences, Mangalore, Karnataka, India
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Structure of Problem Recognition Questionnaire with Hispanic/Latino Adolescents. J Subst Abuse Treat 2016; 71:36-40. [PMID: 27776675 DOI: 10.1016/j.jsat.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/25/2016] [Accepted: 08/08/2016] [Indexed: 11/23/2022]
Abstract
Motivation is a prominent target for substance use interventions because it is theorized to increase engagement in therapy and predict treatment outcomes. Establishing the validity of measures relevant to motivation among Hispanic/Latino adolescents will improve the resources available for screening and measuring change processes in a multicultural population. We examined the structure of the Problem Recognition Questionnaire (PRQ; Cady, Winters, Jordan, Solberg, & Stinchfield, 1996) with Hispanic/Latino adolescents. Participants were adolescents (n=191) in a randomized controlled trial for substance abuse. Data were collected during a baseline pre-treatment time point and post-treatment time point that was four-months post-baseline. Confirmatory factor analysis (CFA) showed that the three-factor structure proposed by Cady et al. (1996) had a poor fit with pre-treatment data. Follow-up exploratory analyses with principal axis factoring identified an alternate three-factor structure with pre-treatment data (problem recognition, readiness, and treatment resistance). A second CFA showed this three-factor model fit data from participants at the post-treatment time point (n=155). The results provide preliminary evidence for using our proposed factor structure for the PRQ subscales with Hispanic/Latino adolescents. We discuss the dimensions we identified in the context of similar measures and the implications for measuring problem recognition, readiness, and treatment resistance.
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McCarthy DE, Ebssa L, Witkiewitz K, Shiffman S. Repeated measures latent class analysis of daily smoking in three smoking cessation studies. Drug Alcohol Depend 2016; 165:132-42. [PMID: 27317043 PMCID: PMC4946336 DOI: 10.1016/j.drugalcdep.2016.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 05/27/2016] [Accepted: 05/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Person-centered approaches to the study of behavior change, such as repeated measures latent class analysis (RMLCA), can be used to identify patterns of change and link these to later behavior change outcomes. METHODS Daily smoking status data from three smoking cessation studies (N=287, N=334, and N=403) were submitted to RMLCA to identify latent classes of smokers based on patterns of abstinence across the first 27days of a quit attempt. Three-month biochemically verified abstinence rates were compared among latent classes with particular patterns of smoking across days. Pharmacotherapy variables and baseline individual differences were added as covariates of latent class membership. RESULTS Results of separate and pooled analyses supported a five-class solution that replicated across studies. Latent classes included a large class that achieved immediate stable abstinence, a smaller class of cessation failures, and three classes with partial abstinence that increased, decreased, or remained stable over time. Three-month point-prevalence abstinence rates varied among the latent classes, with 38-55% abstinent among early quitters, 3-20% abstinent among those who smoked intermittently throughout the first 27days, and fewer than 5% abstinent in the classes marked by little or delayed change in smoking. High-dose nicotine patch and bupropion promoted membership in abstinent classes. Demographics, nicotine dependence, and craving were related to latent class in multiple studies and pooled analyses. CONCLUSIONS We identified five patterns of smoking behavior in the first weeks of a smoking cessation attempt. These patterns are robust across multiple studies and are related to later point-prevalence abstinence rates.
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Affiliation(s)
- Danielle E McCarthy
- Rutgers, the State University of New Jersey, Department of Psychology and Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, USA.
| | - Lemma Ebssa
- Rutgers, the State University of New Jersey, Department of Psychology and Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, USA.
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd SE, MSC 11-6280, Albuquerque, NM 87106, USA.
| | - Saul Shiffman
- University of Pittsburgh, Department of Psychology, Bellefield Professional Building, 130N. Bellefield Ave., Pittsburgh, PA 15260-2695, USA.
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Hanpatchaiyakul K, Eriksson H, Kijsomporn J, Östlund G. Healthcare providers’ experiences of working with alcohol addiction treatment in Thailand. Contemp Nurse 2016; 52:59-73. [PMID: 27139636 DOI: 10.1080/10376178.2016.1183461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Maisto SA, Kirouac M, Witkiewitz K. Alcohol use disorder clinical course research: informing clinicians' treatment planning now and in the future. J Stud Alcohol Drugs 2015; 75:799-807. [PMID: 25208198 DOI: 10.15288/jsad.2014.75.799] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The clinical course of alcohol use disorder (AUD) has been widely researched over the past half-century and has been used to advance our understanding of the treatment of AUD. Nevertheless, new directions in AUD clinical course research could enhance its value in informing clinical decision-making in patient-centered treatment of AUD. METHOD An overview, a critical analysis, and a discussion of AUD clinical course research are presented. RESULTS This article discusses three research directions that promote the advancement of the knowledge regarding the clinical course of AUD to better inform clinical decision-making in patient-centered treatment of AUD. Specifically, we hypothesized that (a) real-time data collection of the clinical course of AUD via ecological momentary assessment would help elucidate near real-time associations between risk factors and alcohol use, (b) future research designs should use person-centered and dynamic analyses of alcohol use over time, and (c) adaptive treatment designs would provide personalized and optimized AUD treatment. Consequently, the field will advance the development of clinical decision-making support systems to better inform clinicians and clients in making informed AUD treatment decisions. In addition, such research would advance clinical practice with more attention to theory and expansion of the study of the clinical course of AUD to include areas of life functioning besides alcohol use. CONCLUSIONS These research directions have the potential to build a scientific knowledge base that could improve our understanding of AUD among individuals with alcohol problems, would allow providers to predict patient outcomes during and after treatment, and would offer practical strategies regarding steps that could ultimately improve the clinical course of AUD.
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Affiliation(s)
- Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Megan Kirouac
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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18
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Miller WR, Moyers TB. The forest and the trees: relational and specific factors in addiction treatment. Addiction 2015; 110:401-13. [PMID: 25066309 DOI: 10.1111/add.12693] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/09/2014] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Abstract
AIMS Increased expectations for the use of evidence-based methods in addiction treatment have fueled a debate regarding the relative importance of 'specific' versus 'common' factors in treatment outcome. This review explores the influence of these factors on addiction treatment outcome. METHODS The authors review and link findings from four decades of research on specific and general factors in addiction treatment outcome research. FINDINGS Although few would argue that what one does in addiction treatment is immaterial, outcome studies tend to find small to no difference when specific treatment methods are compared with each other or with treatment as usual. In contrast, there are usually substantial differences among therapists in client outcomes, and relational factors such as therapist empathy and therapeutic alliance can be significant determinants of addiction treatment outcome. CONCLUSIONS In addiction treatment, relational factors such as empathy, which are often described as common, non-specific factors, should not be dismissed as 'common' because they vary substantially across providers and it is unclear how common they actually are. Similarly they should not be relegated to 'non-specific' status, because such important relational influences can be specified and incorporated into clinical research and training.
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Affiliation(s)
- William R Miller
- Department of Psychology and Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico, USA
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19
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Schuck K, Otten R, Kleinjan M, Bricker JB, Engels RCME. Predictors of cessation treatment outcome and treatment moderators among smoking parents receiving quitline counselling or self-help material. Prev Med 2014; 69:126-31. [PMID: 25278424 DOI: 10.1016/j.ypmed.2014.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 09/18/2014] [Accepted: 09/22/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Several cessation treatments effectively enhance cessation, but it is not always clear which treatment may be most suitable for a particular client. We examined predictors of treatment outcome and treatment moderators among smoking parents in the Netherlands. METHOD We conducted secondary analyses of a randomized controlled trial in which smoking parents received either quitline counselling (n=256) or a self-help brochure (n=256). Data collection was completed in October 2012. Endpoints were 7-day point prevalence abstinence and 6-month prolonged abstinence at 12-month follow-up. Potential predictors and moderators included socio-demographic characteristics, smoking-related variables, and child-related variables. RESULTS Male gender, higher employment status, lower daily cigarette consumption, higher levels of confidence in quitting, presence of a child with a chronic respiratory illness, and wanting to quit for the health of one's child predicted abstinence at 12months. Significant treatment moderators were intention to quit and educational level. Quitline counselling was effective regardless of intention to quit and educational level, but self-help material was less effective among less motivated and lower educated parents. CONCLUSION Certain subgroups of smokers, such as parents who are concerned about the health of their child, are particularly receptive to cessation support. Individual characteristics should be considered in treatment selections.
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Affiliation(s)
- Kathrin Schuck
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | - Roy Otten
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Marloes Kleinjan
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue, P.O. Box 19024, Seattle, WA 98109, USA; University of Washington, Department of Psychology, P.O. Box 351525, Seattle, WA 98195, USA
| | - Rutger C M E Engels
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands; Trimbos Institute, Netherlands National Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands
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20
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Twisk J. Is it necessary to classify developmental trajectories over time? A critical note. ANNALS OF NUTRITION AND METABOLISM 2014; 65:236-40. [PMID: 25413664 DOI: 10.1159/000362506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This paper is a critical note regarding the classification of developmental trajectories. Although the results should be interpreted with caution, it seems that this classification can be interesting for descriptive purposes. For answering additional research questions relating to the prediction and/or the consequences of a different development over time, the classification of developmental trajectories does not seem to be necessary. However, it should be realized that the present analysis employs a relatively simple classification method and that there are some new promising developments within the field of classification methods, which can be of interest.
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Affiliation(s)
- Jos Twisk
- Department of Epidemiology and Biostatistics (EMGO Institute for Health and Care Research), VU University Medical Center, Amsterdam, The Netherlands
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Kuerbis A, Armeli S, Muench F, Morgenstern J. Profiles of confidence and commitment to change as predictors of moderated drinking: a person-centered approach. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:1065-76. [PMID: 25134034 DOI: 10.1037/a0036812] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Identifying who, among problem drinkers, is best suited for moderation and has the greatest likelihood to control drinking has important public health implications. The current study aimed to identify profiles of problem drinkers who may be more or less successful in moderating drinking within the context of a randomized clinical trial of a brief treatment for alcohol use disorder. A person-centered approach was implemented, utilizing composite, baseline daily diary values of confidence and commitment to reduce drinking. Problem drinkers (N = 89) were assessed, provided feedback about their drinking, and randomly assigned to 1 of 3 conditions: 2 brief alcohol use disorder treatments or a third group asked to change on their own. Global self-report assessments were administered at baseline and Week 8 (end of treatment). Daily diary composites were created from data collected via an interactive voice recording system during the week prior to baseline. A K-means cluster analysis identified 3 groups: high, moderate, and low confidence and commitment to change drinking. Group differences were explored, and then group membership was entered into generalized estimating equations to predict drinking trajectories over time. Findings revealed that the groups differentially reduced their drinking, such that the high group had greater reduction in drinking and a faster rate of reduction than the other 2 groups, and the moderate group had greater reduction than the low group. Findings suggest that baseline motivation and self-efficacy are important for predicting prognoses related to successful moderated drinking. Limitations and arenas for future research are discussed.
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Affiliation(s)
- Alexis Kuerbis
- Department of Mental Health Services and Policy Research, Research Foundation for Mental Hygiene, Inc
| | - Stephen Armeli
- Department of Psychology, Fairleigh Dickinson University
| | - Frederick Muench
- Department of Mental Health Services and Policy Research, Research Foundation for Mental Hygiene, Inc
| | - Jon Morgenstern
- Department of Psychiatry, Columbia University Medical Center
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22
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Affiliation(s)
- Nick Heather
- Department of Psychology, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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23
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Schuman-Olivier Z, Hoeppner BB, Evins AE, Brewer JA. Finding the right match: mindfulness training may potentiate the therapeutic effect of nonjudgment of inner experience on smoking cessation. Subst Use Misuse 2014; 49:586-94. [PMID: 24611853 PMCID: PMC4096689 DOI: 10.3109/10826084.2014.850254] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mindfulness training (MT) is an emerging therapeutic modality for addictive disorders. Nonjudgment of inner experience, a component of mindfulness, may influence addiction treatment response. To test whether this component influences smoking cessation, tobacco smokers (n = 85) in a randomized control trial of MT vs. Freedom from Smoking (FFS), a standard cognitive-behaviorally-oriented treatment, were divided into split-half subgroups based on baseline Five Facet Mindfulness Questionnaire nonjudgment subscale. Smokers who rarely judge inner experience (nonjudgment > 30.5) smoked less during follow-up when randomized to MT (3.9 cigs/d) vs. FFS (11.1 cigs/d), p < .01. Measuring trait nonjudgment may help personalize treatment assignments, improving outcomes.
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Affiliation(s)
- Zev Schuman-Olivier
- 1Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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24
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Rodrigue JR, Hanto DW, Curry MP. Substance abuse treatment and its association with relapse to alcohol use after liver transplantation. Liver Transpl 2013; 19:1387-95. [PMID: 24123780 DOI: 10.1002/lt.23747] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/31/2013] [Indexed: 12/20/2022]
Abstract
Many liver transplantation (LT) programs require substance abuse (SA) treatment for candidates with a history of alcohol abuse. However, there are no data indicating that SA treatment prevents post-LT alcohol relapse. We examined 118 adults who underwent LT from May 2002 to February 2011 to explore the relationship between SA treatment and post-LT relapse to any alcohol use. Sixty-one patients (52%) with a history of alcohol abuse or dependence received SA treatment before LT. Relapse to any alcohol use was identified in 40 LT recipients (34%). Patients who received SA treatment before LT did not differ significantly in the rate of post-LT alcohol relapse from patients who did not receive treatment before transplantation(30% versus 39%, P = 0.20). However, patients who received SA treatment both before and after transplantation had significantly lower rates of alcohol relapse (16%) than patients who received no SA treatment (41%) or SA treatment only before LT (45%, P = 0.03). Our findings suggest that LT programs should consider placing more emphasis on the continuation of some type of SA treatment after transplantation. Future research should prospectively examine the optimal timing for SA treatment that will attenuate the risk of alcohol relapse after transplantation.
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Affiliation(s)
- James R. Rodrigue
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute; Beth Israel Deaconess Medical Center; Boston MA
- Harvard Medical School; Boston MA
| | - Douglas W. Hanto
- Continuing Medical Education Office; Washington University School of Medicine; St. Louis MO
| | - Michael P. Curry
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute; Beth Israel Deaconess Medical Center; Boston MA
- Harvard Medical School; Boston MA
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Roedelof AJM, Bongers IL, van Nieuwenhuizen C. Treatment engagement in adolescents with severe psychiatric problems: a latent class analysis. Eur Child Adolesc Psychiatry 2013; 22:491-500. [PMID: 23455601 DOI: 10.1007/s00787-013-0385-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/29/2013] [Indexed: 12/31/2022]
Abstract
Motivation is considered a pivotal factor in treatment, but a better understanding of this topic is needed. Drieschner et al. (Clin Psychol Rev 23:1115-1137, 2004) proposed to distinguish treatment motivation and treatment engagement. This study aimed to discover whether it is possible to identify classes of adolescents with severe psychiatric problems having comparable profiles of treatment engagement. To this end, professionals filled out the Treatment Engagement Rating Scale 5 times for 49 adolescents (mean age 18.3 years; SD = 1.6) during the first year of case management treatment. Using a longitudinal latent class analysis, the number of profiles of treatment engagement was investigated and described. Results identified three profiles: high (19 clients, 39%), medium (20 clients, 41%) and low (10 clients, 20%). Adolescents with a high engagement profile were at first equally, and later on more engaged in treatment than clients with a medium engagement profile. Adolescents with a low engagement profile made the least effort to engage, except after 30 weeks. Adolescents with a low engagement profile were often substance-dependent males with the lowest scores on the Global Assessment of Functioning Scale after a year. Only adolescents with a high engagement profile improved on global functioning. In conclusion, it is possible to identify different treatment engagement profiles by asking one question about level of global treatment engagement. Frequent assessment of engagement of the individual client as well as including a behavioural component into assessment and treatment may help to improve case management treatment for adolescents with medium and low engagement profiles.
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Affiliation(s)
- A J M Roedelof
- GGzE Centre for Child and Adolescent Psychiatry, PO Box 909, 5600 AX, Eindhoven, The Netherlands.
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Ouimet MC, Dongier M, Di Leo I, Legault L, Tremblay J, Chanut F, Brown TG. A randomized controlled trial of brief motivational interviewing in impaired driving recidivists: a 5-year follow-up of traffic offenses and crashes. Alcohol Clin Exp Res 2013; 37:1979-85. [PMID: 23895363 PMCID: PMC4352330 DOI: 10.1111/acer.12180] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 04/04/2013] [Indexed: 11/27/2022]
Abstract
Background In a previously published randomized controlled trial (Brown et al. Alcohol Clin Exp Res 2010; 34, 292–301), our research team showed that a 30-minute brief motivational interviewing (BMI) session was more effective in reducing percentages of risky drinking days in drunk driving recidivists than a control information–advice intervention at 12-month follow-up. In this sequel to the initial study, 2 main hypotheses were tested: (i) exposure to BMI increases the time to further arrests and crashes compared with exposure to the control intervention (CTL) and (ii) characteristics, such as age, moderate the benefit of BMI. Methods A sample of 180 community-recruited recidivists who had drinking problems participated in the study. Participants gave access to their provincial driving records at baseline and were followed up for a mean of 1,684.5 days (SD = 155.7) after randomization to a 30-minute BMI or CTL session. Measured outcomes were driving arrests followed by convictions including driving while impaired (DWI), speeding, or other moving violations as well as crashes. Age, readiness to change alcohol consumption, alcohol misuse severity, and number of previous DWI convictions were included as potential moderators of the effect of the interventions. Results For arrests, Cox proportional hazards modeling revealed no significant differences between the BMI and the CTL group. When analyses were adjusted to age tertile categories, a significant effect of BMI in the youngest age tertile (<43 years old) emerged. For crashes, no between-group differences were detected. Conclusions BMI was better at delaying DWI and other dangerous traffic violations in at-risk younger drivers compared with a CTL similar to that provided in many remedial programs. BMI may be useful as an opportunistic intervention for DWI recidivism prevention in settings such as DWI courts. Treatment effectiveness studies are needed to ascertain how the present findings generalize to the real-world conditions of mandated relicensing programs.
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Affiliation(s)
- Marie Claude Ouimet
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada; Charles LeMoyne Research Center, Longueuil, Quebec, Canada
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Martin GW, Rehm J. The effectiveness of psychosocial modalities in the treatment of alcohol problems in adults: a review of the evidence. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:350-8. [PMID: 22682572 DOI: 10.1177/070674371205700604] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our objectives were to review the effectiveness of psychosocial modalities in the treatment of alcohol use disorders and problems, and to examine the impact of therapists on treatment outcome, the evidence on best practices for comorbid conditions, and the evidence on treatment matching. We based our review on published systematic reviews of this topic after 2000. There is strong evidence that some, but not all, psychosocial treatments are effective in treating alcohol problems. Those with the strongest empirical support are motivational enhancement therapy, various cognitive-behavioural interventions, and brief interventions. Meta-analyses for several of these modalities suggest typical effect sizes in the low-to-moderate range. When these modalities have been compared with one another in well-designed clinical trials, they have been shown to be of comparable effectiveness. There is little basis on which to recommend one of these modalities over another but good reason to select from among them.
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Affiliation(s)
- Garth W Martin
- Addiction Consultant Services, Clarksburg, Ontario, Canada
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The role of demographic characteristics and readiness to change in 12-month outcome from two distinct brief interventions for impaired drivers. J Subst Abuse Treat 2011; 42:383-91. [PMID: 22119179 DOI: 10.1016/j.jsat.2011.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 08/27/2011] [Accepted: 09/15/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study tested specific intervention responsivity to brief intervention in driving while impaired by alcohol and/or drugs recidivists based upon their demographic, substance use, and initial readiness to change characteristics. METHODS A nonclinical community-based sample of 184 male and female recidivists was randomly assigned to receive one of two 30-minute interventions: brief motivational interviewing (n = 92) or an information-advice session (n = 92). Dependent variables were change at the 6- and 12-month follow-ups from baseline in percentage of risky drinking days and blood assay biomarkers of alcohol misuse. Independent variables were age, gender, education, past convictions for impaired driving, and baseline alcohol and drug misuse severity and readiness to change. RESULTS Recidivists who were younger, male, and exhibited more negative consequences and ambivalence towards their problem drinking improved more on alcohol-related outcomes, irrespective of intervention type. CONCLUSIONS The results do not convincingly indicate specific intervention responsivity based upon participant characteristics but provide preliminary guidance about which recidivists are most apt to benefit from these brief approaches.
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Hendershot CS, Witkiewitz K, George WH, Marlatt GA. Relapse prevention for addictive behaviors. Subst Abuse Treat Prev Policy 2011; 6:17. [PMID: 21771314 PMCID: PMC3163190 DOI: 10.1186/1747-597x-6-17] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 07/19/2011] [Indexed: 11/10/2022] Open
Abstract
The Relapse Prevention (RP) model has been a mainstay of addictions theory and treatment since its introduction three decades ago. This paper provides an overview and update of RP for addictive behaviors with a focus on developments over the last decade (2000-2010). Major treatment outcome studies and meta-analyses are summarized, as are selected empirical findings relevant to the tenets of the RP model. Notable advances in RP in the last decade include the introduction of a reformulated cognitive-behavioral model of relapse, the application of advanced statistical methods to model relapse in large randomized trials, and the development of mindfulness-based relapse prevention. We also review the emergent literature on genetic correlates of relapse following pharmacological and behavioral treatments. The continued influence of RP is evidenced by its integration in most cognitive-behavioral substance use interventions. However, the tendency to subsume RP within other treatment modalities has posed a barrier to systematic evaluation of the RP model. Overall, RP remains an influential cognitive-behavioral framework that can inform both theoretical and clinical approaches to understanding and facilitating behavior change.
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Affiliation(s)
- Christian S Hendershot
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S 2S1, Canada
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON M5T 1R8, Canada
| | - Katie Witkiewitz
- Department of Psychology, Washington State University, 14204 NE Salmon Creek Ave, Vancouver, WA, 98686, USA
| | - William H George
- Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195, USA
| | - G Alan Marlatt
- Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195, USA
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Schlaff G, Walter H, Lesch OM. The Lesch alcoholism typology - psychiatric and psychosocial treatment approaches. Ann Gastroenterol 2011; 24:89-97. [PMID: 24713718 PMCID: PMC3959295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/16/2011] [Indexed: 11/02/2022] Open
Abstract
In the past three decades, researchers have been attempting to replace the obsolete concept of homogeneity of alcohol dependence, by classifying these patients into specific heterogeneous subtypes. Based on 30 years of experience and research, the Lesch Typology has proved to be very useful in clinical daily routine. The aim of the Lesch Typology is to provide targeted subtype-specific treatments to patients, thereby increasing their probability of long-term abstinence and hence improving their prognosis. The Lesch Typology is based on data from a longitudinal prospective study (with follow ups even 19 years later) on alcohol dependent patients (n=436). By observing the long term development of these patients, four distinct courses could be identified. In the meantime, a computerized version of the Lesch Typology had been created and translated into many languages, and is currently being employed in numerous psychiatric institutions while assisting clinicians in quickly determining a patient's subtype (www.lat-online.at). Based on the patients' drinking patterns and origin of substance craving, hence according to the Lesch Typology, four subtypes of alcohol dependent patients can be distinguished: 1. the "allergy model" (craving caused by alcohol); 2. the "conflict resolution and anxiety model" (craving caused by stress); 3. the "depressive model" (craving caused by mood); and 4. the "conditioning model" (craving caused by compulsion). Pharmacological treatments are not always the most effective way of preventing relapses in alcohol dependent patients. Many times, a combination with psychosocial as well as psychotherapeutic approaches is necessary and essential for helping patients to stay sober. Depending on the patient's Lesch Type, certain therapeutic approaches are more appropriate and subsequently lead to better results and higher chances of lasting abstinence.
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Affiliation(s)
- Golda Schlaff
- Correspondence to: Dr. Golda Schlaff, Univ. Klinik für Psychiatrie und Psychotherapie Medizinische Universität Wien Währinger Gürtel 18-20 A-1090 Wien; Tel: 0043-1-40400-3526; Fax: 0043-1-40400-3543; e-mail:
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Tober G. Commentary on Witkiewitz et al. (2010): evidence for matching--at last. Addiction 2010; 105:1414-5. [PMID: 20653621 DOI: 10.1111/j.1360-0443.2010.03026.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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