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Motivational Interviewing: Findings from Clinical Trials

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Title: Motivational Interviewing: Findings from Clinical Trials


1
Motivational InterviewingFindings from
Clinical Trials
  • Updated 10 December 2004

2
Alcohol

3
Allsop et al., 1997Addiction, 9261-74
  • Design Randomized clinical trial
  • Population Alcohol abuse
  • Nation Scotland
  • N 60 adult outpatients
  • MI 8 session group MI skills
  • Comparison Group discussion TAU
  • Follow-up 6 months

4
Allsop et al., 1997
plt.01
plt.04
plt.03
5
Baer et al., 1992Journal of Consulting and
Clinical Psychology, 60924-979
  • Design Randomized clinical trial
  • Population College Students
  • Nation US (Seattle, WA))
  • N 134 young adults
  • MI 1 session (60 min)
  • Comparison Two groups
  • (1) six weekly cognitive behavioral
    groups (90 minute ea)
  • (2) a six-unit self-help cognitive
    behavioral manual
  • Follow-up post-treatment (6 weeks),
  • short-term maintenance (3 6 months),
  • long-term maintenance (12 24 months)

6
Baer et al., 1992
  • Comparative analyses exclude the self-help manual
    group because of poor program completion and high
    drop-out in this group
  • Overall reduction on the three dependent
    variables were statistically significant at the
    three follow-up points.
  • Although CB group subjects reported slightly
    lower numbers on all three drinking measures over
    time, differences between MI and CB subjects were
    not statistically significant.
  • Significant interactive effects were noted for
    age, with increases in drinking during the year
    subjects reached legal drinking status.

7
Baer et al., 1992
8
Baer et al., 1992
9
Baer et al., 1992
10
Baer et al., 1992
11
Bien et al., 1993Behavioural Cognitive
Psychotherapy, 21347-356
  • Design Randomized clinical trial
  • Population Outpatient alcohol (VA)
  • Nation US (Albuquerque, NM)
  • N 32 adults
  • MI 1 session MET ( TAU)
  • Comparison TAU
  • Follow-up 6 months post discharge

12
Bien et al., 1993
plt.05
13
Bien et al., 1993
14
Borsari Carey, 2000Journal of Consulting
Clinical Psychology, 68728-733
  • Design Randomized clinical trial
  • Population Binge drinkers
  • Nation US (Syracuse, NY)
  • N 60 college students
  • MI 1 session MET
  • Comparison Assessment only
  • Follow-up 6 weeks

15
Borsari Carey, 2000
plt.006
plt.001
plt.05
16
Brown Miller, 1993Psychology of Addictive
Behaviors, 7211-218
  • Design Randomized clinical trial
  • Population Inpatient alcohol
  • Nation US (Albuquerque, NM)
  • N 28 adults
  • MI 1 session MET ( TAU)
  • Comparison TAU
  • Follow-up 3 months post discharge

17
Brown Miller, 1993
plt.001
18
Brown Miller, 1993
19
Dench Bennett, 2000Behavioural Cognitive
Psychotherapy, 28121-130
  • Design Randomized clinical trial
  • Population 6 week day treatment program
  • Nation United Kingdom
  • N 51 alcohol dependent patients
  • MI 1 session
  • Comparison Attention placebo education
  • Follow-up 1 and 6 weeks

20
Dench Bennett, 2000
plt.001
plt.03
plt.01
21
Handmaker et al., 1999Journal of Studies on
Alcohol, 60285-287
  • Design Randomized clinical trial
  • Population Prenatal care clinics
  • Nation US (Albuquerque, NM)
  • N 42 pregnant drinkers
  • MI 1-hour individual session
  • Comparison Risk-alert letter
  • Follow-up 2 months

22
Handmaker et al., 1999
All differences ns due to small sample size
(N34) Largest effects of MI observed with
heaviest drinkers
23
Heather et al., 1996Drug Alcohol Review,
1529-38
  • Design Block assignment
  • Population General hospital inpatients
  • Nation Australia
  • N 174 adult heavy drinkers
  • MI 1 30-40 minute session
  • Comparison Skills training or TAU
  • Follow-up 6 months

24
Heather et al., 1996
plt.05
plt.05
25
Kuchipudi et al., 1990Journal of Consulting
Clinical Psychology, 65531-541
  • Design Randomized clinical trial
  • Population Acute gastrointestinal ward
  • Nation US (Hines, IL)
  • N 114 alcohol-related admissions
  • MI 5 sessions with 5 practitioners
  • Comparison TAU
  • Follow-up 16 weeks

26
Kuchipudi et al., 1990
ns
27
Kuchipudi et al., 1990Was it Motivational
Interviewing?
  • Each patient talked to by five different
    clinicians
  • Complete staff turnover 3 times in 5 months
  • Emphasized the need for and benefits of
    alcoholism therapy
  • Two prolonged sessions on available treatment
    programs
  • The persons health and drinking were reviewed
    from the viewpoint and with the authority of the
    director of the unit

28
Marlatt et al., 1998Journal of Consulting and
Clinical Psychology, 66604-615
  • Design Randomized clinical trial
  • Population College students
  • Nation US (Seattle, WA)
  • N 348 heavy drinkers
  • MI 1 individual session
  • Comparison Assessment only
  • Follow-up 2 years

29
Marlatt et al., 1998
plt.05
plt.001
plt.05
plt.05
30
Miller et al., 1988Behavioural Psychotherapy,
16251-268
  • Design Randomized clinical trial
  • Population Self-referred problem drinkers
  • Nation US (Albuquerque, NM)
  • N 42 adults
  • MI Assessment 1 MET session
  • Comparison Confrontational counseling
  • Waiting list (6 weeks)
  • Follow-up 18 months

31
Miller et al., 1988
Waiting list was unchanged until receiving MET
32
Miller et al., 1993Journal of Consulting
Clinical Psychology, 61455-461
  • Design Randomized clinical trial
  • Population Self-referred problem drinkers
  • Nation US (Albuquerque, NM)
  • N 42 problem drinkers
  • MI Assessment 1 MET session
  • Comparison Confrontational counseling
  • Waiting list (6 weeks)
  • Follow-up 12 months

33
Miller et al., 1993
plt.02 relative to waiting list control
34
Miller et al., 1993
plt.02 relative to waiting list control
35
Miller et al., 1993
36
Miller et al., 1993
37
Monti et al., 1999Journal of Consulting and
Clinical Psychology, 67989-994
  • Design Randomized clinical trial
  • Population Emergency room
  • Nation US (Providence, RI)
  • N 94 adolescents (18-19)
  • MI 1 session (35-40 min)
  • Comparison Standard care
  • Follow-up 6 months

38
Monti et al., 1999
plt.05
plt.01
plt.05
39
Murphy et al., 2001Psychology of Addictive
Behaviors, 15373-379
  • Design Randomized clinical trial
  • Population College Students
  • Nation US (Auburn, AL)
  • N 99 drinkers
  • MI 1 session (50 min)
  • Comparison Alcohol education No
    intervention
  • Follow-up 9 months

40
Murphy et al., 2001
plt.05
Differences significant for heavy drinkers only
41
Project MATCH, 1997Journal of Studies on
Alcohol, 587-29
  • Design Randomized clinical trial
  • Population Outpatient and aftercare
  • Nation US (9 sites)
  • N 1,726 adults
  • MI 4 session MET
  • Comparison 12 session CBT or TSF
  • Follow-up 15 months post-treatment

42
Project MATCH, 1997
plt.003
plt.04
43
Project MATCH, 1998Alcoholism Clinical and
Experimental Research, 221300-1311
plt.007
On percent days abstinent, MET TSF gt CBT
44
Sellman et al., 2001Journal of Studies on
Alcohol, 62389-396
  • Design Randomized clinical trial
  • Population Mild/moderate dependence
  • Nation New Zealand
  • N 125 alcohol outpatients
  • MI MET 4 sessions
  • Comparison Nondirective reflective listening
  • Control No further counseling
  • Follow-up 6 months post-treatment

45
Sellman et al., 2001
ns
plt.04
ns
46
Senft et al., 1997American Journal of Preventive
Medicine, 13464-470
  • Design Randomized clinical trial
  • Population Primary care
  • Nation US (Portland, OR)
  • N 516 adults
  • MI 1 session, 15 min ( TAU)
  • Comparison TAU
  • Follow-up 12 months

47
Senft et al., 1997
plt.04
ns
48
Senft et al., 1997
plt.04
plt .02
49
Smith et al., 2003Addiction, 9843-52
  • Design Randomized clinical trial
  • Population Oral and maxillofacial surgery
  • clinic out-patients
  • Nation UK (Cardiff, Wales)
  • N 151 young males with alcohol- related
    facial injuries
  • MI 1 manual-guided session ( TAU)
  • Comparison TAU
  • Follow-up 3 months and one year

50
Smith et al., 2003
Alcohol (units)
51
Smith et al., 2003
Alcohol (units)
52
Smith et al., 2003
RCP
AUDIT
RCP Royal College of Physicians, Psychiatrists,
and General Practitioners Recommended Health
Limit AUDIT Alcohol Use Disorders
Identification Test
53
Cardiovascular Health

54
Scales, 1998Doctoral dissertation, University of
New Mexico
  • Design Randomized clinical trial
  • Population Cardiovascular rehab
  • Nation US (Albuquerque, NM)
  • N 61
  • MI TAU MET (1 hr) skills based health ed
    (90 min)
  • Comparison TAU traditional rehab
  • Follow-up 12 weeks

55
Scales, 1998
  • Significantly greater decrease in MI group,
    compared with TAU, in linear combination of three
    risk scores
  • Perceived stress
  • Physical activity
  • Dietary fat
  • All three contributed to the significant
    difference, but only stress was significant in a
    univariate test

56
Scales, 1998
p lt .005
57
Woollard et al., 1995Clinical Experimental
Pharmacology Physiology, 22466-468
  • Design Randomized clinical trial
  • Population General practice
  • Nation Australia (Perth, WA)
  • N 166 patients with hypertension
  • MI High 6 nurse sessions (45 min)
  • Low 1 session 5 phone (15 min)
  • Comparison TAU
  • Follow-up 18 weeks

58
Woollard et al., 1995
plt.05
plt.05
59
Woollard et al., 1995
plt.05
plt.05
60
Diabetes

61
Smith et al., 1997Diabetes Care, 2052-54
  • Design Randomized clinical trial
  • Population Recruited by newspaper
  • Nation US (Birmingham, AL)
  • N 22 older obese women
  • MI 3 sessions MI TAU
  • Comparison TAU (behavior therapy)
  • Follow-up Post-treatment

62
Smith et al., 1997
plt.01
plt.003
plt.05
plt.07
63
Smith et al., 1997
plt.05
ns
64
Drug Abuse

65
Aubrey, 1998Doctoral dissertation, University of
New Mexico
  • Design Randomized clinical trial
  • Population Adolescent drug abuse treatment
  • Nation US (Albuquerque, NM)
  • N 77 adolescents entering treatment
  • MI 1 individual session TAU
  • Comparison TAU
  • Follow-up 3 months

66
Aubrey, 1998
67
Aubrey, 1998
68
Aubrey, 1998
69
Aubrey, 1998
70
Aubrey, 1998
71
Baker et al., 2001Addiction, 961279-1287
  • Design Randomized clinical trial
  • Population Regular amphetamine users
  • Nation Australia
  • N 64 adults
  • MI 2 individual sessions book
  • 4 session MI skill training
  • Comparison Self-help book
  • Follow-up 6 months

72
Baker et al., 2001
plt.01
plt.05
73
Baker et al., 2002Addiction, 971329-1337Acta
Psychiatrica Scandinavica, 105xx
  • Design Randomized clinical trial
  • Population Inpatient psychiatric hospital
  • Nation Australia
  • N 160 adults with concomitant
  • disorders
  • MI 30-45 minute individual session
  • Comparison Self-help book and brief advice
  • Follow-up 12 months

74
Baker et al., 2002
plt.04
75
Baker et al., 2002
plt.02
ns
76
Lincourt et al., in pressAddictive Behavior
  • Design Quasi-experiment (attendance)
  • Population Mandated outpatient treatment
  • Nation US (New York)
  • N 167 adults (substance abuse)
  • MI 6 session group TAU
  • Comparison TAU
  • Follow-up End of treatment

77
Lincourt et al., in press
plt.001
plt.005
78
Longshore et al., 1999Substance Use Misuse,
341223-1241
  • Design Quasi-experiment (attendance)
  • Population Mandated outpatient treatment
  • Nation US (Los Angeles, CA)
  • N 222 African-American drug users
  • MI 1 session
  • Comparison Needs assessment
  • Follow-up End of treatment

79
Longshore et al., 1999
  • MI group rated (non-blind) significantly higher
  • Treatment involvement (self-report plt.04)
  • Motivation for change (self-report plt.05)
  • Treatment participation (clinician rating
    plt.0001)
  • Self-disclosure (clinician rating plt.0001)
  • Preparation for change (clinician rating
    plt.0003)

80
Marijuana Treatment Project Research Group
(2004)Journal of Consulting and Clinical
Psychology, 72455-466
  • Design Randomized clinical trial
  • Population Inpatient or outpatient treatment
  • Nation US (3 sites)
  • N 450 adult marijuana smokers
  • MI 2 session MET
  • Comparison 9-session MET behavior therapy
  • Control 4-month waiting list control
  • Follow-up 15 months

81
Marijuana Treatment Project Research Group (2004)
plt.001
ns
plt.001
82
Marijuana Treatment Project Research Group
(2004)Marijuana Joints per Week
plt.001
83
Miller, Yahne Tonigan (2003)Journal of
Consulting and Clinical Psychology, 71754-763
  • Design Randomized clinical trial
  • Population Inpatient or outpatient treatment
  • Nation US (Albuquerque, NM)
  • N 208 drug dependent adults
  • MI 1 session TAU
  • Comparison TAU only
  • Follow-up 12 months

84
Miller et al. (2003)Percent Days Abstinent from
Alcohol/Drugs
No significant additive effect of MI
85
Saunders et al., 1995Addiction, 90415-424
  • Design Randomized clinical trial
  • Population Methadone maintenance clinic
  • Nation Australia (Perth, WA)
  • N 122 adults
  • MI 1 session (1 hour)
  • Comparison Educational control
  • Follow-up 6 months

86
Saunders et al., 1995
plt.03
plt.01
87
Saunders et al., 1995MI vs. Educational Control
Group
  • The MI group showed greater
  • Immediate (1 week) advance to contemplation stage
    (plt.03)
  • Positive view of abstinence at 3 months(plt.05)
  • Reduction in drug-related problems at 6 months
    (plt.04)
  • Time to relapse to heroin use (plt.05)

88
Schneider et al., 2000Journal of Behavioral
Health Services and Research, 2760-74
  • Design Quasi-experimental
  • Population Employee assistance programs
  • Nation US (Boston, MA)
  • N 89 clients with substance abuse
  • MI 2 session MET
  • Comparison 2 session confrontation/feedback
  • Follow-up 3 and 9 months

89
Schneider et al., 2000
ns
90
Schneider et al., 2000
ns
91
Stein et al., 2002Addiction, 97691-700
  • Design Randomized clinical trial
  • Population Needle exchange program recipients
  • Nation US (Providence, RI)
  • N 187 active injection drug users
  • MI 2 sessions (60 min each)
  • - one month apart
  • Comparison Assessment only
  • Follow-up 1 and 6 months

92
Stein et al., 2002
  • MI subjects (based on observed percentage
    differences and odds ratios) were more likely
    than controls to be abstinent at 6 months.
  • MI subjects reported lower mean heroin use
    frequency than controls at 6 months.
  • MI subjects 37.5 reduction in drinking days is
    larger than that of most brief alcohol
    intervention trials.
  • MI subjects with above median (gt9) baseline
    drinking day frequency were over two times more
    likely than controls to report reductions of 7 or
    more days (plt.05) at 6 months.

93
Stein et al., 2002
1 Month
6 Months
1 Month
6 Months
Plt.05
Plt.01
Plt.01
Plt.01
Plt.01
Plt.01
Plt.01
n. s.
n 187
n 92
Full Sample gt9
Baseline Drinking Days
94
Stephens et al., 2000Journal of Consulting
Clinical Psychology, 68898-908
  • Design Randomized clinical trial
  • Population Recruited by newspaper
  • Nation US (Seattle, WA)
  • N 291 marijuana users
  • MI 2 sessions MET (90 min)
  • Comparison 14 sessions group behavior therapy
    (2 hours)
  • Waiting list (4 months)
  • Follow-up 16 months

95
Stephens et al., 2000
plt.001
96
Stephens et al., 2000
plt.02
plt.01
97
Stephens et al., 2000
plt.001
plt.001
plt.001
98
Stephens et al., 2000
plt.04
plt.001
99
Stotts et al., 2001Journal of Consulting
Clinical Psychology, 69858-862
  • Design Randomized clinical trial
  • Population Outpatient cocaine detoxification
  • Nation US (Houston, TX)
  • N 105 cocaine dependent
  • MI 2 sessions MET (1 hour)
  • Comparison Detoxification only
  • Follow-up 12 weeks post-detox

100
Stotts et al., 2001
plt.03
plt.05
101
Stotts et al., 2001
plt.05
plt.03
102
Dual Diagnosis

103
Barrowclough et al, 2001American Journal of
Psychiatry, 1581706-1713
  • Design Randomized trial
  • Population Schizophrenia or schizoaffective
    substance use disorder
  • Nation US
  • N 36 adults (marijuana)
  • MI 5 sessions 24 CBT sessions
  • Comparison 24 CBT sessions
  • Follow-up 1 year

104
Barrowclough et al., 1998
105
Daley et al, 1998American Journal of Psychiatry,
1551611-1613
  • Design Consecutive assignment
  • Population Discharge from treatment
  • Nation US (Pittsburgh, PA)
  • N 23 adults (cocainedepression)
  • MI 5 individual 4 group sessions
  • Comparison TAU
  • Follow-up 1 year

106
Daley et al., 1998
plt.001
plt.03
plt.01
107
Daley Zuckoff, 1998Social Work, 43470-473
  • Design Consecutive cohorts
  • Population Dual diagnosis inpatients
  • Nation US (Pittsburgh, PA)
  • N Nearly 100
  • MI 1 pre-discharge session
  • Comparison TAU (no MI)
  • Follow-up Proximal

108
Daley Zuckoff, 1998
109
Martino et al., 2000American Journal on
Addictions, 988-91
  • Design Randomized clinical trial
  • Population Partial hospital program
  • Nation US (New Haven, CT)
  • N 23 dual diagnosis patients
  • MI 1 session (45-60 min)
  • Comparison TAU
  • Follow-up End of treatment (12 wk)

110
Martino et al., 2000
plt.05
plt.05
plt.05
111
Eating Disorders

112
Treasure et al., 1999Behaviour Research
Therapy, 37405-418
  • Design Randomized clinical trial
  • Population Bulimia
  • Nation UK (London, Maudsley)
  • N 125 outpatients
  • MI 4 session MET
  • Comparison 4 session behavior therapy
  • Follow-up 4 weeks

113
Treasure et al., 1999
  • No significant differences between MI and
    behavior therapy at 4 weeks on
  • Drop-out rate
  • Binge eating
  • Vomiting
  • Laxative abuse

114
Gambling

115
Hodgins et al., 2001Journal of Consulting
Clinical Psychology, 6950-57
  • Design Randomized clinical trial
  • Population Problem gambling
  • Nation Canada (Calgary, Alberta)
  • N 102 adults
  • MI 1 phone session (20-45 min)
  • Comparison Mailed self-help book
  • Waiting list control
  • Follow-up 12 months

116
Hodgins et al., 2001
plt.03
plt.04
plt.03
plt.05
117
Health Promotion

118
Resnicow et al, 2001American Journal of Public
Health, 91, 1686-1693.
  • Design Randomized Clinical Trial
  • Population Adults recruited through Black
    Churches
  • Nation US (Atlanta, GA)
  • N 861 adults
  • MI 3 telephone contacts by trained dietitians
  • Comparison 1) Health Education only, 2)
    Self-help materials plus one non-MI phone
    call
  • Main Outcome Self-reported fruit vegetable
    intake (F V)
  • Follow-up 1 year

119
Resnicow et al, 2001

MI Group different plt.01 than Groups 1 2
120
Thevos et al, 2000Health Promotion
International, 15207-214
  • Design Comparison zones
  • Population Households
  • Nation Zambia, Africa
  • N 332 households
  • MI Health visitor consults
  • Comparison Health education
  • Follow-up 6 months

121
Thevos et al., 2000
plt.001
122
HIV Risk

123
Carey et al., 1997Journal of Consulting
Clinical Psychology, 65531-541
  • Design Randomized clinical trial
  • Population Women at risk for HIV
  • Nation US (Syracuse, NY)
  • N 102 women from community
  • MI 4 group MET sessions
  • Comparison Attention placebo group
  • Follow-up 3 months

124
Carey et al., 1997MI vs. Educational Control
Group
  • The MI group showed greater
  • HIV knowledge (plt.0001)
  • Perception of HIV risk (plt.001)
  • Intention to protect (plt.003)
  • Communication with partner (plt.05)
  • And significantly lower rates of
  • Unprotected intercourse (plt.01)
  • Substance abuse before sex (plt.001)

125
Carey et al., 2000Health Psychology, 193-11
  • Design Randomized clinical trial
  • Population Women at risk for HIV
  • Nation US (Syracuse, NY)
  • N 102 women from community
  • MI 4 group MET sessions
  • Comparison Attention placebo group
  • Follow-up 3 and 12 weeks

126
Carey et al., 2000MI vs. Educational Control
Group
  • The MI group showed greater
  • HIV knowledge (plt.003)
  • Intention to protect (plt.001)
  • And significantly lower rates of
  • Unprotected intercourse (plt.001)
  • among women with imperfect intentions

127
Mental Health

128
Kemp et al., 1998British Journal of Psychiatry,
172413-419
  • Design Randomized clinical trial
  • Population Acute psychiatric unit
  • Nation UK (London, Maudsley Hospital)
  • N 74 patients with psychosis
  • MI 4-6 session Compliance Therapy
  • Comparison 4-6 session supportive therapy
  • Follow-up 18 months

129
Kemp et al., 1998Clinician (Non-blind) Ratings
of Improvement
  • MI group rates significantly higher on
  • Insight
  • Global functioning
  • Attitudes toward drug use
  • Compliance

130
Kemp et al., 1998
  • MI group showed lower rates of
  • Treatment drop-out
  • 28 vs. 43 (ns)
  • Readmission
  • Relative risk of controls 2.2

131
Swanson et al., 1999Journal of Nervous Mental
Disease, 187630-635
  • Design Randomized clinical trial
  • Population Psychiatric inpatients
  • Nation US (New York)
  • N 121 inpatients
  • MI 2 sessions (15, 60 min) TAU
  • Comparison TAU
  • Follow-up Transition to aftercare

132
Swanson et al., 1999
plt.01
133
Smoking

134
Colby et al., 1998Journal of Consulting
Clinical Psychology, 66574-578
  • Design Randomized clinical trial
  • Population Hospital emergency room
  • Nation US (Providence, RI)
  • N 40 adolescent smokers
  • MI 1 MET session with 4 videos
  • Comparison Brief advice
  • Follow-up 3 months

135
Colby et al., 1998
ns ES .28
136
Stotts et al., 2002Addictive Behaviors,
27275-292
  • Design Randomized clinical trial
  • Population 21 prenatal care clinics
  • Nation USA (Houston and Dallas, TX)
  • N 269 resistant pregnant smokers
  • MI 2 MI phone calls (20-30 min)
  • Comparison TAU
  • Follow-up to 6 months post-partum

137
Stotts et al., 2002
ns
138
Stotts et al., 2002
P lt .05
P lt .01
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