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Motivational Interviewing: Findings from Clinical Trials Updated: 10 December 2004.

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Presentation on theme: "Motivational Interviewing: Findings from Clinical Trials Updated: 10 December 2004."— Presentation transcript:

1 Motivational Interviewing: Findings from Clinical Trials Updated: 10 December 2004

2 Alcohol

3 Allsop et al., 1997 Addiction, 92:61-74 DesignRandomized clinical trial PopulationAlcohol abuse NationScotland N60 adult outpatients MI8 session group MI + skills ComparisonGroup discussion TAU Follow-up6 months

4 Allsop et al., 1997 p<.01p<.04p<.03

5 Baer et al., 1992 Journal of Consulting and Clinical Psychology, 60: DesignRandomized clinical trial PopulationCollege Students NationUS (Seattle, WA)) N134 young adults MI1 session (60 min) ComparisonTwo groups: (1) six weekly cognitive behavioral groups (90 minute ea) (2) a six-unit self-help cognitive behavioral manual Follow-uppost-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

9

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11 Bien et al., 1993 Behavioural & Cognitive Psychotherapy, 21: DesignRandomized clinical trial PopulationOutpatient alcohol (VA) NationUS (Albuquerque, NM) N32 adults MI1 session MET (+ TAU) ComparisonTAU Follow-up6 months post discharge

12 Bien et al., 1993 p<.05

13 Bien et al., 1993

14 Borsari & Carey, 2000 Journal of Consulting & Clinical Psychology, 68: DesignRandomized clinical trial PopulationBinge drinkers NationUS (Syracuse, NY) N60 college students MI1 session MET ComparisonAssessment only Follow-up6 weeks

15 Borsari & Carey, 2000 p<.006p<.001p<.05

16 Brown & Miller, 1993 Psychology of Addictive Behaviors, 7: DesignRandomized clinical trial PopulationInpatient alcohol NationUS (Albuquerque, NM) N28 adults MI1 session MET (+ TAU) ComparisonTAU Follow-up3 months post discharge

17 Brown & Miller, 1993 p<.001

18 Brown & Miller, 1993

19 Dench & Bennett, 2000 Behavioural & Cognitive Psychotherapy, 28: DesignRandomized clinical trial Population6 week day treatment program NationUnited Kingdom N51 alcohol dependent patients MI1 session ComparisonAttention placebo education Follow-up1 and 6 weeks

20 Dench & Bennett, 2000 p<.001p<.03p<.01

21 Handmaker et al., 1999 Journal of Studies on Alcohol, 60: DesignRandomized clinical trial PopulationPrenatal care clinics NationUS (Albuquerque, NM) N42 pregnant drinkers MI1-hour individual session ComparisonRisk-alert letter Follow-up2 months

22 Handmaker et al., 1999 All differences ns due to small sample size (N=34) Largest effects of MI observed with heaviest drinkers

23 Heather et al., 1996 Drug & Alcohol Review, 15:29-38 DesignBlock assignment PopulationGeneral hospital inpatients NationAustralia N174 adult heavy drinkers MI minute session ComparisonSkills training or TAU Follow-up6 months

24 Heather et al., 1996 p<.05

25 Kuchipudi et al., 1990 Journal of Consulting & Clinical Psychology, 65: DesignRandomized clinical trial PopulationAcute gastrointestinal ward NationUS (Hines, IL) N114 alcohol-related admissions MI5 sessions with 5 practitioners ComparisonTAU Follow-up16 weeks

26 Kuchipudi et al., 1990 ns

27 Kuchipudi et al., 1990 Was 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 person’s health and drinking were reviewed from the viewpoint and with the authority of the director of the unit”

28 Marlatt et al., 1998 Journal of Consulting and Clinical Psychology, 66: DesignRandomized clinical trial PopulationCollege students NationUS (Seattle, WA) N348 heavy drinkers MI1 individual session ComparisonAssessment only Follow-up2 years

29 Marlatt et al., 1998 p<.05p<.001p<.05

30 Miller et al., 1988 Behavioural Psychotherapy, 16: DesignRandomized clinical trial PopulationSelf-referred problem drinkers NationUS (Albuquerque, NM) N42 adults MIAssessment + 1 MET session ComparisonConfrontational counseling Waiting list (6 weeks) Follow-up18 months

31 Miller et al., 1988 Waiting list was unchanged until receiving MET

32 Miller et al., 1993 Journal of Consulting & Clinical Psychology, 61: DesignRandomized clinical trial PopulationSelf-referred problem drinkers NationUS (Albuquerque, NM) N42 problem drinkers MIAssessment + 1 MET session ComparisonConfrontational counseling Waiting list (6 weeks) Follow-up12 months

33 Miller et al., 1993 p<.02 relative to waiting list control

34 Miller et al., 1993 p<.02 relative to waiting list control

35 Miller et al., 1993

36

37 Monti et al., 1999 Journal of Consulting and Clinical Psychology, 67: DesignRandomized clinical trial PopulationEmergency room NationUS (Providence, RI) N94 adolescents (18-19) MI1 session (35-40 min) ComparisonStandard care Follow-up6 months

38 Monti et al., 1999 p<.05p<.01p<.05

39 Murphy et al., 2001 Psychology of Addictive Behaviors, 15: DesignRandomized clinical trial PopulationCollege Students NationUS (Auburn, AL) N99 drinkers MI1 session (50 min) ComparisonAlcohol education; No intervention Follow-up9 months

40 Murphy et al., 2001 p<.05 Differences significant for heavy drinkers only

41 Project MATCH, 1997 Journal of Studies on Alcohol, 58:7-29 DesignRandomized clinical trial PopulationOutpatient and aftercare NationUS (9 sites) N1,726 adults MI4 session MET Comparison12 session CBT or TSF Follow-up15 months post-treatment

42 Project MATCH, 1997 p<.003p<.04

43 Project MATCH, 1998 Alcoholism: Clinical and Experimental Research, 22: p<.007 On percent days abstinent, MET = TSF > CBT

44 Sellman et al., 2001 Journal of Studies on Alcohol, 62: DesignRandomized clinical trial PopulationMild/moderate dependence NationNew Zealand N125 alcohol outpatients MIMET 4 sessions ComparisonNondirective reflective listening Control: No further counseling Follow-up6 months post-treatment

45 Sellman et al., 2001 nsp<.04ns

46 Senft et al., 1997 American Journal of Preventive Medicine, 13: DesignRandomized clinical trial PopulationPrimary care NationUS (Portland, OR) N516 adults MI1 session, 15 min (+ TAU) ComparisonTAU Follow-up12 months

47 Senft et al., 1997 p<.04ns

48 Senft et al., 1997 p<.04p<.02

49 Smith et al., 2003 Addiction, 98:43-52 DesignRandomized clinical trial PopulationOral and maxillofacial surgery clinic out-patients NationUK (Cardiff, Wales) N151 young males with alcohol- related facial injuries MI1 manual-guided session (+ TAU) ComparisonTAU Follow-up3 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, 1998 Doctoral dissertation, University of New Mexico DesignRandomized clinical trial PopulationCardiovascular rehab NationUS (Albuquerque, NM) N61 MITAU + MET (1 hr) + skills based health ed (90 min) ComparisonTAU traditional rehab Follow-up12 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 <.005

57 Woollard et al., 1995 Clinical & Experimental Pharmacology & Physiology, 22: DesignRandomized clinical trial PopulationGeneral practice NationAustralia (Perth, WA) N166 patients with hypertension MIHigh: 6 nurse sessions (45 min) Low: 1 session + 5 phone (15 min) ComparisonTAU Follow-up18 weeks

58 Woollard et al., 1995 p<.05

59 Woollard et al., 1995 p<.05

60 Diabetes

61 Smith et al., 1997 Diabetes Care, 20:52-54 DesignRandomized clinical trial PopulationRecruited by newspaper NationUS (Birmingham, AL) N22 older obese women MI3 sessions MI + TAU ComparisonTAU (behavior therapy) Follow-upPost-treatment

62 Smith et al., 1997 p<.01p<.003p<.05p<.07

63 Smith et al., 1997 p<.05ns

64 Drug Abuse

65 Aubrey, 1998 Doctoral dissertation, University of New Mexico DesignRandomized clinical trial PopulationAdolescent drug abuse treatment NationUS (Albuquerque, NM) N77 adolescents entering treatment MI1 individual session + TAU ComparisonTAU Follow-up3 months

66 Aubrey, 1998

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71 Baker et al., 2001 Addiction, 96: DesignRandomized clinical trial PopulationRegular amphetamine users NationAustralia N64 adults MI2 individual sessions + book 4 session MI + skill training ComparisonSelf-help book Follow-up6 months

72 Baker et al., 2001 p<.01p<.05

73 Baker et al., 2002 Addiction, 97: Acta Psychiatrica Scandinavica, 105:xx DesignRandomized clinical trial PopulationInpatient psychiatric hospital NationAustralia N160 adults with concomitant disorders MI30-45 minute individual session ComparisonSelf-help book and brief advice Follow-up12 months

74 Baker et al., 2002 p<.04

75 Baker et al., 2002 p<.02ns

76 Lincourt et al., in press Addictive Behavior DesignQuasi-experiment (attendance) PopulationMandated outpatient treatment NationUS (New York) N167 adults (substance abuse) MI6 session group + TAU ComparisonTAU Follow-upEnd of treatment

77 Lincourt et al., in press p<.001p<.005

78 Longshore et al., 1999 Substance Use & Misuse, 34: DesignQuasi-experiment (attendance) PopulationMandated outpatient treatment NationUS (Los Angeles, CA) N222 African-American drug users MI1 session ComparisonNeeds assessment Follow-upEnd of treatment

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

80 Marijuana Treatment Project Research Group (2004) Journal of Consulting and Clinical Psychology, 72: DesignRandomized clinical trial PopulationInpatient or outpatient treatment NationUS (3 sites) N450 adult marijuana smokers MI2 session MET Comparison9-session MET + behavior therapy Control4-month waiting list control Follow-up15 months

81 Marijuana Treatment Project Research Group (2004) p<.001nsp<.001

82 Marijuana Treatment Project Research Group (2004) Marijuana Joints per Week p<.001

83 Miller, Yahne & Tonigan (2003) Journal of Consulting and Clinical Psychology, 71: DesignRandomized clinical trial PopulationInpatient or outpatient treatment NationUS (Albuquerque, NM) N208 drug dependent adults MI1 session + TAU ComparisonTAU only Follow-up12 months

84 Miller et al. (2003) Percent Days Abstinent from Alcohol/Drugs No significant additive effect of MI

85 Saunders et al., 1995 Addiction, 90: DesignRandomized clinical trial PopulationMethadone maintenance clinic NationAustralia (Perth, WA) N122 adults MI1 session (1 hour) ComparisonEducational control Follow-up6 months

86 Saunders et al., 1995 p<.03p<.01

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

88 Schneider et al., 2000 Journal of Behavioral Health Services and Research, 27:60-74 DesignQuasi-experimental PopulationEmployee assistance programs NationUS (Boston, MA) N89 clients with substance abuse MI2 session MET Comparison2 session confrontation/feedback Follow-up3 and 9 months

89 Schneider et al., 2000 ns

90 Schneider et al., 2000 ns

91 Stein et al., 2002 Addiction, 97: DesignRandomized clinical trial PopulationNeedle exchange program recipients NationUS (Providence, RI) N187 active injection drug users MI2 sessions (60 min each) - one month apart ComparisonAssessment only Follow-up1 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 (>9) baseline drinking day frequency were over two times more likely than controls to report reductions of 7 or more days (p<.05) at 6 months.

93 Stein et al., Month6 Months1 Month6 Months n = 187 n = 92 Full Sample >9 Baseline Drinking Days n. s. P<.05 P<.01

94 Stephens et al., 2000 Journal of Consulting & Clinical Psychology, 68: DesignRandomized clinical trial PopulationRecruited by newspaper NationUS (Seattle, WA) N291 marijuana users MI2 sessions MET (90 min) Comparison14 sessions group behavior therapy (2 hours) Waiting list (4 months) Follow-up16 months

95 Stephens et al., 2000 p<.001

96 Stephens et al., 2000 p<.02p<.01

97 Stephens et al., 2000 p<.001

98 Stephens et al., 2000 p<.04p<.001

99 Stotts et al., 2001 Journal of Consulting & Clinical Psychology, 69: DesignRandomized clinical trial PopulationOutpatient cocaine detoxification NationUS (Houston, TX) N105 cocaine dependent MI2 sessions MET (1 hour) ComparisonDetoxification only Follow-up12 weeks post-detox

100 Stotts et al., 2001 p<.03p<.05

101 Stotts et al., 2001 p<.05p<.03

102 Dual Diagnosis

103 Barrowclough et al, 2001 American Journal of Psychiatry, 158: DesignRandomized trial PopulationSchizophrenia or schizoaffective + substance use disorder NationUS N36 adults (marijuana) MI5 sessions + 24 CBT sessions Comparison24 CBT sessions Follow-up1 year

104 Barrowclough et al., 1998

105 Daley et al, 1998 American Journal of Psychiatry, 155: DesignConsecutive assignment PopulationDischarge from treatment NationUS (Pittsburgh, PA) N23 adults (cocaine+depression) MI5 individual + 4 group sessions ComparisonTAU Follow-up1 year

106 Daley et al., 1998 p<.001p<.03p<.01

107 Daley & Zuckoff, 1998 Social Work, 43: DesignConsecutive cohorts PopulationDual diagnosis inpatients NationUS (Pittsburgh, PA) N“Nearly 100” MI1 pre-discharge session ComparisonTAU (no MI) Follow-upProximal

108 Daley & Zuckoff, 1998

109 Martino et al., 2000 American Journal on Addictions, 9:88-91 DesignRandomized clinical trial PopulationPartial hospital program NationUS (New Haven, CT) N23 dual diagnosis patients MI1 session (45-60 min) ComparisonTAU Follow-upEnd of treatment (12 wk)

110 Martino et al., 2000 p<.05

111 Eating Disorders

112 Treasure et al., 1999 Behaviour Research & Therapy, 37: DesignRandomized clinical trial PopulationBulimia NationUK (London, Maudsley) N125 outpatients MI4 session MET Comparison4 session behavior therapy Follow-up4 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., 2001 Journal of Consulting & Clinical Psychology, 69:50-57 DesignRandomized clinical trial PopulationProblem gambling NationCanada (Calgary, Alberta) N102 adults MI1 phone session (20-45 min) ComparisonMailed self-help book Waiting list control Follow-up12 months

116 Hodgins et al., 2001 p<.03p<.04p<.03p<.05

117 Health Promotion

118 Resnicow et al, 2001 American Journal of Public Health, 91, DesignRandomized Clinical Trial PopulationAdults recruited through Black Churches NationUS (Atlanta, GA) N861 adults MI3 telephone contacts by trained dietitians Comparison1) Health Education only, 2) Self-help materials plus one non-MI phone call Main OutcomeSelf-reported fruit & vegetable intake (F &V) Follow-up1 year

119 Resnicow et al, 2001 * MI Group different p<.01 than Groups 1 & 2 *

120 Thevos et al, 2000 Health Promotion International, 15: DesignComparison zones PopulationHouseholds NationZambia, Africa N332 households MIHealth visitor consults ComparisonHealth education Follow-up6 months

121 Thevos et al., 2000 p<.001

122 HIV Risk

123 Carey et al., 1997 Journal of Consulting & Clinical Psychology, 65: DesignRandomized clinical trial PopulationWomen at risk for HIV NationUS (Syracuse, NY) N102 women from community MI4 group MET sessions ComparisonAttention placebo group Follow-up3 months

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

125 Carey et al., 2000 Health Psychology, 19:3-11 DesignRandomized clinical trial PopulationWomen at risk for HIV NationUS (Syracuse, NY) N102 women from community MI4 group MET sessions ComparisonAttention placebo group Follow-up3 and 12 weeks

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

127 Mental Health

128 Kemp et al., 1998 British Journal of Psychiatry, 172: DesignRandomized clinical trial PopulationAcute psychiatric unit NationUK (London, Maudsley Hospital) N74 patients with psychosis MI4-6 session Compliance Therapy Comparison4-6 session supportive therapy Follow-up18 months

129 Kemp et al., 1998 Clinician (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., 1999 Journal of Nervous & Mental Disease, 187: DesignRandomized clinical trial PopulationPsychiatric inpatients NationUS (New York) N121 inpatients MI2 sessions (15, 60 min) + TAU ComparisonTAU Follow-upTransition to aftercare

132 Swanson et al., 1999 p<.01

133 Smoking

134 Colby et al., 1998 Journal of Consulting & Clinical Psychology, 66: DesignRandomized clinical trial PopulationHospital emergency room NationUS (Providence, RI) N40 adolescent smokers MI1 MET session with 4 videos ComparisonBrief advice Follow-up3 months

135 Colby et al., 1998 ns; ES =.28

136 Stotts et al., 2002 Addictive Behaviors, 27: DesignRandomized clinical trial Population21 prenatal care clinics NationUSA (Houston and Dallas, TX) N269 resistant pregnant smokers MI2 MI phone calls (20-30 min) ComparisonTAU Follow-upto 6 months post-partum

137 Stotts et al., 2002 ns

138 Stotts et al., 2002 P <.05P <.01


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