title: Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study.
abstract: Despite recent emphasis on integrating empirically validated treatment into clinical practice, there are little data on whether manual-guided behavioral therapies can be implemented in standard clinical practice and whether incorporation of such techniques is associated with improved outcomes. The effectiveness of integrating motivational interviewing (MI) techniques into the initial contact and evaluation session was evaluated in a multisite randomized clinical trial. Participants were 423 substance users entering outpatient treatment in five community-based treatment settings, who were randomized to receive either the standard intake/evaluation session at each site or the same session in which MI techniques and strategies were integrated. Clinicians were drawn from the staff of the participating programs and were randomized either to learn and implement MI or to deliver the standard intake/evaluation session. Independent analyses of 315 session audiotapes suggested the two forms of treatment were highly discriminable and that clinicians trained to implement MI tended to have higher skill ratings. Regarding outcomes, for the sample as a whole, participants assigned to MI had significantly better retention through the 28-day follow-up than those assigned to the standard intervention. There were no significant effects of MI on substance use outcomes at either the 28-day or 84-day follow-up. Results suggest that community-based clinicians can effectively implement MI when provided training and supervision, and that integrating MI techniques in the earliest phases of treatment may have positive effects on retention early in the course of treatment.
authors.affiliation: Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, West Haven, CT 06516, USA. kathleen.carroll@yale.edu
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Ball
authors.forename: Charla
authors.initials: C
authors.lastname: Nich
authors.forename: Steve
authors.initials: S
authors.lastname: Martino
authors.forename: Tami L
authors.initials: TL
authors.lastname: Frankforter
authors.forename: Christiane
authors.initials: C
authors.lastname: Farentinos
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Kunkel
authors.forename: Susan K
authors.initials: SK
authors.lastname: Mikulich-Gilbertson
authors.forename: Jon
authors.initials: J
authors.lastname: Morgenstern
authors.forename: Jeanne L
authors.initials: JL
authors.lastname: Obert
authors.forename: Doug
authors.initials: D
authors.lastname: Polcin
authors.forename: Ned
authors.initials: N
authors.lastname: Snead
authors.forename: George E
authors.initials: GE
authors.lastname: Woody
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D009042:Motivation; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000534:rehabilitation*