title: Is the quality of brief motivational interventions for drug use in primary care associated with subsequent drug use?
abstract: BACKGROUND
  Although a number of brief intervention approaches for drug use are based on motivational interviewing (MI), relatively little is known about whether the quality of motivational interviewing skills is associated with intervention outcomes.
  
  
  METHODS
  The current study examined whether indices of motivational interviewing skill were associated with subsequent drug use outcomes following two different MI-based brief interventions delivered in primary care; a 15 min Brief Negotiated Interview (BNI) and a 45 min adaptation of motivational interviewing (MOTIV). Audio recordings from 351 participants in a randomized controlled trial for drug use in primary care were coded using the Motivational Interviewing Treatment Integrity Scale, (MITI Version 3.1.1). Separate negative binomial regression analyses, stratified by intervention condition, were used to examine the associations between six MITI skill variables and the number of days that the participant used his/her main drug 6 weeks after study entry.
  
  
  RESULTS
  Only one of the MITI variables (% reflections to questions) was significantly associated with the frequency of drug use in the MOTIV condition and this was opposite to the hypothesized direction (global p=0.01, adjusted IRR 1.50, 95%CI: 1.03-2.20 for middle vs. lowest tertile [higher skill, more drug use]. None were significantly associated with drug use in the BNI condition. Secondary analyses similarly failed to find consistent predictors of better drug outcomes.
  
  
  CONCLUSIONS
  Overall, this study provides little evidence to suggest that the level of MI intervention skills are linked with better drug use outcomes among people who use drugs and receive brief interventions in primary care. Findings should be considered in light of the fact that data from the study are from negative trial of SBI and was limited to primary care patients. Future work should consider alternative ways of examining these process variables (i.e., comparing thresholds of proficient versus non-proficient skills) or considering alternative methods of coding intervention skills.
authors.affiliation: Department of Psychological and Brain Sciences, Boston University, 648 Beacon St., Boston, MA, United States.
authors.forename: Tibor P
authors.initials: TP
authors.lastname: Palfai
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave., 2(nd) floor, Boston, MA, United States; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave., 4(th) floor, Boston, MA, United States.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Bernstein
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, MA, 801 Massachusetts Ave., Boston, MA, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Palmisano
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, MA, 801 Massachusetts Ave., Boston, MA, United States.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Lloyd-Travaglini
authors.affiliation: Department of Psychological and Brain Sciences, Boston University, 648 Beacon St., Boston, MA, United States.
authors.forename: Tracie
authors.initials: T
authors.lastname: Goodness
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave., 2(nd) floor, Boston, MA, United States; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave., 4(th) floor, Boston, MA, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome
keywords: Brief intervention; Drugs; Mechanisms; Motivational interviewing; Primary care; Substance use