title: A randomized controlled trial to influence client language in substance use disorder treatment.
abstract: Client language is hypothesized to be a mechanism of action in motivational interviewing (MI). Despite the association of change and sustain talk with substance treatment outcomes, it not known whether providers can intentionally influence this language as hypothesized.
  
  
  
  This is a randomized controlled trial to investigate whether substance use providers can be trained to influence client language.
  
  
  
  Treatment providers specializing in substance use disorders (n=190) were randomly assigned to standard training in MI (MI-AU) or training emphasizing an influence of client language (MI-LEAF). Treatment sessions with actual clients were evaluated 3, 6 and 12 months after training by masked raters. Frequencies of client change and sustain talk were the outcome variables.
  
  
  
  Sustain talk, but not change talk, was significantly lower in clients whose providers had received the specialized training (b=-0.175, SE=0.087, p=0.046, CI[-0.348 to 0.002], d=-0.325). Mediation analyses supported a causal chain between a) training, b) providers' attempts to minimize sustain talk in treatment sessions via directive reflective listening and c) client sustain talk in the treatment session (κ2=0.0833, bootstrap SE=0.0394, 95% CI [0.0148, 0.1691]).
  
  
  
  With specialized training, providers can reduce the amount of opposition language their clients offer when considering a change in their substance use. Demonstrating that client language is under partial control of the provider supports the feasibility of clinical trials to investigate the impact of shaping client language on treatment outcomes.
authors.affiliation: Center on Alcoholism, Substance Abuse, and Addictions, MSC11 6280, 1 University of New Mexico, Albuquerque, NM 87131, United States. Electronic address: tmoyers@unm.edu.
authors.forename: Theresa B
authors.initials: TB
authors.lastname: Moyers
authors.affiliation: Center on Alcoholism, Substance Abuse, and Addictions, MSC11 6280, 1 University of New Mexico, Albuquerque, NM 87131, United States. Electronic address: jhouck@unm.edu.
authors.forename: Jon
authors.initials: J
authors.lastname: Houck
authors.affiliation: VA Puget Sound Health Care System, Department of Anesthesiology, 1660 S Columbian Way, Seattle, WA 98108, United States. Electronic address: Lisa.glynn2@va.gov.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Glynn
authors.affiliation: University of Washington Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: khallgre@uw.edu.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Hallgren
authors.affiliation: San Francisco VA Medical Center and University of California, San Francisco, CA, United States. Electronic address: jennifer.manuel@va.gov.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Manuel
mesh_terms: D000328:Adult; D003376:Counseling / Q000193:education / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000193:education / Q000379:methods; D019966:Substance-Related Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Active mechanism; Client language; Counselor training; Motivational interviewing; Randomized controlled trial; Technical component