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Motivational Interviewing and Treatment Retention Among Drug User Patients: A Pilot Study

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Abstract

The effect of motivational interviewing (MI) on retention in the context of an outpatient and drug-free heroin-program is evaluated. Heroin users (N=40) seeking treatment were randomly assigned to MI or to control conditions. Results indicated that participants who received MI significantly increased retention rates in comparison to the control group six months after the commencement of the treatment program (50%, as against 20%). These results suggest that MI could be a useful instrument for improving retention rates in drug-free treatment programs during the initial phases of treatment, when the majority of "drop-outs" from these programs are recorded.

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... When the search on substance abuse is looked from the perspective of gender, the prevalence of substance abuse is much higher in men than in women. In a study conducted by Villa et al. (13) on 40 subjects in the Netherlands in which motivational interviews on substance dependence were addressed, 36 subjects were males and 3 were females. Although there was no female subject in the current study, it is in line with literature in terms of the fact that substance abuse is much more common in men than in women. ...
... In a comprehensive study on substance abuse by Tamar et al. (17), it was seen that of the individuals in the sample, 45 were married, 48 were single, and 3 were divorced. In a study on the same topic, 65% of the subjects were single, 12.5% were married, and 22.5% were divorced or widowed (13). ...
... Marital status may vary depending on structure of the family and features of the society in which the individuals live rather than substance abuse (13,18,19). ...
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Introduction: Treatment motivation in alcohol dependents is usually viewed as a strong predictor of seeking treatment and treatment success. The conditions affecting motivation in alcohol dependence, however, has not been clarified. In this study, it is aimed to determine the effects of depression on treatment motivation in male alcohol dependence. Methods: The present study included 34 male alcohol dependents presenting to outpatient clinics in Manisa Hospital of Mental Disorders and Hospital of Celal Bayar University. The patients underwent evaluation using the socio-demographic and clinical information form, DSM-IV SCID-I Clinical Version, Treatment Motivation Questionnaire (TMQ), and Hamilton Depression Rating Scale (HDRS). Results: A significant relationship was found between the total score of TMQ and HDRS (p=.039). Conclusion: We believe that the present study, in which we examined the relationship between treatment motivation in male alcohol dependence and depression, would provide a significant contribution to literature. It is also important to investigate other factors that may affect treatment motivation in male alcohol dependence. Studies with larger samples are needed on this topic.
... The majority of strategies investigated belonged to one of the four typologies: providing a motivational intervention designed to foster treatment receptiveness in the early stages of treatment contact (Dench and Bennett 2000;Carroll et al. 2001;Conners et al. 2002;Secades-Villa et al. 2004;Carroll et al. 2006); providing a role induction designed to prime the client for pending treatment provision (Zweben and Li 1981;Stark and Kane 1985;Conners et al. 2002;Katz et al. 2004); accelerating the admission process in order that clients may begin treatment earlier than they otherwise would have (Stark et al. 1990;Festinger et al. 1996;Stasiewicz and Stalker 1999;Festinger et al. 2002) or providing some form of appointment reminder service (Gariti et al. 1995;Stasiewicz and Stalker 1999;Booth and Bennett 2004). Other response strategies investigated included: providing a follow-up letter or telephone call to clients who do not attend scheduled treatment appointments (Nirenberg et al. 1980); providing attendance incentives over the course of a treatment program (Petry et al. 2000); promoting health beliefs supportive of longer-term treatment retention (Rees 1986) or attempting to engage clients in a dialogue that identifies potential barriers to treatment attendance and identifies possible solutions (Stark et al. 1990). ...
... Most studies reported protecting against possible contamination between the experimental and control group conditions or experimental conditions less prone to potential contamination were employed (e.g. provision of attendance incentives or an appointment reminder call); however, in five papers the possibility of study contamination could not be ruled out (Stark and Kane 1985;Rees 1986;Gariti et al. 1995;Carroll et al. 2001;Secades-Villa et al. 2004;). With respect to the level of contextual information provided in each study, eight papers described the attendance requirements of the respective treatment program or stated that attendance is determined on a case-by-case basis (Gariti et al. 1995;Dench and Bennett 2000;Petry et al. 2000;Conners et al. 2002;Festinger et al. 2002;Katz et al. 2004;Secades-Villa et al. 2004;Carroll et al. 2006); seven described the treatment approach (Dench and Bennett 2000;Petry et al. 2000;Festinger et al. 2002;Conners et al. 2002;Booth and Bennett 2004;Katz et al. 2004;Carroll et al. 2006) and four specified the treatment goal (Dench and Bennett 2000;Petry et al. 2000;Conners et al. 2002;Carroll et al. 2006). ...
... provision of attendance incentives or an appointment reminder call); however, in five papers the possibility of study contamination could not be ruled out (Stark and Kane 1985;Rees 1986;Gariti et al. 1995;Carroll et al. 2001;Secades-Villa et al. 2004;). With respect to the level of contextual information provided in each study, eight papers described the attendance requirements of the respective treatment program or stated that attendance is determined on a case-by-case basis (Gariti et al. 1995;Dench and Bennett 2000;Petry et al. 2000;Conners et al. 2002;Festinger et al. 2002;Katz et al. 2004;Secades-Villa et al. 2004;Carroll et al. 2006); seven described the treatment approach (Dench and Bennett 2000;Petry et al. 2000;Festinger et al. 2002;Conners et al. 2002;Booth and Bennett 2004;Katz et al. 2004;Carroll et al. 2006) and four specified the treatment goal (Dench and Bennett 2000;Petry et al. 2000;Conners et al. 2002;Carroll et al. 2006). Table II presents the number of participants and selected demographic data reported in each publication. ...
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This article reviews the evidence in support of current treatment dropout responses designed for use in outpatient, psychosocial-based alcohol and other drug (AOD) treatment settings. A total of 17 publications meeting the inclusion criteria were identified for this review, reporting findings from 19 randomised controlled trials or controlled clinical trials. The methodological quality of these studies was largely sound; however, a lack of contextual information made it difficult to generalise the reported findings across treatment settings and the effectiveness of the reported strategies was modest at best. Future possibilities in dropout response research are subsequently discussed and a novel conceptual framework, termed treatment-fit, is described in detail. It is anticipated that the findings and ideas presented in this article will assist AOD treatment providers formulate an informed response to client dropout. It is also the authors’ intention to promote a fundamental shift in how treatment dropout is understood. Achieving such a shift, as will be argued, may result in a truly effective response to treatment dropout.
... No se encontró ninguna diferencia significativa entre ambos grupos. Aunque hubo deserción del TBUC, ésta resultó, en general, menor a las tasas de deserción encontradas con otros programas de tratamiento dirigidos a usuarios de diversas sustancias (Fernánde-Hermida & Arnáez-Montaraz, 2004;Sayre et al., 2002;Secades-Villa), así como de otros tratamientos específicamente dirigidos a usuarios de cocaína (Agosti et al., 1991;Gainey et al., 1993;Gawin, 1989;Gawin & Kleber, 1987;Kleinmann, 1992). ...
... No se encontró ninguna diferencia significativa entre ambos grupos. Aunque hubo deserción del TBUC, ésta resultó, en general, menor a las tasas de deserción encontradas con otros programas de tratamiento dirigidos a usuarios de diversas sustancias (Fernánde-Hermida & Arnáez-Montaraz, 2004;Sayre et al., 2002;Secades-Villa), así como de otros tratamientos específicamente dirigidos a usuarios de cocaína (Agosti et al., 1991;Gainey et al., 1993;Gawin, 1989;Gawin & Kleber, 1987;Kleinmann, 1992). ...
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Consumption of cocaine in Mexico has increased dramatically in the last 2 decades. Effective programs to treat behavioral aspects of cocaine use are needed to address this problem. The present paper describes the development, application, and evaluation of a brief cognitive-behavioral treatment program for cocaine users (TBUC). A total of 19 cocaine-dependent users (defined by DSM-IV criteria), 18 men and 1 woman, completed the intervention. The TBUC employed 10, 90-minute weekly sessions aimed at achieving abstinence. Participants engaged in cognitive and behavioral tasks related to reduced consumption. In a 6-month follow up, results indicated that participants reached the cocaine abstinence criterion. The program's brevity, low cost and effectiveness suggest that it is especially appropriate for developing countries such as Mexico, where scarcity of resources impedes programs requiring individualized attention.
... A small number of clinical trials have examined attendance as an outcome for MI interventions [24][25][26][27][28][29][30]. These studies report contradictory findings for the effectiveness of MI; for example, studies have reported MI to be more effective for longer-term treatment retention compared with short-term treatment attendance [26,28], while other studies have reported opposite findings [24,25]. ...
... A small number of clinical trials have examined attendance as an outcome for MI interventions [24][25][26][27][28][29][30]. These studies report contradictory findings for the effectiveness of MI; for example, studies have reported MI to be more effective for longer-term treatment retention compared with short-term treatment attendance [26,28], while other studies have reported opposite findings [24,25]. No clear conclusions can be drawn from the evidence on MI for session attendance (for detailed reviews, please see Pulford et al. [31] and Dunn et al. [32]). ...
Article
IssuesRates of non-attendance are among the highest in substance misuse services. Non-attendance is costly and results in the inefficient use of limited resources. Patients who frequently miss their appointments have worse outcomes including treatment dropout and decreased likelihood of achieving long-term abstinence.ApproachThis narrative review evaluates interventions targeting non-attendance in addiction services and draws upon the wider health-care literature to identify interventions that could be adapted for substance-abusing populations.Key FindingsBoth fixed value and intermittent reinforcement contingency management demonstrate potential for improving attendance. However, small sample sizes and heterogeneous populations make it difficult to draw firm conclusions. Appointment reminders by letter or telephone have demonstrated moderate evidence for improving attendance in substance-abusing populations. Text message appointment reminders are extensively utilised in general health-care settings and consistently improve attendance; however, there is a paucity of research examining the feasibility and effectiveness of text message reminders in addiction services.ImplicationsA lack of evidence for methods to improve attendance is reflected in the continuing challenge faced by addiction services attempting to manage high rates of non-attendance.Conclusions Non-attendance remains a persistent issue for addiction services. While there is limited evidence that contingency management improves attendance, more rigorous research is needed to determine the optimal intervention components and effectiveness in different populations, particularly those receiving maintenance treatments. Multicomponent text message interventions incorporating different delivery and content strategies demonstrate a promise for improving non-attendance and poor engagement.
... No se encontró ninguna diferencia significativa entre ambos grupos. Aunque hubo deserción del TBUC, ésta resultó, en general, menor a las tasas de deserción encontradas con otros programas de tratamiento dirigidos a usuarios de diversas sustancias (Fernánde-Hermida & Arnáez-Montaraz, 2004;Sayre et al., 2002;Secades-Villa), así como de otros tratamientos específicamente dirigidos a usuarios de cocaína (Agosti et al., 1991;Gainey et al., 1993;Gawin, 1989;Gawin & Kleber, 1987;Kleinmann, 1992). ...
... No se encontró ninguna diferencia significativa entre ambos grupos. Aunque hubo deserción del TBUC, ésta resultó, en general, menor a las tasas de deserción encontradas con otros programas de tratamiento dirigidos a usuarios de diversas sustancias (Fernánde-Hermida & Arnáez-Montaraz, 2004;Sayre et al., 2002;Secades-Villa), así como de otros tratamientos específicamente dirigidos a usuarios de cocaína (Agosti et al., 1991;Gainey et al., 1993;Gawin, 1989;Gawin & Kleber, 1987;Kleinmann, 1992). ...
Article
Full-text available
Consumption of cocaine in Mexico has increased dramatically in the last 2 decades. Effective programs to treat behavioral aspects of cocaine use are needed to address this problem. The present paper describes the development, application, and evaluation of a brief cognitive-behavioral treatment program for cocaine users (TBUC). A total of 19 cocaine-dependent users (defined by DSM-IV criteria), 18 men and 1 woman, completed the intervention. The TBUC employed 10, 90-minute weekly sessions aimed at achieving abstinence. Participants engaged in cognitive and behavioral tasks related to reduced consumption. In a 6-month follow up, results indicated that participants reached the cocaine abstinence criterion. The program¿s brevity, low cost and effectiveness suggest that it is especially appropriate for developing countries such as Mexico, where scarcity of resources impedes programs requiring individualized attention.
... The evidence-based practice becomes more effective because people are more responsive to participate and complete what is intended by the EBP treatment. And similarly, when combined, MI becomes more effective because this EBP increases both client engagement and retention in treatment (Carroll et al.. 2006;Secades-Villa, 2004)-all of which is added to the intervention in use. MI is not a prelude to treatment but rather it forms a "base" approach (a "way of being") to be used throughout programming with participants. ...
Article
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This article focuses on direct practice for deradicalization programming. Considering the progression of research to practice, there is a lack of recommendations from existing deradicalization research to inform those engaged in actual service delivery with extremists. Those engaged in one-to-one efforts or group modalities need strategies and techniques to better structure and standardize their efforts. This article suggests motivational interviewing (MI) as one evidence�based practice and well-researched approach that could be applied for countering violent extremism (CVE) work. Motivational interviewing is an approach that is particularly useful when the goal is observable behavior change. It is favored for those who are ambivalent to change as well those who are more resistant, angry or reluctant to change. This article will describe how motivational interviewing appears to be a natural fit for deradicalization and disengagement programs (DDPs) by reviewing eight benefits to this approach. The helpfulness of motivational interviewing is realized as many DDP staff are not trained in methods to increase motivation nor do they have a working knowledge of the process of human behavior change. A point of confluence is made that regardless of the challenging population one works with, whether they are offenders from the criminology field or radicalized terrorists in the deradicalization field, the mechanics that propel behavior change remain the same
... A large number of controlled trials over more than 35 years have demonstrated the efficacy of MI in helping people to change risky or unhealthy behavior in a range of settings, including substance abuse treatment, mental health treatment, health settings, and criminal justice (Miller & Rollnick, 2013). Additionally, MI may be a useful approach to promoting intervention engagement in IPV programs as it has been found to increase intervention engagement (Baker & Hambridge, 2002;Dean et al., 2016), reduce dropout (Roberto et al., 2004), and improve outcomes among clients who are reluctant to attend intervention and/or change their behavior (Chlebowy et al., 2015;Lewis-Fernández et al., 2013;Lincourt et al., 2002). Zuckoff et al., (2015) have noted the distinction between MI for intervention engagement and MI for behavior change. ...
Article
The outcome of treatment for intimate partner violence (IPV) is hampered by high rates of nonattendance, drop-out, and low motivation or readiness to change. As a brief pre-intervention strategy, Motivational interviewing (MI) can be used for perpetrators and those who may not yet be committed to active personal change. Previous research on MI as preparation for IPV intervention programs has reported mixed results. Further research is required to address the limitations in past research and to make a distinction between MI for IPV intervention engagement and MI for IPV behavior change. The current study utilised a quasi-experimental between-groups design. Two groups (control and MI) were compared to each other on the following variables: readiness to attend IPV intervention, IPV intervention commencement and completion, the number of sessions attended, the importance of changing IPV behavior, and the ability and commitment to change these behavior. The within-group analysis found a statistically significant result from pre- to post-MI, which was associated with a large effect size ( p = 0.025, r = 0.64). With regards to the other primary outcomes, the results showed that the MI participants attended significantly more IPV program sessions (mean = 12.18) compared to the control participants (mean = 7), and also completed the intervention (60%) at a higher rate than the control condition (40%). Taken together, the current study contributed to the knowledge in this area by addressing gaps in the literature, by evaluating MI as a pre-intervention strategy for increasing engagement, and including a fidelity measure. The results suggest that well defined MI for engagement has promise as a method to increase male perpetrators’ engagement in IPV intervention.
... MI has been found to be effective in increasing treatment adherence and reducing dropout in the field of addictions (e.g., Secades-Villa, Fernande-Hermida, & Arnaez-Montaraz, 2004) and the promotion of health behaviors (e.g., compliance to diet and exercise regimes, HIV risk reduction; for reviews, see Britt, Blampied, & Hudson, 2003;Martins & McNeil, 2009;Rubak, Sandbaek, Lauitzen, & Christensen, 2005). ...
Article
Although exposure and response prevention (ERP) is the first line psychological treatment for individuals with obsessive compulsive disorder (OCD), many people experience partial recovery and others refuse treatment or drop out. This randomized controlled study (n= 40) examined the effect of a three-session motivational interviewing (MI) intervention compared to a three-session relaxation intervention prior to 15 sessions of ERP on treatment dropout, homework compliance, and treatment outcome post-ERP and at follow up. Contrary to hypotheses, there were no group differences in ERP dropout rates or homework compliance. Both groups experienced significant reductions in OCD symptoms post-ERP. Consistent with our hypothesis, the MI group experienced a greater reduction in OCD symptoms (clinician-rated YBOCS) compared to the comparison group immediately post-ERP. However, this difference did not hold over 12-month follow up. There were also no group differences in associated symptoms (depression, anxiety, stress) across treatment. All participants achieved significant symptom reductions that were maintained over time. A correlational analysis of the whole sample revealed that action scores pre-ERP were significantly negatively correlated with post-ERP OCD symptom severity. These findings suggest that MI prior to ERP may confer a small but meaningful benefit for enhancing treatment outcome post ERP.
... Given the association of therapeutic alliance to positive outcomes, a viable strategy for improving the success of IPV treatment may be to tailor treatment to maximize clients' agreement with the goals of intervention and trust in their therapists, as well as developing strategies that specifically address the perpetrator's motivation to engage in treatment. Motivational interviewing (Miller & Rollnick, 2002) may be a useful approach to promoting treatment engagement in IPV treatment as it has been found to increase treatment engagement (Baker & Hambridge, 2002;Dean et al., 2016), reduce dropout (Roberto, José Ramón, & Cristina, 2004) and improve outcomes among clients who are reluctant to attend treatment and/or change their behaviour (Chlebowy et al., 2015;Lewis-Fernández et al., 2013;Lincourt et al., 2002). Zuckoff, Swartz, and Grote (2015) have noted the distinction between MI for treatment engagement and MI for behaviour change. ...
Article
Client engagement is an essential component in Intimate Partner Violence (IPV) treatment. Engaged clients are more likely to engage with treatment and report a greater degree of treatment satisfaction. Likewise, enhanced engagement is associated with positive treatment outcomes such as session attendance and homework compliance. Only small effect sizes have been reported for reductions in IPV itself, and treatment engagement has been identified as an important factor in this, with studies reporting high rates of non-attendance and drop-out. This article reviews research on the efficacy of motivational interviewing (MI) as a pre-treatment intervention to promote treatment engagement for men who have been mandated or self-referred to attend Intimate Partner Violence treatment. Although limited in number (n = 5), these studies revealed a significant improvement in the level of engagement, session attendance and homework compliance following MI. Further research to focus on MI for treatment engagement, specifically, rather than MI for behaviour change is needed.
... proposes that 'the task of drug treatment professionals is to produce a step-by-step process of motivation enhancement' in unmotivated criminal justice clients. Despite the evidence to suggest that MI is effective (Saunders, Wilkinson, & Phillips, 1995;Secades-Villa, Fernande-Hermida, & Arnaez-Montaraz, 2004;Stotts, Schmitz, Rhoades, & Grabowski, 2001) this intervention was largely absent in the DRR programme, with only 17 keyworkers reporting ever having used MI with their clients. Perhaps this poor utilization of MI may be due to insufficient guidance as to how to follow the principles of MI within a system of quasi-coerced treatment. ...
... When reading different guidelines and various critical surveys of guidelines for treatment, you could almost be led to believe that a treatment facility can establish an EBP by using treatment methods such as cognitive-behavioural therapy (Carroll et al. 1994;Azrin et al. 1994; Kelley et al. 2002;Winters et al. 2002), motivational interviewing (Dunn et al. 2001;Secades-Villa et al. 2004), contingency management (Higgins et al. 1994;Griffith et al. 2000), methadone treatment (Carroll et al. 2001;Carroll & Onken 2005), 12-step counselling (Siqueland & Crits-Christoph 1999;Stoffel & Moyers 2004;Weiss et al. 2005), multisystemic treatment (Curtis et al. 2004), familiy therapy (Stanton & Shadish 1997), and others. ...
Article
The term evidence-based practice (EBP) has developed into a mantra not just within the medical area of treatment, but within the psychosocial realm of treatment as well. Today, decision-makers and funding authorities are increasingly demanding that psychosocial treatment should be evidence-based and that the different types of treatment facilities should attempt to adapt to this, inter alia by providing offers that are reputed to be evidence-based. In this article, EBP is viewed under a slightly different perspective than the one usually used when discussing it. It is claimed that evidence-based counselling and therapeutic methods only account for a small part of the strategies that are relevant for treating clients with substance and/or alcohol misuse. In the first part of the article, EBP is defined and placed in relation to evidence-based counselling/therapy (EBC/T). In the article's second part, the relevance of – not least – EBC/T in the “real world” is discussed. The real world is defined as, among other things, “what clients receive, not what they are offered” and “what clients need, not what the system needs”. This is illustrated by discussing two Danish research projects that demonstrate, inter alia, that what is received does not have much in common with what is offered.
... These would include, for example, brief interventions such as the Motivational Interview (Miller & Rollnick, 1991). The Motivational Interview is a type of approach that has shown itself to be highly effective above all for reducing alcohol consumption and the associated harm in heavy drinkers (with low or moderate levels of dependence) (Saunders, Wilkinson & Phillips, 1995;Stotts, Schmitz, Rhoades & Grabowski, 2001), but also for reducing the use of other drugs (Bien, Miller & Boroughs, 1993;Handmaker, Miller & Manicke, 1999) or increasing treatment retention (Secades-Villa, Fernández-Hermida & Arnáez Montaraz, 2004). The Motivational Interview is a particularly useful technique with those who are resistant to change. ...
Article
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There is substantial scientific support for the effectiveness of psychological techniques in the treatment of drug addiction, based on empirical evidence demonstrating that drug use and abuse behaviours are operant behaviours, and that contingencies play a determinant role in their explanation. Behaviour therapy offers empirically validated approaches that are considered essential strategies for the effective treatment of drug addiction. Operant (contingency management), classical conditioning (exposure) and cognitive-behavioural (skill training) techniques -as well as their different combinations- have emerged as critical components of such programmes. Nevertheless, despite this relative effectiveness, relapse rates in the long term (more than one year of follow-up) remain high in all types of addictive behaviours. Therefore, future research lines should aim to remedy some of the deficiencies with a view to improving the long-term results of these programmes.
... In den letzten Jahren erfreut sich die Motivierende Gesprächsführung zunehmender Beliebtheit unter Suchttherapeuten, und die Evidenz konnte für verschiedene Substanzabhängigkeiten demonstriert werden [78]. So zeigten sich bei Opioidabhängigen in mehreren Untersuchungen unter anderem eine geringere Rückfallrate und eine höhere Therapieretention im Vergleich zu einfacher Beratung [79][80][81]. ...
Article
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After the heroin-wave in Switzerland in the 1980s and 1990s and the establishment of successful maintenance therapies for harm reduction in many western countries, the first evidence-based guidelines for the treatment of opioid dependence appeared. Prevalence of heroin use in Switzerland has decreased subsequently in recent years with a large proportion of patients enrolled in maintenance therapies. In this review, pharmacological and psychosocial treatment strategies for opioid dependence are described and discussed with particular regard to current guidelines from European and American medical societies. Opioid dependence is a chronic brain disease associated with neuroadaptive processes and structural changes that lead to substance craving and relapses despite of negative consequences. Like all substance use disorders, opioid-related disorders comprise acute intoxication, harmful use, dependency and withdrawal states. These diagnoses are discussed in short. Comorbid psychiatric disorders as well as multiple substance use are frequent among opioid-dependent subjects and may complicate an effective treatment. Diagnosis and treatment of comorbidity are therefore crucial and necessary to fundamentally improve the prognosis of opioid dependence. Standardised questionnaires and interviews can be used for this purpose. Treatment in acute phases usually begins with the assessment of physical complications and detailed drug anamnesis. It is followed by the withdrawal of additionally consumed substances like cocaine, benzodiazepines and alcohol. Opioid withdrawal can be treated with agonists as well as other medication directed at specific symptoms. Already at this stage, patients should be motivated to begin maintenance treatment, although abstinence can be a reasonable goal for patients with a short history of opioid abuse as well as in subsequent stable phases of the disorder. Agonist maintenance treatment with methadone or buprenorphine constitutes the first-line therapy at this time. Maintenance treatment with slow-release morphine is currently still carried out as "off-label use". Maintenance with diacetylmorphine (Heroin) is regarded as an important treatment alternative after aborted or failed maintenance therapy and has been established in diverse European countries. Motivational interviewing and contingency management are well-examined psychotherapeutic interventions effective in the treatment of substance-related disorders. Furthermore, disorder-specific psychotherapies enable the integrated treatment of comorbid personality disorders or depressive disorders in parallel to substance use and show positive effects on the course of opioid dependence. Further research is needed to improve our understanding of the neurobiological mechanisms underlying this disorder. Moreover it should aim to advance the efficacy of medical and psychotherapeutic treatments and identify subgroups of patients that can be targeted by specific interventions. Innovative techniques like neuroimaging will provide new options and insights.
... Una opción terapéutica que se centra principalmente en mejorar la retención al tratamiento es la Entrevista Motivacional [EM] (Miller y Rollnick, 2002), utilizando técnicas específi cas para trabajar la ambivalencia y fomentar la motivación al cambio. Ésta ha mostrado su efi cacia en el tratamiento de Trastornos por Uso de Sustancias, reduciendo el consumo de sustancias (Burke, Arkowitz y Menchola, 2003) y aumentando la retención en el tratamiento (Connors, Walitzer y Dermen, 2002;Secades-Villa, Fernández-Hermida y Arnáez-Montaraz, 2004). Concretamente, se ha estudiado el efecto de esta técnica en pacientes dependientes de cocaína (Carroll et al., 2006;McKee et al., 2007) y en dependientes de cocaína con trastorno mental concomitante (Horsfall, Cleary, Hunt y Walter, 2009) encontrando un aumento en la retención en el tratamiento. ...
Article
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Las intervenciones psicológicas en pacientes con dependencia de cocaína han demostrado ser efi caces, destacando el Manejo de Contingencias y la Terapia Cognitivo-Conductual [TCC], siendo la falta de adherencia la limitación más importante. La Entrevista Motivacional [EM] mejora la adherencia. El objetivo de este estudio es evaluar la retención y abstinencia con tratamiento combinado de EM y TCC grupal en pacientes cocainómanos que han alcanzado el estadio de mantenimiento según el modelo transteórico de Prochaska y DiClemente (1982). Para ello se realizó un estudio longitudinal, en dependientes de cocaína con o sin trastorno mental concomitante. Se realizó un grupo abierto de 12 sesiones con periodicidad semanal. Se incluyeron 19 pacientes (78,9% hombres, edad media 36,58 años), el 95% consumía vía intranasal y el 47% tenía otra comorbilidad psiquiátrica. La tasa de retención fue del 84%. Durante el tratamiento y el primer mes de seguimiento todos los pacientes se mantuvieron abstinentes, mientras que entre el primer y tercer mes de seguimiento tres pacientes recayeron. Los datos avalan que el tratamiento combinado de EM+TCC para dependientes de cocaína en estadio de mantenimiento mejora la adherencia y es efi caz para mantener la abstinencia.
... Motivaèní rozhovory (MI) jsou podle veho efektivní pøi zlepování úspìnosti udrení uivatelù heroinu v léèebném programu zaloeném na abstinenci (Secades-Villa et al., 2004). Porovnání mezi standardním hodnocením a rozíøeným hodnocením plus MI mezi uivateli drog zjistilo u druhé skupiny vyí pravdìpodobnost docházky k dalí léèbì (Gossop, 2006). ...
... proposes that 'the task of drug treatment professionals is to produce a step-by-step process of motivation enhancement' in unmotivated criminal justice clients. Despite the evidence to suggest that MI is effective (Saunders, Wilkinson, & Phillips, 1995;Secades-Villa, Fernande-Hermida, & Arnaez-Montaraz, 2004;Stotts, Schmitz, Rhoades, & Grabowski, 2001) this intervention was largely absent in the DRR programme, with only 17 keyworkers reporting ever having used MI with their clients. Perhaps this poor utilization of MI may be due to insufficient guidance as to how to follow the principles of MI within a system of quasi-coerced treatment. ...
Article
Aims: The aim of this article is to assess what goes on in treatment sessions in court-mandated drug treatment in the UK. Methods: The study used a case note audit involving interviews with drug workers about each of their active cases, assessing client characteristics and their reports on what activities had taken place in treatment sessions. Findings: The average session lasts just under 30 minutes and typically at least three different types of worker-led activity are engaged in per session, often including time spent on compliance with treatment, with prescriptions and with the testing requirements of the court mandate. The amount of time dedicated to evidenced psychosocial interventions is typically less than 10 minutes. Conclusions: The tensions reported elsewhere for drug workers engaged in criminal justice services are evidenced in the study given the range of tasks (potentially conflicting) that drug workers are required to engage in and the limited opportunity for them to engage in effective psychosocial drug treatment.
... Una opción terapéutica que se centra principalmente en mejorar la retención al tratamiento es la Entrevista Motivacional [EM] (Miller y Rollnick, 2002), utilizando técnicas específi cas para trabajar la ambivalencia y fomentar la motivación al cambio. Ésta ha mostrado su efi cacia en el tratamiento de Trastornos por Uso de Sustancias, reduciendo el consumo de sustancias (Burke, Arkowitz y Menchola, 2003) y aumentando la retención en el tratamiento (Connors, Walitzer y Dermen, 2002;Secades-Villa, Fernández-Hermida y Arnáez-Montaraz, 2004). Concretamente, se ha estudiado el efecto de esta técnica en pacientes dependientes de cocaína (Carroll et al., 2006;McKee et al., 2007) y en dependientes de cocaína con trastorno mental concomitante (Horsfall, Cleary, Hunt y Walter, 2009) encontrando un aumento en la retención en el tratamiento. ...
Article
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Psychological interventions in cocaine dependent patients have demonstrated efficacy. Remarkable approaches are Contingency Management (CM) and Cognitive Behavioral Therapy (CBT). Lack of treatment adherence is the most important limitation. Motivational Interview (MI) has been shown to be an adherence enhancer. The objective of this study is to evaluate retention and abstinence in a combined CM and CBT group treatment in patients who have reached maintenance stage according to Prochaska and DiClemente's transtheoretical model (1982). Therefore, a longitudinal study was carried out with cocaine dependent patients with or without concomitant mental health disease. A 12-session open group was conducted weekly. Nineteen patients were included (78.9% men, mean age 36.6 years), 95% consumed intranasally and 47% had another psychiatric comorbidity. Treatment retention was 84%. During treatment and the first month of follow-up, all patients remained abstinent whereas at three months, 3 patients relapsed. These data confirm that using combined CM and CBT group therapy in cocaine dependents undergoing maintenance treatment enhances adherence and is effective to achieve abstinence.
... Residents in an alcohol treatment program, given a two session assessment and an MI style assessment feedback interview, participated more fully in treatment and showed reduced alcohol consumption at three months post-intervention (Brown and Miller, 1993). Individuals using heroin, who received a three session MET intervention, showed improved outpatient treatment retention when compared to similar patients who did not receive the motivational component (Secades-Villa et al., 2004) patient treatment for alcohol use disorders, who received an additional 2 h of assessment and a 1 h MET session, had better three-month outcomes than control subjects who received the same assessment with an attention placebo interview (Bien et al., 1993). MI has been less frequently tested in the most severely dependent populations and in those with co-occurring mental health concerns. ...
Article
Motivational Interviewing (MI) has successfully been used to facilitate entry and compliance in drug and alcohol treatment programs. Some questions have been raised as to the effectiveness of MI in severely distressed populations. This study aims to assess the effectiveness of MI in a population of homeless, unemployed, and substance dependent veterans who are being wait-listed for entry into a residential treatment program. Seventy-five veterans placed on a wait-list were randomized to receive a single MI or standard (Std) intake interview. Outcomes assessed were entry, and length of stay (LOS). Secondary outcomes assessed included program completion and rates of graduation. Readiness to change and self-efficacy were assessed before and after the interview. Significantly more participants entered the program in the MI group (95%) than in the Std group (71%). Although those in the MI group remained in the program longer, and had higher program completion and graduation rates, these differences were not statistically significant. No significant between-group or within-group differences were found in readiness or self-efficacy. This study demonstrates that a single, easily administered intervention can increase program entry. Also based on the study findings, further research into the question of whether MI can increase program retention, in a severely distressed population, is warranted.
Chapter
There are myriad nonpharmacologic interventions that are used in traditional addiction treatment, ranging from individual and group psychotherapies, to self-control and social skills training, to aversion therapies. However, despite the vast array of treatment strategies, the literature suggests that when it comes to treating substance addiction, no one modality is superior to any other (1). Rather, there are a variety of treatments, and combinations of treatments, that can be helpful for the addicted patient. Unfortunately, for the majority of primary care physicians, obstacles such as limited time and lack of training in this area make the implementation of traditional interventions unfeasible. This chapter gives the physician an overview of two well-known and well-studied brief nonpharmacologic interventions—cognitive-behavioral therapy (CBT) and motivational interviewing (MI)—that can be administered by the physician in an office-based setting.
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In Denmark women in drug-free residential treatment have proved to have significantly more psychosocial problems and a significantly higher dropout rate from treatment than men. The question is raised whether or not it is adequate to treat all the women with the same method, this method being an evidence-based one. It is suggested that instead we have to implement strategies that make it possible to identify different target groups with different needs and different risks of leaving treatment before planned. This strategy is defined as a bottom-up strategy. A prediction of completion instrument identifying such a specific target group of women is presented and the rationale behind such an instrument is discussed. It is concluded that it certainly is possible to develop a prediction of completion scale with a very strong prediction power and that such an instrument with advantage could be developed at a local level.
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Chapter 58, Substance Abuse Disorders: Cocaine Use Disorders, provides the reader with a review of the epidemiology, neurobiology, diagnosis of cocaine use disorders and cocaine- related disorders, and treatment of these disorders. The text emphasizes evidence-based psychosocial therapies for the treatment of cocaine use disorders and provides a review of research in the area of cocaine pharmacotherapy development.
Chapter
This chapter includes a review of the substances cocaine, the substituted phenylethylamines amphetamine (AMPH), dextroamphetamine, and methamphetamine, and the structurally different methylphenidate. The amphetaminetype stimulants (ATS) as defined here encompass the clandestinely synthesized methamphetamine (METH), principally crystal methamphetamine or “ice,” and the nonmedical use of prescription stimulants (NMUPS). Stimulant use disorders are chronic relapsing illnesses that present substantial challenges in treatment. There is a high risk for relapse, particularly in the first few months of treatment, related to acute craving often in the context of ongoing psychosocial stressors that result from or have been exacerbated by drug abuse. Substance abuse treatment for cocaine use disorders has been influenced by the known disease course. The selection of the appropriate treatment for stimulant use disorders will depend on the particular stage that the patient is in after abstin.
Article
Distintos estudios muestran que cuando se utiliza la entrevista motivacional (EM) añadida a un tratamiento estándar, con el objetivo de aumentar la motivación, mejoran los resultados del tratamiento. El objetivo del presente estudio fue analizar si los fumadores que reciben una intervención con EM antes de un tratamiento psicológico cognitivo conductual para dejar de fumar mejoran la adherencia y la eficacia del tratamiento y reducen la recaída en los seguimientos, en comparación con fumadores que únicamente reciben un tratamiento psicológico cognitivo conductual para dejar de fumar. Se comparó en 58 fumadores (46.6% hombres y 53.4% mujeres) la eficacia de añadir o no EM a un tratamiento psicológico para dejar de fumar. El grupo experimental recibió 2 sesiones de EM antes del comienzo de las 6 sesiones del tratamiento psicológico, mientras que el grupo de control recibió únicamente las 6 sesiones del tratamiento. Los resultados no mostraron diferencias estadísticamente significativas entre los 2 grupos en la adherencia al tratamiento, resultados al final del tratamiento y en los seguimientos a los 6 y 12 meses. Concluimos que la intervención con EM no produce mejores resultados en comparación con la aplicación de un tratamiento psicológico cognitivo conductual solo.
Book
Evidence-Based Treatments for Alcohol and Drug Abuse encompasses the developments in the field over the last decade, blending theory, techniques and clinical flexibility. Research in the past decade has shown that substance abuse and substance dependence are treatable. The field has witnessed the introduction of evidence-based psychological and specific pharmacological treatments. Unfortunately, many of the empirical supported therapies for addictions are still not widely applied by practitioners. The third volume in the Practical Clinical Guidebooks Series (PCG), Evidence-Based Treatments for Alcohol and Drug Abuse, defines the characteristics, classification, and prevalence of substance use disorders, and provides the clinician with practical guidelines applicable across a variety of treatment settings and patient groups. Drawing on the recent research in the field, the authors provide the practicing clinician and student with an up-to-date understanding of the epidemiology, etiology, course and prognosis of substance abuse disorders that would be relevant to clinical practice. In addition to describing phenomenology and etiology, the book provides a comprehensive guide to the assessment and treatment of DSM-IV-TR substance abuse disorders (SUDs), including abuse and dependence of alcohol, stimulants, opiates, hallucinogens, cannabis/marijuana, sedative, and party drugs.
Chapter
This chapter focuses on evidence-based treatment for illicit drug use disorders. The treatments addressed are motivational interviewing, treatments based on cognitive behavioral principals such as cue exposure, coping skills training and contingency management, and 12-step orientated treatment programs. Contingency management approaches are probably the most effective interventions for drug dependent patients. There is consistent evidence that treatments based on coping skills training and relapse prevention are more effective than inactive control conditions, but effect sizes are slightly smaller than those of contingency management approaches. There are a few studies that show that the combination of community reinforcement and coping skills training/relapse prevention is slightly more effective than stand-alone community reinforcement. The results with respect to the value of motivational interviewing in drug-using patients are mixed. In less motivated patients, motivational interviewing led to a better adherence and increased motivation in some, but not in all, studies and generally did not decrease drug use. Given the fact that very few studies have specifically focused on illicit drugs other than cocaine, conclusions with respect to the 12-step approaches are inconclusive. Keywords: substance use disorder; behavior therapy; motivational interviewing; 12-step; evidence-based treatment
Article
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Objective: The authors investigated the unique contribution motivational interviewing (MI) has on counseling outcomes and how MI compares with other interventions. Method: A total of 119 studies were subjected to a meta-analysis. Targeted outcomes included substance use (tobacco, alcohol, drugs, marijuana), health-related behaviors (diet, exercise, safe sex), gambling, and engagement in treatment variables. Results: Judged against weak comparison groups, MI produced statistically significant, durable results in the small effect range (average g = 0.28). Judged against specific treatments, MI produced nonsignificant results (average g = 0.09). MI was robust across many moderators, although feedback (Motivational Enhancement Therapy [MET]), delivery time, manualization, delivery mode (group vs. individual), and ethnicity moderated outcomes. Conclusions: MI contributes to counseling efforts, and results are influenced by participant and delivery factors.
Article
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Nach der grossen „Heroin-Welle“ der 80er und 90er Jahre in der Schweiz und der Etablierung erfolgreicher Substitutionsbehandlungen zur Therapie und Schadensminderung in vielen westlichen Nationen sind in den letzten Jahren die ersten evidenzbasierten Leitlinien zur Behandlung der Opioidabhängigkeit erschienen. In dieser Übersichtsarbeit werden die medikamentösen und psychosozialen Behandlungsstrategien der Opioidabhängigkeit anhand dieser aktuellen Leitlinien beschrieben und diskutiert. Wie bei allen Abhängigkeitserkrankungen umfassen die Störungen durch Opioide die akute Intoxikation, den schädlichen Gebrauch, die Abhängigkeit sowie die Entzugssyndrome. Zudem sind die Diagnostik und Behandlung komorbider psychischer Störungsbilder erforderlich, um die Prognose der Opioidabhängigkeit entscheidend verbessern zu können. In der Akutphase der Behandlung erfolgt zunächst der sogenannte „Beikonsumentzug“. Bereits in dieser Phase sollten die Patienten für eine Substitutionsbehandlung motiviert werden. Das Abstinenzziel kann in einer frühen oder stabilen Krankheitsphase sinnvoll sein. Die Substitutionsbehandlung mit Methadon oder Buprenorphin stellt derzeit die Therapie der ersten Wahl dar. Die Substitution mit slow-release Morphin findet derzeit noch im off-label use statt. Die Substitution mit Diacetylmorphin (Heroin) gilt nach abgebrochenen oder erfolglosen Therapie- und Substitutionsversuchen als eine wichtige Behandlungsalternative. Motivierende Gesprächsführung sowie störungsspezifische Psychotherapieverfahren, die komorbide Persönlichkeitsstörungen und depressive Störungen parallel zur Abhängigkeitserkrankung integriert behandeln, zeigen erste positive Effekte auf den Verlauf der Opioidabhängigkeit. Nachdem die Rahmenbedingungen für eine Behandlung der Opioidabhängigkeit in der Schweiz geschaffen worden sind, werden zukünftig neurobiologische und psychotherapeutische Forschung wichtig sein, um die Therapie der Opioidabhängigkeit weiter verbessern und ausbauen zu können.
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This study explored the characteristics associated with treatment dropout in substance dependence patients. A sample of 122 addicted patients (84 treatment completers and 38 treatment dropouts) who sought outpatient treatment was assessed to collect information on sociodemographic, consumption (assessed by EuropASI), psychopathological (assessed by SCL-90-R), and personality variables (assessed by MCMI-II). Completers and dropouts were compared on all studied variables. According to the results, dropouts scored significantly higher on the EuropASI variables measuring employment/support, alcohol consumption, and family/social problems, as well as on the schizotypal scale of MCMI-II. Because most of the significant differences were found in EuropASI variables, three clusters analyses (2, 3, and 4 groups) based on EuropASI mean scores were carried out to determine clinically relevant information predicting dropout. The most relevant results were obtained when four groups were used. Comparisons between the four groups derived from cluster analysis showed statistically significant differences in the rate of dropout, with one group exhibiting the highest dropout rate. The distinctive characteristics of the group with highest dropout rate included the presence of an increased labor problem combined with high alcohol consumption. Furthermore, this group had the highest scores on three scales of the MCMI-II: phobic, dependent, and schizotypal. The implications of these results for further research and clinical practice are discussed. 
Article
Different pharmacological approaches aimed at opioid detoxification are effective. Nevertheless a majority of patients relapse to heroin use, and relapses are a substantial problem in the rehabilitation of heroin users. Some studies have suggested that the sorts of symptoms which are most distressing to addicts during detoxification are psychological rather than physiological symptoms associated with the withdrawal syndrome. To evaluate the effectiveness of any psychosocial plus any pharmacological interventions versus any pharmacological alone for opioid detoxification, in helping patients to complete the treatment, reduce the use of substances and improve health and social status. We searched the Cochrane Drugs and Alcohol Group trials register (June 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 6, 2011), PUBMED (1996 to June 2011); EMBASE (January 1980 to June 2011); CINAHL (January 2003 to June 2008); PsycINFO (1985 to April 2003) and reference list of articles. Randomised controlled trials and controlled clinical trial which focus on any psychosocial associated with any pharmacological intervention aimed at opioid detoxification. People less than 18 years of age and pregnant women were excluded. Two authors independently assessed trials quality and extracted data. Eleven studies, 1592 participants, fulfilled the criteria of inclusion and were included in the review. The studies considered five different psychosocial interventions and two pharmacological treatments (methadone and buprenorphine). Compared to any pharmacological treatment alone, the association of any psychosocial with any pharmacological was shown to significantly reduce dropouts RR 0.71 (95% CI 0.59 to 0.85), use of opiate during the treatment, RR 0.82 (95% CI 0.71 to 0.93), at follow up RR 0.66 (95% IC 0.53 to 0.82) and clinical absences during the treatment RR 0.48 (95%CI 0.38 to 0.59). Moreover, with the evidence currently available, there are no data supporting a single psychosocial approach. Psychosocial treatments offered in addition to pharmacological detoxification treatments are effective in terms of completion of treatment, use of opiate, participants abstinent at follow-up and clinical attendance. The evidence produced by this review is limited due to the small number of participants included in the studies, the heterogeneity of the assessment or the lack of detailed outcome information that prevented the possibility of cumulative analysis for several outcomes. Nevertheless it seems desirable to develop adjunct psychosocial approaches that might make detoxification more effective.
Article
Different pharmacological approaches aimed at opioid detoxification are effective. Nevertheless a majority of patients relapse to heroin use, and relapses are a substantial problem in the rehabilitation of heroin users. Some studies have suggested that the sorts of symptoms which are most distressing to addicts during detoxification are psychological rather than physiological symptoms associated with the withdrawal syndrome. To evaluate the effectiveness of any psychosocial plus any pharmacological interventions versus any pharmacological alone for opioid detoxification, in helping patients to complete the treatment, reduce the use of substances and improve health and social status. We searched the Cochrane Drugs and Alcohol Group trials register (27 February 2008). Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2008), PUBMED (1996 to February 2008); EMBASE (January 1980 to February 2008); CINAHL (January 2003-February 2008); PsycINFO (1985 to April 2003) and reference list of articles. Randomised controlled trials which focus on any psychosocial associated with any pharmacological intervention aimed at opioid detoxification. People less than 18 years of age and pregnant women were excluded. Three reviewers independently assessed trials quality and extracted data. Nine studies involving people were included. These studies considered five different psychosocial interventions and two substitution detoxification treatments: Methadone and Buprenorphine. The results show promising benefit from adding any psychosocial treatment to any substitution detoxification treatment in terms of completion of treatment relative risk (RR) 1.68 (95% confidence interval (CI) 1.11 to 2.55), use of opiate RR 0.82 (95% CI 0.71 to 0.93), results at follow-up RR 2.43 (95% CI 1.61 to 3.66), and compliance RR 0.48 (95% CI 0.38 to 0.59). Psychosocial treatments offered in addition to pharmacological detoxification treatments are effective in terms of completion of treatment, use of opiate, results at follow-up and compliance. Although a treatment, like detoxification, that exclusively attenuates the severity of opiate withdrawal symptoms can be at best partially effective for a chronic relapsing disorder like opiate dependence, this type of treatment is an essential step prior to longer-term drug-free treatment and it is desirable to develop adjunct psychosocial approaches that might make detoxification more effective. Limitations to this review are imposed by the heterogeneity of the assessment of outcomes. Because of lack of detailed information no meta analysis could be performed to analyse the results related to several outcomes.
Article
despite a large percentage of health care costs being related to smoking, obesity, and substance abuse, most physicians are not confident in motivating patients to change health behaviors. Motivational interviewing (MI) is a directive, patient-centered approach for eliciting behavior change. The purpose of this study was to teach students MI skills and assess their confidence and knowledge during the psychiatry clerkship using smoking cessation as the target behavior. using a pretest/posttest design, 98 students were given a 10-item questionnaire during the psychiatry clerkship to assess their knowledge and confidence in health behavior change. Students received a 3-hour presentation on the principles of MI and practiced skills through role play. Students were encouraged to utilize these skills with patients. paired t tests results showed significant differences pre- and postclerkship for nine of the 10 items, including the student's confidence in working with patients in the area of smoking cessation. students can gain basic knowledge and increased confidence in working with patients for promoting behavioral change, even with a brief session, taught by nonexperts in motivational interviewing theory.
Article
Homelessness is a significant problem in the United States. Recent estimates suggest that nearly three million people experience homelessness over the course of a year. Further, the rates of substance abuse are considerably higher among the homeless than in the general population. Substance abuse treatment has been found to be effective in reducing substance use among those persons with substance use disorders, as well as ameliorating other consequences of substance abuse (e.g., reducing rates of crime associated with substance abuse and dependence). One of the more robust predictors of positive outcomes for substance abuse treatment is retention, which is defined as the length of time clients remain in treatment. However, while a considerable amount of research has been conducted regarding what predicts retention among non-homeless persons with substance use disorders, less is known about what predicts retention among homeless persons with substance use disorders.The following study was conducted to determine if a set of pre-treatment biopsychosocial variables could effectively predict retention among a cohort of homeless men with substance use disorders who were seeking treatment in a substance abuse clinic, which was located in a homeless shelter for men. Path analysis was used to compare two predictive models of retention.The results indicated that both models represented an adequate fit to the data, though each model explained approximately 15% of the variance in retention. In both models, initial severity of biopsychosocial issues and perceived consequences of substance abuse did appear to predict higher motivation for treatment, which itself appeared to predict greater length of time in treatment. However, nearly 85% of the variance in retention was not explained by either model. This suggests that the factors that lead homeless individuals to remain in substance abuse treatment over the long-term may be better accounted for by variables not in the model, such as during treatment process factors, rather than pre-treatment factors. Study implications, limitations, and directions for future research are discussed.
Article
The effectiveness and efficacy of substance abuse treatment is well established. At the same time, clients often prematurely drop out of substance abuse treatment, negatively impacting their chances of achieving favorable outcomes. Investigating variables associated with treatment retention has become increasingly important considering one of the most robust findings in substance abuse treatment outcome research is the positive relationship between the amount of time spent in treatment and post-treatment outcomes (e.g., decreased drug/alcohol use, decreased criminal activity, improved social functioning). This study examined the relationship between pre-treatment client characteristics and treatment drop-out among 273 adults who were admitted to intensive outpatient substance abuse treatment. An intake assessment battery was administered to all participants in an effort to gain a broad understanding of client attributes at the point of treatment entry. A series of regression analyses were used to investigate if client characteristics could help predict treatment completion status, time to drop-out, and number of treatment sessions attended. Results indicate that age and meeting criteria for an anxiety disorder were statistically significant predictors in all three regression analyses. Meeting criteria for a cocaine disorder was found to be a statistically significant predictor of treatment completion status and time to drop-out. Finally, number of years using alcohol regularly was found to be a statistically significant predictor of the number of treatment sessions attended. The clinical implications of these findings are discussed and recommendations to help improve client retention in the substance abuse treatment program utilized for this study are provided.
Article
The effect of Motivational Interviewing (MI) was evaluated in a sample of incarcerated substance abusers, using the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). The design was a pre-post between-groups design. To explore the importance of feedback in MI-training participants (N = 98) were randomized to two conditions that differed in terms of feedback or no feedback to the counsellor, and received five sessions of MI. As predicted, the results indicated a significant overall pre to post effect of the MI sessions, but contrary to the prediction the treatment effect of MI was observed in the non-feedback group only. By exploring treatment effect in the light of the subject variables length of sentence, age and type of crime committed, no significant overall effect of these factors were observed. However, violence and drug offenders deviated from the rest of the samples by indicating a lower motivational level (violence) and negative effect of MI (drug). As part of the project, the psychometric properties of the SOCRATES were explored in a factor analysis for the purpose of testing the suitability of the test in a prison sample. SOCRATES indicated an overall suitability in the present sample. Adjustments are suggested in MI training programmes in prison, as well as further research on differences between offender groups.
Article
Different pharmacological approaches aimed at opioid detoxification are effective. Nevertheless a majority of patients relapse to heroin use, and relapses are a substantial problem in the rehabilitation of heroin users. Some studies have suggested that the sorts of symptoms which are most distressing to addicts during detoxification are psychological rather than physiological symptoms associated with the withdrawal syndrome. To evaluate the effectiveness of any psychosocial plus any pharmacological interventions versus any pharmacological alone for opioid detoxification, in helping patients to complete the treatment, reduce the use of substances and improve health and social status. We searched the Cochrane Drugs and Alcohol Group trials register (27 February 2008). Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2008), PUBMED (1996 to February 2008); EMBASE (January 1980 to February 2008); CINAHL (January 2003-February 2008); PsycINFO (1985 to April 2003) and reference list of articles. Randomised controlled trials which focus on any psychosocial associated with any pharmacological intervention aimed at opioid detoxification. People less than 18 years of age and pregnant women were excluded. Three reviewers independently assessed trials quality and extracted data. Nine studies involving people were included. These studies considered five different psychosocial interventions and two substitution detoxification treatments: Methadone and Buprenorphine. The results show promising benefit from adding any psychosocial treatment to any substitution detoxification treatment in terms of completion of treatment relative risk (RR) 1.68 (95% confidence interval (CI) 1.11 to 2.55), use of opiate RR 0.82 (95% CI 0.71 to 0.93), results at follow-up RR 2.43 (95% CI 1.61 to 3.66), and compliance RR 0.48 (95% CI 0.38 to 0.59). Psychosocial treatments offered in addition to pharmacological detoxification treatments are effective in terms of completion of treatment, use of opiate, results at follow-up and compliance. Although a treatment, like detoxification, that exclusively attenuates the severity of opiate withdrawal symptoms can be at best partially effective for a chronic relapsing disorder like opiate dependence, this type of treatment is an essential step prior to longer-term drug-free treatment and it is desirable to develop adjunct psychosocial approaches that might make detoxification more effective. Limitations to this review are imposed by the heterogeneity of the assessment of outcomes. Because of lack of detailed information no meta analysis could be performed to analyse the results related to several outcomes.
Article
This study examined the relationship between continuation in an opiate treatment program and patient characteristics such as affect regulation, insight, and capacity for interpersonal relations. Participants consisted of 63 patients randomly selected from those completing an initial interview at a short-term heroin detoxification program. Patient characteristics were assessed using the Capacity for Dynamic Process Scale (CDPS). Results of this study indicated that the CDPS total score for each patient was related to the subsequent number of treatment sessions attended by that patient and significantly differentiated dropouts from completers. These findings support previous use of the CDPS in psychotherapy research. In addition, this study extends use of the CDPS to research on brief pharmacotherapy treatment of opiate addiction.
Article
The introduction of effective antiretroviral therapy has resulted in dramatic clinical benefits for those persons who have access to it. Adherence to such therapy has emerged as both the major determinant and the Achilles' heel of this success. Many patients have levels of adherence too low for durable virologic control. Virologic failure from suboptimal adherence diminishes the potential for long-term clinical success, leads to the emergence of drug-resistant virus, and may undermine the dramatic benefits in health parameters seen in resource-rich countries and expected in developing countries as effective antiretroviral therapy becomes more widely available. While adherence to antiretroviral therapy is regarded as the most important determinant of clinical outcomes in HIV-positive persons, most clinicians receive little guidance on practical steps to support and improve adherence. A structured, evidence-based, 7-step approach to supporting and improving antiretroviral adherence is described here. These steps can serve as a starting point or review for care providers working to support HIV-positive patients to successfully adhere to antiretroviral therapy.
Article
Effective behavior change counseling is an important component of the optimal care of patients, yet only a minority of medical schools currently include such training in their curriculum. To design and evaluate a formal curriculum to teach medical students the principles of motivational interviewing (MI) that will improve knowledge, skills, and confidence in the area of counseling patients for health behavior change. Fifty-three 3rd year medical students at the University of California, San Diego. A 4-week curriculum consisting of four 2-h sessions, in a small group format (8-12 students). Educational strategies included a combination of short didactics, video demonstrations, small group role plays, and interactive exercises. Students completed identical pre- and post-assessments, consisting of a questionnaire measuring confidence and knowledge, and a performance assessment using the Video Assessment of Simulated Encounters-Revised (VASE-R) tool. Knowledge improved significantly (pre-mean: 7.04, post-mean: 11.54; P < 0.001), as did skill development (pre-mean: 7.02, post-mean: 9.47; P < 0.001). Student satisfaction with behavior change counseling training improved from 3.6 to 8.1 (P < 0.001). Students were significantly more confident (P < 0.001) in their abilities to assess a patient's readiness for change and counsel the patient on behavior change after the course. Participation in a focused curriculum on the use of motivational interviewing techniques significantly improved 3rd year medical students' knowledge, confidence, and skills in the area of behavior change counseling. These gains may help students succeed in promoting good health habits in their future patients.
Article
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High risk injection practices are common among injecting drug users (IDUs), even following intervention efforts. Moreover, relapse to risk behaviors has been reported among those who initiate risk reduction. Substance abuse treatment offers the potential to reduce or eliminate injecting risk behaviors through drug cessation. We report on the effectiveness of two intervention strategies in facilitating treatment entry among out-of-treatment IDUs: motivational interviewing (MI), and intervention developed to help individuals resolve their ambivalence about behavior change, and free treatment for 90 days. These conditions were compared with an intervention focusing on a hierarchy of safer injecting practice, referred to here as risk reduction (RR), and no free treatment. Nearly 200 out-of-treatment IDUs were randomly assigned to one of four experimental conditions: MI/free treatment, MI/no free treatment, RR/free treatment, and RR/no free treatment. Regardless of assignment, we assisted anyone desiring treatment by calling to schedule the appointment, providing transportation, and waiving the intake fee. Overall, 42% of study participants entered treatment. No significant differences were found between MI and RR; however, 52% of those assigned free treatment entered compare with 32% for those who had to pay. Other predictors of treatment entry included prior treatment experiences, perceived chance of contracting acquired immunodeficiency syndrome (AIDS) greater than 50%, "determination" stage of change, greater frequency of heroin injecting, and fewer drug-using friends. These findings support the importance of removing barriers to treatment entry.
Article
Full-text available
This pilot study examined the effect of a modified motivational therapy intervention on outpatient treatment adherence and completion for patients with comorbid depressive disorder and cocaine dependence. Depressed cocaine patients, stabilized with antidepressant medications on an inpatient psychiatric unit, were consecutively assigned on discharge to motivational therapy (N = 11) or treatment-as-usual (N = 12) during the first month of outpatient care. Patients were compared on treatment adherence and completion and on 1-year rehospitalization rates. Motivational therapy patients attended significantly more treatment sessions during month 1, completed 30 and 90 days of outpatient care at higher rates, and experienced fewer psychiatric rehospitalizations and days in the hospital during the first year from entry into outpatient treatment. An outpatient program combining individual and group motivational therapy sessions holds promise for improving treatment adherence and completion among depressed patients with cocaine dependence.
Article
Full-text available
A brief motivational interviewing (MI) intervention was evaluated within the context of an outpatient, cocaine-detoxification program. MI was hypothesized to assist patients in completing the detoxification program and to improve outcomes during subsequent treatment. Participants (N = 105) were randomly assigned to MI or to detox-only conditions. Results indicated that although participants completed the detoxification program at equal rates, completers who received MI increased use of behavioral coping strategies and had fewer cocaine-positive urine samples on beginning the primary treatment. MI patients with lower initial motivation were more likely to complete detoxification.
Article
Client ambivalence is a key stumbling block to therapeutic efforts toward constructive change. Motivational interviewing—a nonauthoritative approach to helping people to free up their own motivations and resources—is a powerful technique for overcoming ambivalence and helping clients to get "unstuck." The first full presentation of this powerful technique for practitioners, this volume is written by the psychologists who introduced and have been developing motivational interviewing since the early 1980s. In Part I, the authors review the conceptual and research background from which motivational interviewing was derived. The concept of ambivalence, or dilemma of change, is examined and the critical conditions necessary for change are delineated. Other features include concise summaries of research on successful strategies for motivating change and on the impact of brief but well-executed interventions for addictive behaviors. Part II constitutes a practical introduction to the what, why, and how of motivational interviewing. . . . Chapters define the guiding principles of motivational interviewing and examine specific strategies for building motivation and strengthening commitment for change. Rounding out the volume, Part III brings together contributions from international experts describing their work with motivational interviewing in a broad range of populations from general medical patients, couples, and young people, to heroin addicts, alcoholics, sex offenders, and people at risk for HIV [human immunodeficiency virus] infection. Their programs span the spectrum from community prevention to the treatment of chronic dependence. All professionals whose work involves therapeutic engagement with such individuals—psychologists, addictions counselors, social workers, probations officers, physicians, and nurses—will find both enlightenment and proven strategies for effecting therapeutic change. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The Addiction Severity Index (ASI) is a clinical/research instrument which has been in wide use during the past 6 years to assess the treatment problems found in alcohol- and drug-abusing patients. In a study of male veterans, a preliminary evaluation of the ASI has indicated reliability and validity. The present report presents an expanded examination of these issues; 181 subjects from three treatment centers were studied. Results of concurrent reliability studies indicate that trained technicians can estimate the severity of patients' treatment problems with an average concordance of .89. Test-retest studies show that the information obtained from the ASI is consistent over a 3-day interval, even with different interviewers. Comparisons of the ASI severity ratings and composite measures with a battery of previously validated tests indicate evidence of concurrent and discriminant validity. The reliability and validity results were consistent across subgroups of patients categorized by age, race, sex, primary drug problem, and treatment center. The authors discuss the strengths and limitations of the instrument based upon 5 years of use. The overall conclusion is that the ASI is a reliable and valid instrument that has a wide range of clinical and research applications, and that it may offer advantages in the examination of important issues such as the prediction of treatment outcome, the comparison of different forms of treatment, and the "matching" of patients to treatments.
Article
During the 1980s Motivational Interviewing emerged as one of the memes of the addictions field. This occurred despite the lack of scientific evidence supporting its utility. In this paper findings of a controlled trial of a brief motivational intervention with illicit drug users (n = 122) attending a methadone clinic are reported. Clients who met the study's inclusion criteria were randomly allocated to either a motivational (experimental, n = 57) or educational (control, n = 65) procedure. Over the 6-month follow-up period the motivational subjects demonstrated a greater, immediate, commitment to abstention, reported more positive expected outcomes for abstention, reported fewer opiate-related problems, were initially more contemplative of change, complied with the methadone programme longer and relapsed less quickly than the control group. There was, however, no difference in terms of the severity of reported opiate dependence and the control group fared better on reported self-efficacy. It was concluded that motivational interventions of the type investigated are useful adjuncts to methadone programmes.
Article
The effect of motivational interviewing on outpatient treatment adherence among psychiatric and dually diagnosed inpatients was investigated. Subjects were 121 psychiatric inpatients, 93 (77%) of whom had concomitant substance abuse/dependence disorders, who were randomly assigned to: a) standard treatment (ST), including pharmacotherapy, individual and group psychotherapy, activities therapy, milieu treatment, and discharge planning; or b) ST plus motivational interviewing (ST+MI), which involved 15 minutes of feedback on the results of a motivational assessment early in the hospitalization, and a 1-hour motivational interview just before discharge. Interviewers utilized motivational techniques described in Miller and Rollnick (1991), such as reflective listening, discussion of treatment obstacles, and elicitation of motivational statements. Results indicated that the proportion of patients who attended their first outpatient appointment was significantly higher for the ST+MI group (47%) than for the ST group (21%; chi2 = 8.87, df = 1, p<.01) overall, and for dually diagnosed patients (42% for ST+MI vs. 16% for ST only; chi2 = 7.68, df = 1, p<.01). Therefore, brief motivational interventions show promise in improving outpatient treatment adherence among psychiatric and dually diagnosed patients.
Article
This pilot study reports the relative efficacy of a one-session preadmission motivational interview (n = 13) compared to a standard preadmission interview (n = 10) for psychiatrically ill substance abusing patients in a partial hospital program.
Article
Sixty individuals referred for a substance abuse evaluation by a child welfare worker were randomly assigned to either a standard evaluation or an evaluation enhanced by Motivational Interviewing techniques, each delivered in a single session. Participants who received the enhanced evaluation were significantly more likely to attend at least one additional treatment session after the initial evaluation (59% versus 29%). This finding suggests that comparatively inexpensive modifications of "standard" initial evaluations with substance-using parents may increase engagement of substance-abusing parents in treatment. Moreover, this study adds to an overwhelmingly positive literature supporting Motivational Interviewing with alcohol-using populations and extends prior findings to non-research community settings.
Article
In this paper, the effectiveness of the treatment program developed by Proyecto Hombre ('Project Mankind') in Asturias, Spain, is evaluated. In a long-term follow-up (range from 73 days to 8 years) with a sample of 249 subjects, the results obtained by subjects completing the treatment (194) were compared with pre-treatment results and with those of the group that dropped out (55). The measurements used were relapses in illegal drugs, alcohol, changes in family situation, educational level, employment, criminal involvement and state of health. External validation of self-report measures given in the questionnaire was carried out. Findings support the effectiveness of the treatment in all measures and the validity of self-report items. Relapse rate in 'treatment-completed' group was 10.3%, whilst in the non-completers group it reached 63.6% (significant difference, p < 0.001). Relapses of non-completers were more severe, occurred sooner after leaving the program (they stayed abstinent for shorter periods) and lasted longer than those of subjects completing the treatment.
Article
Treatment compliance is an important variable in drug use intervention. For pregnant drug-misusing women, compliance with treatment has been particularly problematic, even in specialized and more intensive treatment programs. The present study, conducted from March 1999 to June 2000, compared maternal/infant outcomes in pregnant drug-using women who were either compliant or noncompliant with drug use interventions offered through a prenatal care clinic. Compliant women (N = 11) completed four therapy sessions (behavioral reinforcement of drug abstinence + brief motivational therapy), while noncompliant women (N = 20) participated in zero to three therapy sessions. The two groups were similar on demographic and drug use severity measures. Compliant mothers, however, gave birth to infants with higher birthweights than noncompliant mothers. Over half of compliant mothers were also drug-free at delivery, compared to one-fourth of noncompliant mothers. These data support an association between treatment compliance and birth outcomes, and highlight the need to develop strategies for improving compliance with such interventions.
Article
The concept of motivational interviewing is based on helping individual clients build and sustain a commitment to reach and carry out a decision to change. In this paper, the motivational interviewing model is applied to systems change. Different stages of involvement and readiness to change are identified within systems which closely resemble those found in individuals. When applied to a system, we call this process "Motivational Intervention." In this paper, the motivational intervention model is applied to a psychiatric system of health care delivery where large numbers of psychiatric patients are found to also have substance use-related problems. Several Italian health districts invited the authors to present a series of lectures and workshops in order to facilitate the incorporation of substance user treatment into existing psychiatric services. Using the motivational intervention model to determine where the system was in the process of change, we then identified the tasks necessary to facilitate further change.
  • Saunders B.