Tibor P Palfai

Boston University, Boston, Massachusetts, United States

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Publications (101)291.22 Total impact

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    ABSTRACT: Objective: This study tested a motivational text message treatment adjunct for individuals with eating disorders (EDs) who exhibited high dietary restraint/restriction. Method: A replicated single-case alternating treatment design was used to examine 1) the feasibility of combining a brief motivational interview with subsequent text messages and 2) the influence of the text messages on eating behaviors and motivation to change in individuals with EDs (N = 12). The protocol was eight weeks and the text messages were adjunctive to cognitive behavioral therapy. Results: The intervention was well accepted (mean rating = 7/10) and feasible within the context of monetary compensation (mean daily-monitoring compliance = 91%). Text messages did not impact behavioral outcomes: dietary restraint and kilocalorie intake. They had mixed effects on motivation to change dietary restraint, measured by the Readiness and Motivation Questionnaire (RMQ). When receiving text messages, RMQ precontemplation scores (desire to restrict) significantly increased, indicating decreased motivation; however, action scores (effort towards reducing dietary restraint) significantly increased, indicating increased motivation. These effects were moderated by weight status. Underweight individuals (n = 4; BMI < 19.0) reported increased ambivalence, that is increased desire to restrict and increased action toward reducing restriction, in response to the text messages. Normal-weight participants (n = 8; BMI > 19.0) reported only increased action towards reducing restriction in response to the text messages. Discussion: These data demonstrate text messages are a potentially feasible and acceptable treatment adjunct and may be effective at increasing motivation to change for normal-weight individuals, while their influence on underweight patients is more complex. These findings provide a foundation for future research in technology-based motivational interventions for EDs and offer preliminary evidence for using these methods among normal-weight individuals.
    No preview · Article · Jan 2016
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    ABSTRACT: Cross-sectional and intervention research have shown that mindfulness is inversely associated with difficulties in controlling alcohol use. However, little is known regarding the mechanisms through which mindfulness is related to increased control over drinking. One potential mechanism consists of the way individuals represent their drinking behaviour. Action identification theory proposes that self-control of behaviour is improved by shifting from high-level representations regarding the meaning of a behaviour to lower-level representations regarding "how-to" aspects of a behaviour. Because mindfulness involves present-moment awareness, it may help to facilitate such shifts. We hypothesized that an inverse relation between mindfulness and dyscontrolled drinking would be partially accounted for by the way individuals mentally represent their drinking behaviour - i.e., reduced levels of high-level action identification and increased levels of low-level action identification. One hundred and twenty five undergraduate psychology students completed self-report measures of mindful awareness, action identification of alcohol use, and difficulty in controlling alcohol use. Results supported the hypothesis that high-level action identification partially mediates the relation between mindfulness and dyscontrolled drinking but did not support a mediating role for low-level action identification. These results suggest that mindfulness can improve self-control of alcohol by changing the way we think about our drinking behaviour.
    Full-text · Article · Jan 2016 · Addictive behaviors
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    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. Method: 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 15min Brief Negotiated Interview (BNI) and a 45min 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 6weeks 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. Conclusion: 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.
    No preview · Article · Jan 2016 · Addictive behaviors
  • Tibor Palfai · Richard Saitz · Michael R. Winter

    No preview · Article · Nov 2015
  • Tibor P. Palfai · Kelli D. Tahaney · Michael R. Winter
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    ABSTRACT: This study sought to examine whether student marijuana use identified by screening in a student health center is associated with health-promoting behaviors. Students completed a brief web-based, health behavior screening instrument. Those who reported marijuana use of monthly or more on the Alcohol, Smoking, and Substance Involvement Test (ASSIST)—and a subset of those who did not—were invited to complete additional baseline assessments, including questions about health-promoting behaviors, alcohol, and substance use (n = 321). Results showed marijuana users were more likely to use a variety of substances and engage in hazardous drinking than non-users. Moreover, level of marijuana use was associated with greater likelihood of using a variety of substances but not with hazardous drinking. There was no evidence that marijuana use was associated with health-promoting behaviors. These findings highlight the concomitant substance-related risks associated with marijuana use but do not support the view that these students are less likely to engage in health-promoting behaviors than non-users.
    No preview · Article · Oct 2015 · Journal of drug issues
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    ABSTRACT: Background: The use of brief intervention for decreasing frequent marijuana use holds potential, but its efficacy in primary care is not known. Methods: Objective: To assess the impact of two brief interventions on marijuana use among daily/ or almost daily marijuana users. Design: Subgroup analysis of a 3-arm randomized clinical trial of two brief counseling interventions compared to no brief intervention on daily marijuana use in a primary care setting (ASPIRE). Participants: ASPIRE study participants who both reported 21-30 days of marijuana use during the past month and identified marijuana as their drug of most concern. Interventions: 1) Brief Negotiated Interview (BNI), a 10-15 minute structured interview, and 2) an Adaptation of Motivational Interviewing (MOTIV), a 30-45 minute intervention. Control group participants received only a list of substance use treatment resources. Main measures: The primary outcome was number of days of marijuana use in the past 30 days at the 6-month follow-up. Secondary outcomes were 1) number of days of marijuana use at 6-week follow-up and 2) drug problems (Short Inventory of Problems, SIP-D) at 6-week and 6-month. Differences between intervention groups were analyzed using negative binomial regression models. Results: Among the 167 eligible participants, we did not find any significant impact of either of the two interventions on past 30 days of marijuana use at 6-months [adjusted incidence rate ratio (aIRR): 0.95 (95% confidence interval (CI)):0.75-1.15, p = 0.82 for BNI vs. control; aIRR:1.02, 95%CI:0.85-1.23, p = 0.82 for MOTIV vs. control]. There was no significant impact on drug-related problems at 6-month follow-up [aIRR:1.12 (95%CI:0.69-1.82) p = 0.66 and aIRR:1.46 (95%CI:0.89-2.38) p = 0.27 for BNI vs. control and MOTIV vs. control, respectively]. Results were similar at 6 weeks. Conclusions: Brief intervention has no apparent impact on marijuana use or drug-related problems among primary care patients with frequent marijuana use identified by screening.
    No preview · Article · Oct 2015 · Substance Abuse

  • No preview · Article · Sep 2015 · Addiction science & clinical practice
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    Preview · Article · Sep 2015 · Addiction science & clinical practice
  • Rebecca M Shingleton · Tibor P Palfai
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    ABSTRACT: The aims of this paper were to describe and evaluate the methods and efficacy of technology-delivered motivational interviewing interventions (TAMIs), discuss the challenges and opportunities of TAMIs, and provide a framework for future research. We reviewed studies that reported using motivational interviewing (MI) based components delivered via technology and conducted ratings on technology description, comprehensiveness of MI, and study methods. The majority of studies were fully-automated and included at least one form of media rich technology to deliver the TAMI. Few studies provided complete descriptions of how MI components were delivered via technology. Of the studies that isolated the TAMI effects, positive changes were reported. Researchers have used a range of technologies to deliver TAMIs suggesting feasibility of these methods. However, there are limited data regarding their efficacy, and strategies to deliver relational components remain a challenge. Future research should better characterize the components of TAMIs, empirically test the efficacy of TAMIs with randomized controlled trials, and incorporate fidelity measures. TAMIs are feasible to implement and well accepted. These approaches offer considerable potential to reduce costs, minimize therapist and training burden, and expand the range of clients that may benefit from adaptations of MI. Published by Elsevier Ireland Ltd.
    No preview · Article · Aug 2015 · Patient Education and Counseling
  • Tibor P Palfai · Carl K Kantner · Kelli D Tahaney
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    ABSTRACT: Previous work has shown that automatic alcohol-action associations, assessed by the Implicit Association Test (IAT), may play a role in hazardous drinking patterns. The majority of alcohol-related IATs have been constructed using verbal stimuli, and even those who have used pictorial stimuli have only represented beverage categories with pictures. To assess implicit appetitive responses among a broader population of alcohol users, such as those who experience limitations reading and understanding English, there may be utility in the development of an IAT that utilizes only non-verbal stimuli. The current study presents an initial effort to develop such a task and examine its association with drinking. One hundred and fifty-three university students participated individually in a laboratory study in which they first completed a pictorial alcohol-specific approach/avoid IAT, followed by self-report measures of drinking. As hypothesized, negative binomial regression analyses showed that IAT scores predicted the number of heavy drinking episodes and typical number of drinks per occasion. The use of a university student sample for this initial study represents an important limitation of this work, which should be addressed in future research. These findings provide initial evidence for the potential use of non-verbal IATs to assess alcohol-related implicit cognition among adults. Implications for the assessment of hazardous drinking behavior across populations are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Jul 2015 · Journal of Behavior Therapy and Experimental Psychiatry
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    ABSTRACT: To test 1) whether abstinence and reduction in illicit psychoactive drug use were associated with changes in health outcomes in primary care patients and 2) whether these associations varied by drug type. Secondary analysis of data from a randomized controlled trial that tested a brief intervention for drug use in primary care patients (589 enrolled, 574 completed 6-month assessment). Analyses were conducted overall and stratified by the most commonly self-identified main drugs (marijuana, cocaine, and opioids). Patients who screened positive for illicit drug use at an urban primary care clinic in Boston, Massachusetts, USA. Differences in past-month main drug use at baseline and 6-month outcome were categorized as continued or increased use, decreased use without abstinence, and abstinence. Primary outcomes were 6-month changes in drug use consequences (Short Inventory of Problems scores [range 0-45]), depressive symptoms, and health-related quality of life (HRQOL). Abstinence was associated with a greater decrease in adverse drug use consequences than continued or increased use among the full sample and cocaine and opioids subgroups (adjusted means, full sample: -8.11 vs. -0.05, p < 0.001; cocaine: -13.33 vs. +1.09, p < 0.001, opioids; -16.84 vs. -2.10, p < 0.001). Differences were not significant between those who decreased use compared with those who continued or increased use. There were no significant associations between drug use and depressive symptoms or HRQOL. Neither abstinence nor decreased use was significantly associated with consequences in the marijuana subgroup. Among primary care patients in the US who use illicit psychoactive drugs, abstinence but not reduction in use without abstinence appears to be associated with decreased adverse drug use consequences. This article is protected by copyright. All rights reserved.
    No preview · Article · Jun 2015 · Addiction
  • Samuel N. Meisel · Tibor P. Palfai
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    ABSTRACT: This study sought to examine whether life goal meaning serves as a protective factor against the effects of social influences on hazardous drinking. The sample consisted of 156 college drinkers who had consumed alcohol in the past 30 days. Results indicated that goal meaning moderated the relation between both injunctive norms and direct offers and heavy drinking episodes. Simple slopes' analyses showed that injunctive norms predicted heavy episodic drinking for students with low but not high levels of goal meaning. Direct offers predicted heavy episodic drinking, however, the strength of this association was reduced at high levels of goal meaning. Results suggest that higher levels of goal meaning may buffer the effects of social influences on college student hazardous drinking.
    No preview · Article · Mar 2015 · Journal of Applied Social Psychology
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    Full-text · Article · Jan 2015 · Drug and Alcohol Dependence
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    ABSTRACT: Importance The United States has invested substantially in screening and brief intervention for illicit drug use and prescription drug misuse, based in part on evidence of efficacy for unhealthy alcohol use. However, it is not a recommended universal preventive service in primary care because of lack of evidence of efficacy.Objective To test the efficacy of 2 brief counseling interventions for unhealthy drug use (any illicit drug use or prescription drug misuse)—a brief negotiated interview (BNI) and an adaptation of motivational interviewing (MOTIV)—compared with no brief intervention.Design, Setting, and Participants This 3-group randomized trial took place at an urban hospital-based primary care internal medicine practice; 528 adult primary care patients with drug use (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST] substance-specific scores of ≥4) were identified by screening between June 2009 and January 2012 in Boston, Massachusetts.Interventions Two interventions were tested: the BNI is a 10- to 15-minute structured interview conducted by health educators; the MOTIV is a 30- to 45-minute intervention based on motivational interviewing with a 20- to 30-minute booster conducted by master’s-level counselors. All study participants received a written list of substance use disorder treatment and mutual help resources.Main Outcomes and Measures Primary outcome was number of days of use in the past 30 days of the self-identified main drug as determined by a validated calendar method at 6 months. Secondary outcomes included other self-reported measures of drug use, drug use according to hair testing, ASSIST scores (severity), drug use consequences, unsafe sex, mutual help meeting attendance, and health care utilization.Results At baseline, 63% of participants reported their main drug was marijuana, 19% cocaine, and 17% opioids. At 6 months, 98% completed follow-up. Mean adjusted number of days using the main drug at 6 months was 12 for no brief intervention vs 11 for the BNI group (incidence rate ratio [IRR], 0.97; 95% CI, 0.77-1.22) and 12 for the MOTIV group (IRR, 1.05; 95% CI, 0.84-1.32; P = .81 for both comparisons vs no brief intervention). There were also no significant effects of BNI or MOTIV on any other outcome or in analyses stratified by main drug or drug use severity.Conclusions and Relevance Brief intervention did not have efficacy for decreasing unhealthy drug use in primary care patients identified by screening. These results do not support widespread implementation of illicit drug use and prescription drug misuse screening and brief intervention.Trial Registration clinicaltrials.gov Identifier: NCT00876941
    Preview · Article · Aug 2014 · JAMA The Journal of the American Medical Association
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    ABSTRACT: AimsThis study assessed the effectiveness of HERMITAGE (HIV's Evolution in Russia - Mitigating Infection Transmission and Alcoholism in a Growing Epidemic), an adapted secondary HIV prevention intervention, compared with an attention control condition in decreasing sexually transmitted infections (STIs) and sex and drug risk behaviors among Russian HIV-infected heavy drinkers.DesignWe conducted a single-blinded, two-armed, randomized controlled trial with 12-month follow-up.SettingThe study was conducted in St. Petersburg, Russia. Participants were recruited from four HIV and addiction clinical sites. The intervention was conducted at Botkin Infectious Disease Hospital.ParticipantsHIV-infected persons with past 6-month risky sex and heavy alcohol consumption (n=700) were randomized to the HERMITAGE intervention (n=350) or an attention control condition (n=350).InterventionA Healthy Relationships Intervention stressing disclosure of HIV serostatus and condom use, adapted for a Russian clinical setting with two individual sessions and three small group sessions.MeasurementsThe primary outcome was incident STI by laboratory test at 12-month follow-up. Secondary outcomes included change in unprotected sex and several alcohol and injection drug use (IDU) variables.FindingsParticipants had the following baseline characteristics: 59% male, mean age 30, 60% past year IDU, 15.4% prevalent STI and mean CD4 cell count 413/μl. Assessment occurred among 75% and 71% of participants at 6 and 12-months, respectively. STIs occurred in 20 subjects (8%) in the intervention group and 28 subjects (12%) in the control group at 12-month follow-up; logistic regression analyses found no significant difference between groups (adjusted odds ratio 0.69; 95% CI: 0.36-1.30; P=0.25). Both groups decreased unsafe behaviors, although no significant differences between groups were found.Conclusions The HERMITAGE HIV risk reduction intervention does not appear to reduce sexually transmitted infections and HIV risk behaviors in Russian HIV-infected heavy drinkers compared with attention controls.
    No preview · Article · Aug 2014 · Addiction
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    ABSTRACT: This pilot study sought to test the feasibility of procedures to screen students for marijuana use in Student Health Services (SHS) and test the efficacy of a web-based intervention designed to reduce marijuana use and consequences. Students were asked to participate in voluntary screening of health behaviors upon arrival at SHS. One hundred and twenty-three students who used marijuana at least monthly completed assessments and were randomized to one of four intervention conditions in a 2 (intervention: Marijuana eCHECKUP TO GO vs. control)×2 (site of intervention: on-site vs. off-site) between-groups design. Follow-up assessments were conducted online at 3 and 6months. Latent growth modeling was used to provide effect size estimates for the influence of intervention on outcomes. One thousand and eighty undergraduate students completed screening. The intervention did not influence marijuana use frequency. However, there was evidence of a small overall intervention effect on marijuana-related consequences and a medium effect in stratified analyses in the on-site condition. Analyses of psychological variables showed that the intervention significantly reduced perceived norms regarding peer marijuana use. These findings demonstrate that it is feasible to identify marijuana users in SHS and deliver an automated web-based intervention to these students in different contexts. Effect size estimates suggest that the intervention has some promise as a means of correcting misperceptions of marijuana use norms and reducing marijuana-related consequences. Future work should test the efficacy of this intervention in a full scale randomized controlled trial.
    Full-text · Article · May 2014 · Addictive Behaviors
  • Kelli D Tahaney · Carl W Kantner · Tibor P Palfai
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    ABSTRACT: Dual process models characterize hazardous drinking as a function of appetitive processes and executive processes that enable self-control. Although central to a number of models (e.g., Hofmann et al., 2009a,b), little empirical research has examined how drinking restraint may influence the effects of these processes on alcohol use. The current study examined whether drinking restraint influenced the predictive value of appetitive responses to alcohol cues and executive functioning on typical drinking behavior. It was hypothesized that the interaction between appetitive responses and executive functioning would only be observed among those who had stronger drinking restraint goals. Sixty-nine hazardous drinking young adults (ages 21-30) completed the Trail Making Test and then were exposed to the sight and smell of an alcoholic beverage that they anticipated they would consume. Urge and anticipated stimulant effects of alcohol (A-BAES) were measured following the exposure. The interaction between Trails B and each of the appetitive response ratings (i.e., urge rating and A-BAES) was predictive of drinking behavior (TLFB) only among those high in drinking restraint. These findings highlight the importance of incorporating the role of motivational constructs such as restraint goals in current dual process models of alcohol-related self-control.
    No preview · Article · Mar 2014 · Drug and alcohol dependence
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    ABSTRACT: Alcohol use among first-year university students continues to be a central health concern. Efforts to address drinking in this population have increasingly relied on web-based interventions, which have the capacity to reach large numbers of students through a convenient and highly utilized medium. Despite evidence for the utility of this approach for reducing hazardous drinking, recent studies that have examined the effectiveness of this approach as a universal prevention strategy in campus-wide studies have produced mixed results. We sought to test the effectiveness of a web-based alcohol intervention as a universal prevention strategy for first-year students. An e-mail invitation linked to a brief, web-based survey on health behaviors was sent to all first-year students during the fall semester. Those who completed the baseline assessment were randomized to receive either a feedback-based alcohol intervention (intervention condition) or feedback about other health-related behaviors such as sleep and nutrition (control condition). A second web-based survey was used to collect follow-up drinking data 5 months later. The number of heavy drinking episodes in the previous month and alcohol-related consequences in the previous 3 months served as the primary dependent variables. Negative binomial regression analyses did not indicate a significant effect of the intervention at follow-up on either heavy drinking episodes or alcohol-related consequences. Analyses of additional drinking outcomes among the subsample of students who reported that they did not drink at baseline showed that those who received the alcohol intervention were subsequently less likely to drink alcohol. These results suggest that web-based alcohol interventions may be a potentially useful method of maintaining abstinence among underage, non-drinking students. Overall, however, results indicate that an e-mail-linked, campus-wide, web-intervention approach to address alcohol use among first-year students may have limited effectiveness as an approach to minimize hazardous drinking over the course of the year.
    Full-text · Article · Jan 2014 · The Journal of Prevention
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    ABSTRACT: The impact of depressive symptoms on ART initiation among Russian HIV-infected heavy drinkers enrolled in a secondary HIV prevention trial (HERMITAGE) was examined. We assessed 133 participants eligible for ART initiation (i.e., CD4 count <350 cells/μl) who were not on ART at baseline. Depressive symptom severity and ART use were measured at baseline, 6- and 12-months. Association between depressive symptoms and subsequent ART initiation was evaluated using GEE logistic regression adjusting for gender, past ART use, injection drug use and heavy drinking. Depressive symptom severity was not significantly associated with lower odds of initiating ART. Cognitive depression symptoms were not statistically significant (global p = 0.05); however, those with the highest level of severity had an AOR of 0.25 (95 % CI 0.09-0.71) for delayed ART initiation. Although the effect of depression severity was not significant, findings suggest a potential role of cognitive depression symptoms in decisions to initiate ART in this population.
    No preview · Article · Dec 2013 · AIDS and Behavior
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    ABSTRACT: Questions remain about how brief motivational interventions (BMIs) for unhealthy alcohol use work, and addressing these questions may be important for improving their efficacy. Therefore, we assessed the effects of various characteristics of BMIs on drinking outcomes across 3 randomized controlled trials (RCTs). Audio recordings of 314 BMIs were coded. We used the global rating scales of the Motivational Interviewing Skills Code (MISC) 2.1: counselor's acceptance, empathy, and motivational interviewing (MI) spirit, and patient's self-exploration were rated. MI proficiency was defined as counselor's rating scale scores ≥5. We also used the structure, confrontation, and advice subscale scores of the Therapy Process Rating Scale and the Working Alliance Inventory. We examined these process characteristics in interventions across 1 U.S. RCT of middle-aged medical inpatients with unhealthy alcohol use (n = 124) and 2 Swiss RCTs of young men with binge drinking in a nonclinical setting: Swiss-one (n = 62) and Swiss-two (n = 128). We assessed the associations between these characteristics and drinks/d reported by participants 3 to 6 months after study entry. In all 3 RCTs, mean MISC counselor's rating scales scores were consistent with MI proficiency. In overdispersed Poisson regression models, most BMI characteristics were not significantly associated with drinks/d in follow-up. In the U.S. RCT, confrontation and self-exploration were associated with more drinking. Giving advice was significantly associated with less drinking in the Swiss-one RCT. Contrary to expectations, MI spirit was not consistently associated with drinking across studies. Across different populations and settings, intervention characteristics viewed as central to efficacious BMIs were neither robust nor consistent predictors of drinking outcome. Although there may be alternative reasons why the level of MI processes was not predictive of outcomes in these studies (limited variability in scores), efforts to understand what makes BMIs efficacious may require attention to factors beyond intervention process characteristics typically examined.
    No preview · Article · Oct 2013 · Alcoholism Clinical and Experimental Research

Publication Stats

3k Citations
291.22 Total Impact Points


  • 1999-2016
    • Boston University
      • Department of Psychology
      Boston, Massachusetts, United States
  • 1997-2013
    • University of Massachusetts Boston
      • Department of Psychology
      Boston, Massachusetts, United States
  • 2012
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
  • 2004
    • Florida International University
      Miami, Florida, United States
  • 1997-2003
    • Brown University
      • Center for Alcohol and Addiction Studies
      Providence, RI, United States
  • 2001
    • University of Rhode Island
      • Department of Psychology
      Кингстон, Rhode Island, United States
  • 1995
    • University of Toronto
      • Department of Psychology
      Toronto, Ontario, Canada