Motivational interviewing for substance abuse

132 Pages·2014·0.94 MB·English

Motivational interviewing for substance abuse (Review)
SmedslundG, Berg RC, Hammerstrøm KT, Steiro A, Leiknes KA, Dahl HM, Karlsen K
ThisisareprintofaCochranereview,preparedandmaintainedbyTheCochraneCollaborationandpublishedinTheCochraneLibrary
2011,Issue5
http://www.thecochranelibrary.com
Motivationalinterviewingforsubstanceabuse(Review)
Copyright©2011TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PLAINLANGUAGESUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
SUMMARYOFFINDINGSFORTHEMAINCOMPARISON . . . . . . . . . . . . . . . . . . . 3
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Figure1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Figure3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Figure4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Figure6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ADDITIONALSUMMARYOFFINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . 19
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
AUTHORS’CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
CHARACTERISTICSOFSTUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
DATAANDANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Analysis1.1.Comparison1MIversusnointervention,Outcome1Extentofsubstanceuse. . . . . . . . . . 112
Analysis1.2.Comparison1MIversusnointervention,Outcome2Readinesstochange. . . . . . . . . . . 114
Analysis1.3.Comparison1MIversusnointervention,Outcome3Retentionintreatment. . . . . . . . . . 115
Analysis2.1.Comparison2MIversustreatmentasusual,Outcome1Extentofsubstanceuse. . . . . . . . . 116
Analysis2.2.Comparison2MIversustreatmentasusual,Outcome2Retentionintreatment. . . . . . . . . 117
Analysis3.1.Comparison3MIversusassessmentandfeedback,Outcome1Extentofsubstanceuse. . . . . . . 118
Analysis4.1.Comparison4MIversusotheractiveintervention,Outcome1Extentofsubstanceuse. . . . . . . 119
Analysis4.2.Comparison4MIversusotheractiveintervention,Outcome2Readinesstochange. . . . . . . . 120
Analysis4.3.Comparison4MIversusotheractiveintervention,Outcome3Retentionintreatment. . . . . . . 121
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
WHAT’SNEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
CONTRIBUTIONSOFAUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
DECLARATIONSOFINTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
SOURCESOFSUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
DIFFERENCESBETWEENPROTOCOLANDREVIEW . . . . . . . . . . . . . . . . . . . . . 130
INDEXTERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Motivationalinterviewingforsubstanceabuse(Review) i
Copyright©2011TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
[InterventionReview]
Motivational interviewing for substance abuse
GeirSmedslund1,RigmorCBerg1,KarianneTHammerstrøm1,AsbjørnSteiro1,KariALeiknes1,HeleneMDahl2,KjetilKarlsen2
1Norwegian Knowledge Centre for the Health Services, Oslo, Norway. 2Department of Clinical Psychiatry, Institute of Clinical
Medicine,Tromsø,Norway
Contactaddress:GeirSmedslund,NorwegianKnowledgeCentrefortheHealthServices,Postboks 7004, St.Olavsplass,Oslo,N-
0130,[email protected].
Editorialgroup:CochraneDrugsandAlcoholGroup.
Publicationstatusanddate:Edited(nochangetoconclusions),commentaddedtoreview,publishedinIssue11,2011.
Reviewcontentassessedasup-to-date: 27March2011.
Citation: SmedslundG,BergRC,HammerstrømKT,SteiroA,LeiknesKA,DahlHM,KarlsenK.Motivationalinterviewingforsub-
stanceabuse.CochraneDatabaseofSystematicReviews2011,Issue5.Art.No.:CD008063.DOI:10.1002/14651858.CD008063.pub2.
Copyright©2011TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
ABSTRACT
Background
Thereare76.3millionpeoplewithalcoholusedisordersworldwideand15.3millionwithdrugusedisorders.Motivationalinterviewing
(MI)isaclient-centred,semi-directivemethodforenhancingintrinsicmotivationtochangebyexploringandresolvingambivalence.
Theinterventionisusedwidely,andthereforeitisimportanttofindoutwhetherithelps,harmsorisineffective.
Objectives
Toassesstheeffectivenessofmotivationalinterviewingforsubstanceabuseondruguse,retentionintreatment,readinesstochange,
andnumberofrepeatconvictions.
Searchmethods
Wesearched18electronicdatabases,5websites,4mailinglists,andreferencelistsfromincludedstudiesandreviews.Searchdates
wereNovember30,2010forCochraneLibrary,Medline,EmbaseandPsychINFO.
Selectioncriteria
Randomized controlled trials with persons dependent or abusing substance. Interventions were MI or motivational enhancement
therapy.Theoutcomeswereextentofsubstanceabuse,retentionintreatment,motivationforchange,repeatconviction.
Datacollectionandanalysis
Threeauthorsindependentlyassessedstudiesforinclusion,andtwoauthorsextracteddata.Resultswerecategorizedinto(1)MIversus
no-treatmentcontrol,(2)MIversustreatmentasusual,(3)MIversusassessmentandfeedback,and(4)MIversusotheractivetreatment.
Withineachcategory,wecomputedmeta-analysesseparatelyforpost-intervention,short,mediumandlongfollow-ups.
Mainresults
We included 59 studies with a total of 13,342 participants. Compared to no treatment control MI showed a significant effecton
substanceusewhichwasstrongestatpost-interventionSMD0.79,(95%CI0.48to1.09)andweakeratshortSMD0.17(95%CI
0.09to0.26],andmediumfollow-upSMD0.15(95%CI0.04to0.25]).Forlongfollow-up,theeffectwasnotsignificantSMD0.06
(95%CI-0.16to0.28).TherewerenosignificantdifferencesbetweenMIandtreatmentasusualforeitherfollow-uppost-intervention,
shortandmediumfollowup.MIdidbetterthanassessmentandfeedbackformediumfollow-upSMD0.38(95%CI0.10to0.66).
Forshortfollow-up,therewasnosignificanteffect.Forotheractiveinterventiontherewerenosignificanteffectsforeitherfollow-up.
TherewasnotenoughdatatoconcludeabouteffectsofMIonthesecondaryoutcomes.
Motivationalinterviewingforsubstanceabuse(Review) 1
Copyright©2011TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Authors’conclusions
MIcanreducetheextentofsubstanceabusecomparedtonointervention.Theevidenceismostlyoflowquality,sofurtherresearchis
verylikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandislikelytochangetheestimate.
PLAIN LANGUAGE SUMMARY
Motivationalinterviewingisashortpsychologicaltreatmentthatcanhelppeoplecutdownondrugsandalcohol
Morethan76millionpeopleworldwidehavealcoholproblems,andanother15millionhavedrugproblems.Motivationalinterviewing
(MI)isapsychologicaltreatmentthataimstohelppeoplecutdownorstopusingdrugsandalcohol.Thedrugabuserandcounsellor
typicallymeetbetweenoneandfourtimesforaboutonehoureachtime.Thecounsellorexpressesthatheorsheunderstandshowthe
clientsfeelabouttheirproblemandsupportstheclientsinmakingtheirowndecisions.Heorshedoesnottrytoconvincetheclientto
changeanything,butdiscusseswiththeclientpossibleconsequencesofchangingorstayingthesame.Finally,theydiscusstheclients’
goalsandwheretheyaretodayrelativetothesegoals.Wesearchedforstudiesthathadincludedpeoplewithalcoholordrugproblems
andthathaddividedthembychanceintoMIoracontrolgroupthateitherreceivednothingorsomeothertreatment.Weincluded
onlystudiesthathadcheckedvideoorsoundrecordingsofthetherapiesinordertobecertainthatwhatwasgivenreallywasMI.The
resultsinthisreviewarebasedon59studies.TheresultsshowthatpeoplewhohavereceivedMIhavereducedtheiruseofsubstances
morethanpeoplewhohavenotreceivedanytreatment.However,itseemsthatotheractivetreatments,treatmentasusualandbeing
assessedandreceivingfeedbackcanbe aseffectiveasmotivational interviewing. Therewasnotenough datatoconclude about the
effectsofMIonretentionintreatment,readinesstochange,orrepeatconvictions.Thequalityoftheresearchforcesustobecareful
aboutourconclusions,andnewresearchmaychangethem.
Motivationalinterviewingforsubstanceabuse(Review) 2
Copyright©2011TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
CoMo SUMMARY OF FINDINGS FOR THE MAIN COMPARISON [Explanation]
pyrighttivation
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boratioeabuse Outcomes Illustrativecomparativerisks*(95%CI) R(9e5la%tivCeI)effect N(sotuodfiePsa)rticipants Q(GuRaAlitDyEo)ftheevidence Comments
n.Pu(Rev Assumedrisk Correspondingrisk
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ed no treatment control motivational interview-
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Jo
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W amount of substance Themeanamountofsub- 202 ⊕⊕(cid:13)(cid:13)
iley abusepostintervention stance abuse post inter- (4studies) low1,2
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S
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n groupswas
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,
L 0.79standarddeviations
td
. lower
(0.48to1.09higher)
amount of substance Themeanamountofsub- 2327 ⊕⊕⊕(cid:13)
abuseshortfollow-up stance abuse short fol- (15studies) moderate1
Follow-up:1-6months low-upintheintervention
groupswas
0.17standarddeviations
lower
(0.09to0.26higher)
amount of substance Themeanamountofsub- 2326 ⊕⊕(cid:13)(cid:13)
abuse medium follow- stanceabusemediumfol- (12studies) low1
up low-upintheintervention
Follow-up:7-12months groupswas
0.15standarddeviations
3
CM
oo
pyrighttivation higher
©a (0.04to0.25higher)
20lin
11ter
Thvie amount of substance Themeanamountofsub- 363 ⊕⊕(cid:13)(cid:13)
eCwin abuselongfollow-up stance abuse long fol- (1study) low1,3
ochgfo Follow-up: mean 12 low-upintheintervention
raneCorsubsta months g0r.0ou6psstawnadsarddeviations
llanc lower
be
oratioabuse h(0ig.1h6er) lower to 0.28
n.Publish(Review) Readinessforchange TchhaenmgeeainnthReeiandteinrevesnstifoonr 1(549s5tudies) ⊕low⊕4(cid:13),5(cid:13)
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y higher)
&
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o
n
s, Retention ThemeanRetentioninthe 427 ⊕(cid:13)(cid:13)(cid:13)
L
td Follow-up:0-3months interventiongroupswas (2studies) verylow4,6,7
.
0.26standarddeviations
higher
(0to0.52higher)
*Thebasisfor theassumedrisk(e.g.themediancontrol groupriskacross studies) isprovidedinfootnotes. Thecorresponding risk(andits95%confidence interval) isbasedonthe
assumedriskinthecomparisongroupandtherelativeeffectoftheintervention(andits95%CI).
CI:Confidenceinterval;
GRADEWorkingGroupgradesofevidence
Highquality:Furtherresearchisveryunlikelytochangeourconfidenceintheestimateofeffect.
Moderatequality:Furtherresearchislikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandmaychangetheestimate.
Lowquality:Furtherresearchisverylikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandislikelytochangetheestimate.
Verylowquality:Weareveryuncertainabouttheestimate.
1Unclearrandomisationandblindingofassessor.
2Confidenceintervalfrom0.48to1.09
4
CoMo 3Confidenceintervalincludesbothnegativeandpositivevalues.
pyrighttivation 54II-nscqoumapreledte=ou4t8c%om. edataaddressed.Unclearallocationconcealmentandblinding.
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5
BACKGROUND is a client-centred, semi-directive method for enhancing intrin-
sicmotivationtochangebyexploringandresolvingambivalence.
MIintegratestherelationship-buildingprinciplesofCarlRogers
(Rogers1951)withmoreactivecognitive-behavioural strategies.
Descriptionofthecondition
The intervention has four basic principles (described below). A
AccordingtotheWorldHealthOrganization(WHO2009)there brief variant of MI is called Motivational Enhancement Ther-
are76.3millionpeoplewithalcoholusedisordersworldwide.In apy (MET). MET is manual-based, and was developed as part
addition, thereare atleast15.3millionpeoplewhosufferfrom of ProjectMATCH (Project MATCH 1997). Project MATCH
a drug use disorder, and injecting drug use is reported in 136 wasalargemultisitetrial comparing MIwith cognitive behav-
countries. ioraltherapy(CBT)andtwelve-stepfacilitationtherapy.MIcoun-
Substanceabusereferstotheoverindulgenceinanddependence sellingdoesnotrequireprofessionaltrainingasnurse,psycholo-
onadrugorothersubstanceleadingtoeffectsthataredetrimen- gist,etc.Hence,MImaybeincorporatedinprogrammesrunby
taltotheindividual’sphysicalandmentalhealth,orthewelfare healthcarestaffaswellase.g.prisonstaff.Thereareexplicitstan-
of others. The disorder is characterized by a pattern of contin- dardsforpractitionersregardingeducationandcompetence,and
ued pathological use of a drug or other substance, that results thereisqualitycontroltoensurethatthemethodisinfactused
inrepeatedadversesocialconsequencesrelatedtodruguse,such asintended. Oneinstrumentfor assessing treatmentintegrity is
as failure to meet work, family, or school obligations, interper- theMotivational Interviewing TreatmentIntegrity (MITI) scale
sonalconflicts,orlegalproblems.Thereareon-goingdebatesas (Moyers2005).Foradescriptionofvariousmeasuresoftreatment
totheexactdistinctions betweensubstanceabuseandsubstance fidelityinMI,werecommendthereviewbyMadsonandCamp-
dependence.Wefollowthedefinitions bytheAmericanPsychi- bell(Madson 2006).Promisingresultshavebeenreportedasto
atricAssociation(APA2000)anddistinguishbetweenthetwoby theeffectofthemethodforalcoholdependence,smokingcessa-
defining substance dependence as a cluster of cognitive, behav- tion,drugaddiction,HIV-riskbehaviours,treatmentadherence,
ioral,andphysiologicalsymptomsindicatingthattheindividual diet&exercise,andeatingdisorders(Carey2007;Burke2004;
continuesuseofthesubstancedespitesignificantsubstance-related Hettema2005; Rubak 2005). MI has recentlybeen introduced
problems.Thereisapatternofrepeatedself-administrationthat into thecriminal justice system, inEurope aswellasin North-
canresultintolerance,withdrawal,andcompulsivedrug-taking America.Intheresearchliterature,themostwidelyusedapproach
behavior (APA 2000).Substance abuse isamaladaptive pattern relatedtoMIhasbeenoneinwhichtheclientisgivenfeedback
ofsubstance usemanifestedbyrecurrentandsignificant adverse basedonindividualresultsfromstandardizedassessmentmeasures
consequencesrelatedtotherepeateduseofsubstances. Inorder oramodificationofit.Burkeetal.(Burke2003)consideredthis
foranAbusecriteriontobemet,thesubstance-relatedproblem feedback-basedapproachtoconstitute anadaptation ofmotiva-
musthaveoccurredrepeatedlyduringthesame12-monthperiod tionalinterviewing(AMI)becauseitisdefinedbythepresenceof
orbeenpersistent. thefeedbackcomponentandnotsolelybytheuseofmotivational
Substanceabusemayleadtoaddictionorsubstancedependence. interviewingperse.Morebroadly,theyalsoappliedthetermAMI
Medically, physiologic dependence requires the development of tointerventionsthatincorporateadditionalnon-motivationalin-
toleranceleadingtowithdrawalsymptoms.Bothabuseanddepen- terviewing techniqueswhileretaining motivational interviewing
dencearedistinctfromaddictionwhichinvolvesacompulsionto principlesasthecoreoftreatmentaswellastointerventionsthat
continueusingthesubstancedespitethenegativeconsequences, havebeenspecificallyadaptedforusebynon-specialists.
andmayormaynotinvolvechemicaldependency(APA2000).
Dependence almost always implies abuse, but abuse frequently
occurswithoutdependence,particularlywhenanindividualfirst Howtheinterventionmightwork
begins toabuse asubstance. Thereisalsoadistinction between
“misuse”and“abuse” of substances. Substance misuse isthein- MIisintendedtoworkthroughitsfourmainprinciples:(1)ex-
correct use of medication by patients, who may use a drug for press empathy, (2) support self-efficacy,(3) roll with resistance,
apurposeotherthanthatforwhichitwasprescribed;oruseof and(4)developdiscrepancy.Asexpressedontheofficialhomepage
asubstance for unintended purposes(APA 2000).Thefocus of of Motivational Interviewing (http://motivationalinterview.org/
clinical/principles.html),expressingempathyinvolvesseeingthe
thisreviewissubstanceabuse,dependencyoraddiction,butnot
worldthroughtheclient’seyes.Supportingself-efficacymeansthat
misuse.
clientsareheldresponsibleforchoosingandcarryingoutactions
tochange.Thethirdprinciple,rollingwithresistance,meansthat
thecounsellordoesnotfightclientresistance,but“rollswithit.”
Descriptionoftheintervention
Statementsdemonstrating resistance are notchallenged.Instead
Motivational interviewing (MI) was started by Miller (Miller thecounsellorusestheclient’s“momentum”tofurtherexplorethe
1983)anddevelopedbyMillerandRollnick(Miller1991).MI client’sviews. Lastly,motivation forchangeoccurswhenpeople
Motivationalinterviewingforsubstanceabuse(Review) 6
Copyright©2011TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
perceiveadiscrepancybetweenwheretheyareandwheretheywant hadnolimitationonlengthofstudy.Weexcludedstudiesthatre-
tobe.MIcounsellorsworktodevelopthissituationthroughhelp- cruitedparticipantsinemergencyroomsandprovidedonesession
ingclientsexaminethediscrepanciesbetweentheircurrentbehav- ofMIduringthestayintheemergencyroom.
iorandfuturegoals.Whenclientsperceivethattheircurrentbe-
havioursarenotleadingtowardsomeimportantfuturegoal,they
becomemoremotivatedtomakeimportantlifechanges.Apodaca Typesofparticipants
andLongabaugh(Apodaca2009)didaliteraturesearchtoidentify
Personsdefinedashavingeithersubstanceabuse,dependencyor
potentialwithin-sessionmechanismsofchangeinMI.Themost
addiction, butnot misuse. There wereno limitations onage or
consistentevidencewasfoundforthreeconstructs:clientchange
other participant characteristics. The term substance refers to a
talk/intention (related to better outcomes); client experience of
drugofabuse,amedication,atoxinoralcohol,excludingnico-
discrepancy(relatedtobetteroutcomes);andtherapistMI-incon-
tine.Thereasonforexcludingnicotine, isthatthereisanexist-
sistentbehavior(relatedtoworseoutcomes).
ing Cochrane review on motivational interviewing for smoking
cessation(Lai2010).AccordingtoInternational classificationof
Diseasesversion10(ICD-10)(WHO1993)weincludedthefol-
Whyitisimportanttodothisreview lowingcodes,F10toF19*,excludingF15(caffeine)andF17(to-
bacco).EquivalentdisordersandcodesintheDiagnosticandSta-
Theinterventionisusedwidely,andthereforeitisimportantto
tisticalManualofMentalDisorders,thirdrevisededition(DSM-
findoutwhetherithelps,harmsorisineffective.Severalreviews
III-R) (APA1987)andfourthedition, (DSM-IV)(APA1994),
and meta-analyses have been published (e.g. Andreasson 2003;
chapterSubstance-Relateddisorders,werealsoincluded.Wealso
Burke 2003; Burke 2004; Carey 2007; deWildt 2002; Dunn
includedstudiesinwhichsubstanceabusewasnotformallydiag-
2001;Emmelkamp2006;Grenard2006;Hettema2005;Larimer
nosed.Participantscouldbedualdiagnosisclients.Weincluded
2007;Lundahl2010;Nahom2005;Rubak2005;Vasilaki2006
bothparticipantswhoonlyabusesubstancesandparticipantswho
) but they all differ somewhat from our review. Some of them
alsohavementalproblems,butweanalysedthetwogroupssepa-
havestudiedeffectsofMI(AMI)onothergroupsinadditionto
rately.
substanceabusersorstudiedonlyalcoholabusers.Othersincluded
*[Mentalandbehaviouraldisordersduetouseof-alcohol(F10
otherdesignsinadditiontorandomisedtrials.Themainstrengths
-303),-opioids(F11),-cannabinoids(F12),-sedativesorhyp-
of the present review are that it employs a comprehensive and
notics(F13),-cocaine(F14),-otherstimulants(amphetamine)
systematic search strategy aiming to be exhaustive, and that it
(F15),-hallucinogens(F16),-volatilesolvents(F18)and-mul-
includesonlyrandomizedcontrolledtrials.Wewillalsoassessthe
tipledruguseanduseofotherpsychoactivesubstances(F19).]
riskofbiasoftheincludedstudiesandgradetheevidenceforthe
primaryoutcomes.
Typesofinterventions
Experimentalintervention
Primarily,theinterventionsshouldbelabelledmotivationalinter-
OBJECTIVES
viewing(M))ormotivationalenhancementtherapy(MET).The
Toassesstheeffectivenessofmotivationalinterviewing, asapri- interventioncouldbasicallybeofferedinthreeways:(1)asastand-
maryorsupportintervention,forsubstanceabuse,intermsoflev- alonetherapy,(2)MIintegratedwithanothertherapy,or(3)MI
elsofdruguse,retentionintreatment,andreadinessforchange. asapreludetoanothertherapy(e.g.cognitivebehavioraltherapy).
Onlyindividual,face-to-faceinterventionswereincluded.Weex-
cludedgroupinterventions, andinterventions notgiveninper-
son(e.g.computer-deliveredortelephoneinterventions).Because
METHODS
mostpsychosocialinterventionshavemanyunspecificelementsin
common,andbecausetermslike“motivationalintervention”and
“motivationalinterview”notnecessarilyreferstoMiller’sspecific
Criteriaforconsideringstudiesforthisreview
programofMI,weincludedonlystudiesthatreviewedaudioor
videorecordingstoensurethattheinterventiongivenwasindeed
MI.
Typesofstudies
Studieshadtoincludechecksofaudio-orvideotapingofsessions
Weincludedstudieswhereunits(persons,therapists,institutions) inordertoassessfidelityoftreatment.
wereallocatedrandomlyorquasi-randomlytomotivationalinter- Controlintervention
viewingorotherconditions.Includedstudiedhadtobepublished The comparator could be no intervention, waiting list control,
inorafter1983,whichwastheyearthatMIwasintroduced.We placebopsychotherapyorotheractivetherapy.
Motivationalinterviewingforsubstanceabuse(Review) 7
Copyright©2011TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Typesofoutcomemeasures substanceabuseandmotivationalinterviewing.TheMEDLINE
Dataonsubstanceabusecouldbebothdichotomous(numberof searchstrategywastranslatedintotheotherdatabases using the
participantsceasingsubstanceabuse)andcontinuous(e.g.mean appropriatecontrolledvocabularyasapplicable.Thesearchstrate-
numberofdaysusedinlast30days).Substanceabusecouldalsobe giesforalldatabasesareshowninAppendix1.
measuredusingvariousscalesorinventoriesliketheOTI(Opiate Wesearchedthefollowingwebsitesandmailinglists:
TreatmentIndex)(Darke1991;Darke1992),theTimelineFol- Websites:
low-Back(Sobell1992),andtheRutgersAlcoholProblemsIndex • www.motivationalinterview.org(bibliographyupdated
(RAPI;White1989). November2009)
• http://nrepp.samhsa.gov/programfulldetails.asp?
PROGRAM_ID=182(accessedJune7th,2010)
Primaryoutcomes
• http://www.controlled-trials.com(accessedAugust24th,
• ceaseofsubstanceusemeasuredbyself-report,reportby
2010)
collaterals,urineanalysis,orbloodsamples,etc. • http://clinicalstudyresults.org(accessedAugust24th,2010
• reductioninsubstanceabusemeasuredasabove. • http://centrewatch(accessedAugust24th,2010).
Outcomesare typicallyrecorded as aposttest immediately after
Mailinglists:
theinterventionsended,short-termfollow-upsuntilsixmonths
• MINT-listserv;amailinglistavailabletomembersof
aftertheinterventionended,medium-termfollow-upsofbetween
MINT(MotivationalInterviewingNetworkofTrainers)
six and 12 months, and long-term follow-ups of 12 months or
• AustralianCriminologyListserv
longer.Theexactfollow-updurationsarerecordedforeachstudy.
• CampbellCrime&JusticeGroupSteeringCommittee
• Crimnet.http://www.law.usyd.edu.au/mailman/listinfo/
Secondaryoutcomes crimnet.
• Retentionintreatment.
Wehadnolanguagerestrictions.
• Improvemotivationforchange,e.g.measuredbythe
ReadinesstoChangeQuestionnaire(RCQ;Heather1993).
• Numberofrepeatconvictions(forconvictedsubstance Searchingotherresources
abusers).
Referencesinobtainedreviewsandincludedprimarystudieswere
searched(inJune2010)toidentifynewleads.
Searchmethodsforidentificationofstudies
Datacollectionandanalysis
Electronicsearches
Dealingwithdependentdata
We searched the following electronic databases: Medline (1950 Whentherewasmorethanoneinterventiongroupthatwascom-
toNovember Week3, 2010), Embase (1980 to 2010, week4), paredwithasinglecontrolgroup,wedidnotincludebothcom-
PsycInfo(1806toNovemberweek4,2010),PsychExtra(1908to parisonsinthesamemeta-analysis.Whentherewereseveralfol-
January14,2008),CochraneCentralRegisterofControlledTri- low-uptimes, wecategorisedthemintopost, short,mediumor
als(searchdate:November30,2010),C2-SPECTR(Searchdate: longfollow-upasdescribedabove.Incaseswhenthereweredata
November23,2009),InternationalBibliographyoftheSocialSci- frommorethanonefollow-uptimewithinoneofourcategories,
ences(1951toNovemberweek3,2009), SociologicalAbstracts weusedthemeanvalue.Whentherewasmorethanonemeasure
(search date: November 30, 2010), ISI Web of Science (search ofthesameoutcome,weusedthestandardisedmeanvalue.
date: November 30, 2010), SveMed+ (search date: November
30,2010),CINCH(searchdate:November30,2010),NCJRS
Selectionofstudies
(searchdate:November30,2010),SpringerLink(searchdate:Oc-
tober2,2010),WileyInterscience(searchdate:October2,2010), The screening of studies proceededin 3 levels.At Level 1, two
DrugScopeLibrary(searchdate:October2,2010),ElectronicLi- reviewerswhoweremethodologistsscannedthetitlesofeachref-
braryoftheNationalDocumentationCentreonDrugUse(search erence.Eachreviewerscoredeither“promotetonextlevel”,“ex-
date:October2,2010),GoogleScholar,andGoogle(searchdate: clude”or“can’ttell”.Onlyifbothreviewersscored“exclude”was
February2,2010). Yearofpublicationwaslimitedto1983and thereferenceexcluded.Ifatleastonereviewerscored“can’ttell”
later. or“include”,thereferencewaspromotedtoLevel2.AtLevel2,
Databases were searched using a strategy developed incorporat- thetitlesandabstractswereread,andthesamepromotionrules
ingthefilterfortheidentificationofRCTs(Higgins2009)com- applied.ReferencespromotedtoLevel3wereorderedinfulltext.
binedwith selectedMeSHtermsandfreetexttermsrelating to Tworeviewersreadthefulltextsandscored“include”or“exclude”.
Motivationalinterviewingforsubstanceabuse(Review) 8
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