Motivational interviewing for substance abuse

131 Pages·2011·1.93 MB·English

Campbell Systematic Reviews
2011:6
First published: 29 August, 2011
Last updated: 27 March, 2011

Motivational interviewing for
substance abuse

Geir Smedslund, Rigmor C. Berg, Karianne T.
Hammerstrøm, Asbjørn Steiro, Kari A. Leiknes, Helene M.
Dahl, Kjetil Karlsen

Please note: Pending reformatting.
Colophon

Title Motivational interviewing for substance abuse
Institution The Campbell Collaboration
Authors Geir Smedslund
Rigmor C. Berg
Karianne T. Hammerstrøm
Asbjørn Steiro
Kari A. Leiknes
Helene M. Dahl
Kjetil Karlsen
DOI 10.4073/csr.2011.6
No. of pages 128
Last updated 27 March, 2011
Citation Smedslund G, Berg RC, Hammerstrøm KT, Steiro A, Leiknes KA, Dahl HM,
Karlsen K. Motivational interviewing for substance abuse.
Campbell Systematic Reviews 2011:6
DOI: 10.4073/csr.2011.6
Co-registration This review is co-registered within both the Cochrane and Campbell
Collaborations. A version of this review can also be found in the Cochrane
Library.
Keywords
Contributions Karlsen conceived of the idea and commissioned the review. All reviewers
were involved in planning the review. Smedslund wrote
the methods section of the protocol. Karlsen and Smedslund wrote the
background. Hammerstrøm developed the search strategy,
performed the original searches and the final search in November 2010. All
authors were involved with screening of studies. Smedslund
and Berg did the risk of bias and data extraction. Berg and Smedslund graded
the results. Smedslund did the analyses and wrote the
results and discussion.
Support/Funding Norwegian Knowledge Centre for the Health Services, Norway
Potential Conflicts None.
of Interest

Corresponding Geir Smedslund
author Norwegian Knowledge Centre for Health Services
PB 7004 St. Olavs plass
Oslo N-0130
Norway
Telephone: [phone]
E-mail: [email protected] or [email protected]
Campbell Systematic Reviews

Editors-in-Chief Mark W. Lipsey, Vanderbilt University, USA
Arild Bjørndal, The Centre for Child and Adolescent Mental Health, Eastern
and Southern Norway & University of Oslo, Norway
Editors
Crime and Justice David B. Wilson, George Mason University, USA
Education Sandra Wilson, Vanderbilt University, USA
Social Welfare William Turner, University of Bristol, UK
Geraldine Macdonald, Queen’s University, UK & Cochrane Developmental,
Psychosocial and Learning Problems Group
Managing Editor Karianne Thune Hammerstrøm, The Campbell Collaboration
Editorial Board
Crime and Justice David B. Wilson, George Mason University, USA
Martin Killias, University of Zurich, Switzerland
Education Paul Connolly, Queen's University, UK
Gary W. Ritter, University of Arkansas, USA
Social Welfare Aron Shlonsky, University of Toronto, Canada
Paul Montgomery, University of Oxford, UK
Methods Therese Pigott, Loyola University, USA
Peter Tugwell, University of Ottawa, Canada
The Campbell Collaboration (C2) was founded on the principle that
systematic reviews on the effects of interventions will inform and help
improve policy and services. C2 offers editorial and methodological support to
review authors throughout the process of producing a systematic review. A
number of C2's editors, librarians, methodologists and external peer-
reviewers contribute.
The Campbell Collaboration
P.O. Box 7004 St. Olavs plass
0130 Oslo, Norway
www.campbellcollaboration.org
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 . . . . . . . . . . . . . . . . . . . 2
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
DATAANDANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Analysis1.1.Comparison1MIversusnointervention,Outcome1Extentofsubstanceuse. . . . . . . . . . 110
Analysis1.2.Comparison1MIversusnointervention,Outcome2Readinesstochange. . . . . . . . . . . 112
Analysis1.3.Comparison1MIversusnointervention,Outcome3Retentionintreatment. . . . . . . . . . 112
Analysis2.1.Comparison2MIversustreatmentasusual,Outcome1Extentofsubstanceuse. . . . . . . . . 113
Analysis2.2.Comparison2MIversustreatmentasusual,Outcome2Retentionintreatment. . . . . . . . . 114
Analysis3.1.Comparison3MIversusassessmentandfeedback,Outcome1Extentofsubstanceuse. . . . . . . 115
Analysis4.1.Comparison4MIversusotheractiveintervention,Outcome1Extentofsubstanceuse. . . . . . . 116
Analysis4.2.Comparison4MIversusotheractiveintervention,Outcome2Readinesstochange. . . . . . . . 117
Analysis4.3.Comparison4MIversusotheractiveintervention,Outcome3Retentionintreatment. . . . . . . 118
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
CONTRIBUTIONSOFAUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
DECLARATIONSOFINTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
SOURCESOFSUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
DIFFERENCESBETWEENPROTOCOLANDREVIEW . . . . . . . . . . . . . . . . . . . . . 126
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:New,publishedinIssue5,2011.
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.
Searchstrategy
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.
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SUMMARYOFFINDI motivationalinterviewingcomparedtono Patientorpopulation:patientswithsubstaSettings:Intervention:motivationalinterviewingComparison:notreatmentcontrolgroup OutcomesIllustrativecom Assumedrisk notreatmentgroup amountofsubstanceabusepostintervention amountofsubstanceabuseshortfollow-upFollow-up:1-6months amountofsubstanceabusemediumfollow-upFollow-up:7-12months
Motivationalinterviewingforsubstanceabuse(Review) 3
Copyright©2011TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
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Motivationalinterviewingforsubstanceabuse(Review) 4
Copyright©2011TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
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Motivationalinterviewingforsubstanceabuse(Review) 5
Copyright©2011TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.