Keane, Martin
(2012)
Review of motivational interviewing in addressing substance abuse.
Drugnet Ireland,
Issue 40, Winter 2011,
p. 17.
Motivational interviewing (MI) is acknowledged in the National Drugs Strategy (NDS) as an effective evidence-based intervention in the treatment of alcohol and stimulant abuse. The NDS also promotes the training and up-skilling of addiction counsellors to deliver MI to clients.
Smedslund and colleagues1 undertook a systematic review of randomised controlled trials that assessed the effectiveness of MI in reducing drug use, improving retention in treatment and readiness to change, and reducing the number of repeat criminal convictions. The authors provide a useful description of how MI is intended to work, and describe four key strategies that addiction counsellors employ:
· The counsellor expresses empathy with the client; they try to see the world through the eyes of the client.
· The counsellor supports self-efficacy; they give responsibility to the client for choosing and undertaking actions to change.
· The counsellor rolls with resistance; they do not fight with client’s resistance or ambivalence to change, they continue to assist clients to further explore statements that signal ambivalence.
· The counsellor develops discrepancy; they assist the client to perceive a discrepancy between their current behaviour and their future goals and aspirations.
Fifty-nine trials undertaken between 1993 and 2010 covering 13,342 participants were included in the review; 57 were RCTs and two were quasi-RCTs. Twenty-nine trials involved alcohol abusers, eight involved cannabis abusers, four involved cocaine abusers, and 18 involved abusers of more than one substance. Only trials that included video or sound recordings of the intervention being delivered were included, to ensure that the intervention provided was in fact MI.
The authors found that people who received MI reduced their use of alcohol and drugs more than people who did not receive any treatment. The effect was strongest immediately following treatment and became progressively weaker at short-term (up to five months), medium-term (6–11 months) and long-term follow-up (12 months or more). The authors conclude that delivering MI to reduce substance abuse is more effective than doing nothing. Compared with interventions such as giving feedback on assessments or other types of psychotherapy, MI did not prove superior or inferior in reducing substance abuse. There were insufficient data in the trials to reach conclusions about the effects of MI on retention in treatment, readiness to change, or repeat convictions. The authors signal concern about the quality of the research available on the effectiveness of MI and call for a degree of caution to be applied when reading their conclusions in this review.
1. Smedslund G, Berg RC, Hammerstrøm KT, Steiro A, Leiknes KA, Dahl HM et al. (2011) Motivational interviewing for substance abuse. Cochrane Database of Systematic Reviews. https://www.drugsandalcohol.ie/13573/ Publication Type
Irish-related, Open Access, Article
Intervention Type
Treatment method, Psychosocial treatment method
Issue Title
Issue 40, Winter 2011
Publisher
Health Research Board
Volume
Issue 40, Winter 2011
Accession Number
HRB (Electronic Only)
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