Home > Motivational interviewing for the prevention of alcohol misuse in young adults.

Foxcroft, David and Coombes, Lindsey and Wood, Sarah and Allen, Debby and Almeida Santimano, Nerissa ML and Moreira, Maria Teresa (2016) Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database of Systematic Reviews, (7), DOI: 10.1002/14651858.CD007025.pub4.

External website: http://onlinelibrary.wiley.com/doi/10.1002/1465185...

Background: Alcohol misuse results in about 3.3 million deaths each year worldwide. Around 9% of deaths that occur in people aged 15 to 29 years are attributable to alcohol, mainly resulting from car accidents, homicides (murders), suicides and drownings. We wanted to find out if MI had an effect on the prevention of alcohol misuse and problems in young adults aged up to 25 years. If those involved with tackling alcohol misuse in young people are to apply MI in practice, clear evidence needs to support it.


Search date: the evidence was current to December 2015.


Study characteristics: We found a total of 84 randomised controlled trials (studies where participants were randomly divided into one of two or more treatment or control groups) that compared MI with either no intervention or with a different approach. Seventy of these trials focused on higher risk individuals or settings. We were mainly interested in trials with a follow-up period of 4 or more months, and the typical follow-up period was 12 months. We also evaluated the quality of the studies' designs and their applicability to our research, finding that these studies provided moderate to low quality evidence. In 66 trials, the MI consisted of a single, individual session. In 12 studies, young people attended multiple individual sessions or mixtures of both individual sessions and group sessions. Six trials used group MI sessions only. The length of MI sessions varied, but in 57 studies it was one hour or less. The shortest MI intervention was 10 to 15 minutes, and the longest had five dedicated MI sessions over a 19-hour period.


Settings for the trials varied: 58 of the 84 studies took place in college (mainly university but also four vocational) settings. The remaining trials took place in healthcare locations, a youth centre, local companies, a job-related training centre, an army recruitment setting, UK drug agencies and youth prisons. The total number of young adults was 22,872, aged on average from 15 to 24 years old. The proportion of males in the trials with both males and females ranged from 22% to 90%. The ethnicity of the young adults was typically mixed, but 52 of the 67 studies that reported ethnicity involved mostly white people.


Key results: At four or more months follow-up, we found only small or borderline effects showing that MI reduced the quantity of alcohol consumed, frequency of alcohol consumption, alcohol problems and peak blood alcohol concentration (BAC). We didn't find any effects for binge drinking, average BAC, drink-driving or other alcohol-related risky behaviour. We found no relationship between the length of MI and its effectiveness. Also, there were no clear subgroup differences in effects when we examined the type of comparison group (assessment only control or alternative intervention, the setting (college/university vs other settings), or risk status (higher risk students vs all/low-risk students). None of the studies reported harms related to MI. Although we found some significant effects for MI, our reading of these results is that the strength of the effects was slight and therefore unlikely to confer any advantage in practice.


Quality of evidence: Overall, there is only low or moderate quality evidence for the effects found in this review. Many of the studies did not adequately describe how young people were allocated to the study groups or how they concealed the group allocation to participants and personnel. Study drop-outs were also an issue in many studies. These problems with study quality could result in inflated estimates of MI effects, so we cannot rule out the possibility that any slight effects observed in this review are overstated. The US National Institutes of Health provided funding for half (42/84) of the studies included in this review. Twenty-nine studies provided no information about funding, and only eight papers had a clear conflict of interest statement.

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