The In-Session and Long-Term Role of a Significant Other in Motivational Enhancement Therapy for Alcohol Use Disorders

College Women's Perceptions of a Friend-Based Intervention to Prevent Alcohol-Involved Sexual Assault

Sexual assault (SA), particularly alcohol-involved SA, remains prevalent among college women. Because SA often begins in social contexts, bystander intervention has become a popular approach to prevention. Bystander interventions train individuals to intervene on behalf of others, including strangers, despite research indicating that intervention is more likely to occur when the bystander has a relationship with the target. Shifting the focus to friends as potential bystanders capitalizes on the qualities of relationship and responsibility that facilitate intervention. College women (N = 35) participated in focus groups (N = 8) during which they viewed a video prototype of a friend-based motivational interviewing (FMI) intervention session conducted with a friend dyad and provided feedback about the relevance and feasibility of using such an approach to reduce SA among friends who drink together in social settings. Content analysis of focus group transcripts yielded three themes: a) Friends as Natural Bystanders; b) The Role of Alcohol in Intervention, and c) Receptivity to FMI intervention. Women indicated that they feel responsible for keeping their friends safe, and that this sense of responsibility facilitates helping behaviors. Women also described ways through which alcohol intoxication can affect helping behavior. Women expressed enthusiasm for the FMI intervention approach and identified its emphasis on friendship and flexible approaches to personal safety as strengths. Findings highlight the promise of FMI intervention approaches that capitalize on the strengths of women's friendship to create safety goals that align with participants' values and overcome barriers to intervention, including alcohol intoxication.

A qualitative interview study of patient experiences of receiving motivational enhancement therapy in a Swedish addiction specialist treatment setting

BACKGROUND

Motivational enhancement therapy (MET) has shown to be efficacious as treatment of alcohol use disorder (AUD), in reducing alcohol consumption and related consequences. However, qualitative research on how patients perceive this treatment is lacking. The aim of this study was to explore how patients experience MET as a treatment for AUD.

METHODS

Fifteen patients (8/7 female/male) participated in semi-structured interviews after receiving MET at a specialized addiction outpatient clinic in Sweden. Data were analyzed by thematic analysis.

RESULTS

Five themes were identified: the therapist conveyed the MI-spirit, the therapist did not guide on how to reach the goal, participants were committed to change before starting treatment, participants were uncertain if treatment was enough to maintain change, and significant others were not wanted in sessions. Participants appreciated the supportive relationship with their therapist, but some experienced therapy as overly positive, with no room to talk about failure. Further, they experienced a low level of guidance in goal-setting. For some, this was empowering, while others requested more direction and advice. Participants perceived their motivational process to have started before treatment. MET was considered to be too brief. None of the participants brought a significant other to a session.

CONCLUSIONS

Therapist behaviors in line with MI spirit were emphasized as key to the development of a positive therapeutic relationship. More specific advice on goal-setting may be effective for supporting change in some patients. Longer treatment is requested among patients to support the patient's self-efficacy for change. Significant others can support change without necessarily being present in sessions.

TRIAL REGISTRATION

The current trial was retrospectively registered at isrtcn.com (14539251).

Value of family involvement in substance use disorder treatment: Aligning clinical and financing priorities

BACKGROUND

Family members' support (e.g., informational, tangible, emotional) has important and lasting impacts on individuals' recovery from substance use disorders (SUDs). Unfortunately, SUD services in the United States do not consistently incorporate patients' family members effectively. One barrier to family involvement in SUD services is the mechanisms through which SUD services in the United States are commonly financed.

METHOD

Using our recent experiences with developing a group intervention for support persons of patients with opioid use disorder, we illustrate how gaps in feasible financing models limit SUD service systems from effectively implementing and sustaining family services for individuals receiving SUD treatment.

DISCUSSION

Long-term availability of family-inclusive interventions will require collaboration with payors and health systems. We offer two sets of recommendations for funding family involvement in SUD services; one set of immediately implementable recommendations and other longer-term goals requiring structural changes in SUD service delivery and financing.

Inside Alcohol Behavioral Couple Therapy (ABCT): In-session speech trajectories and drinking outcomes

The alcohol treatment literature has established in-session client speech as a mechanism of change that therapist behavior can influence and that can predict drinking outcomes. This study aimed to explore temporal patterns of in-session speech in Alcohol Behavioral Couple Therapy (ABCT), including the unique interplay between client and partner speech and the role of speech trajectories in predicting client drinking outcomes. Participants were 165 heterosexual couples receiving ABCT in one of four clinical trials. We coded client speech on an utterance-by-utterance basis using the System for Coding Couples' Interactions in Therapy-Alcohol. We focused on individual-level speech codes of change talk and sustain talk and couple-level variables of positive and negative interactions. We segmented the initial and midtreatment sessions into quartiles to conduct path analyses and latent growth curve models. Path analyses suggested that clients and partners may not have been aligned in terms of treatment goals at the start of the therapy. This misalignment within couples was pronounced during the initial session and decreased by the midtreatment session, reflecting progression toward treatment goals. Of the latent growth curve models, only client sustain talk during the midtreatment session predicted greater client drinking at the end of treatment. Results provide insight into the inner workings of ABCT and suggest recommendations for ABCT therapists. This study also supports a growing consensus that sustain talk may be a stronger mechanism of change than change talk in various alcohol treatment interventions.