A pilot test of motivational interviewing groups for dually diagnosed inpatients

Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.

Managing Obesity in Young Children: A Multiple Methods Study Assessing Feasibility, Acceptability, and Implementation of a Multicomponent, Family-Based Intervention

Background: We developed a multicomponent, family-based intervention for young children with obesity consisting of parent group sessions, home nursing visits, and multidisciplinary clinical encounters. Our objective was to assess intervention feasibility, acceptability, and implementation. Methods: From 2017 to 2020, we conducted a multiple methods study in the obesity management clinic at a tertiary children's hospital (Toronto, Canada). We included 1-6 year olds with a body mass index ≥97th percentile and their parents; we also included health care providers (HCPs) who delivered the intervention. To assess feasibility, we performed a pilot randomized controlled trial (RCT) comparing the intervention to usual care. To explore acceptability, we conducted parent focus groups. To explore implementation, we examined contextual factors with HCPs using the Consolidated Framework for Implementation Research. Results: There was a high level of ineligibility (n = 34/61) for the pilot RCT. Over 21 months, 11 parent-child dyads were recruited; of 6 randomized to the intervention, 3 did not participate in group sessions or home visits. In focus groups, themes identified by parents (n = 8) related to information provided at referral; fit between the intervention and patient needs; parental gains from participating in the intervention; and feasibility of group sessions. HCPs (n = 10) identified contextual factors that were positively and negatively associated with intervention implementation. Conclusions: We encountered challenges related to intervention feasibility, acceptability, and implementation. Lessons learned from this study will inform the next iteration of our intervention and are relevant to intervention development and implementation for young children with obesity. Clinical Trial Registration number: NCT03219658.

Randomized controlled trial of group motivational interviewing for veterans with substance use disorders

BACKGROUND

Motivational interviewing delivered in a group format is understudied yet promising as a treatment for substance use disorders (SUD). We evaluated the efficacy of group motivational interviewing (GMI) relative to a treatment-control (TCC) for enhancing treatment and self-help engagement and decreasing alcohol and drug use among veterans with SUD and co-existing psychiatric disorders.

METHOD

Veterans (n = 118) with alcohol use disorder were recruited within an outpatient SUD treatment program and randomized to GMI or TCC upon program entry. Alcohol use, SUD treatment, and 12-step session attendance were primary outcomes. Drug use days was the secondary outcome. Participants were assessed at baseline and at one-and three-month follow-up.

RESULTS

Significant differences were observed between GMI and TCC for binge drinking at both one (RR = .74; 95 % CI [.58, .94]) and three-month follow-up (RR = .74; 95 % CI [.59, .91]). At three-month follow-up, significant differences between treatment conditions were observed for alcohol use days (RR = .79; 95 % CI [.67, .94]), number of SUD treatment sessions (RR = 2.53; 95 % CI [1.99, 3.22]), and 12-step sessions attended (RR = 1.64; 95 % CI [1.35-1.98]). Similarly, we observed significant effects for GMI on reducing alcohol consumption in standard drinks (RR = .49; 95 % CI [.25, .95]). Drug use days declined at each follow-up, with no significant differences between treatment conditions.

CONCLUSIONS

GMI delivered at SUD treatment program entry enhanced treatment session and 12-step group attendance and lowered alcohol consumption among outpatient Veterans. Future research should study how GMI works and its effectiveness in SUD treatment settings.

Assessment and treatment of substance use in adults with ADHD: a psychological approach

Over half of young people and adults diagnosed with Attention Deficit Hyperactivity Disorder [ADHD] also have substance use disorder [SUD]. Their use of substances may arise from an attempt to self-medicate and/or to cope with their difficulties. This manuscript reviews key research in the literature and identifies that traditional SUD psychological interventions are an effective treatment for those presenting with a dual diagnosis of ADHD and SUD. However, typically, this is only available to those presenting to specialist SUD services for treatment of harmful use and/or dependency. This misses an opportunity to intervene much earlier, before drug use escalates to these levels. The manuscript aims to provide practical guidance for healthcare practitioners, by detailing a psychological framework for earlier assessment and intervention of problematic drug use in young people and adults with ADHD. Specific techniques are outlined drawing on psychoeducation, motivational interviewing and cognitive behavioural therapy in a phased approach to address factors that motivate initial use of substances and those that maintain use.

Effectiveness of a worksite social & physical environment intervention on need for recovery, physical activity and relaxation; results of a randomized controlled trial

Objective

To investigate the effectiveness of a worksite social and physical environment intervention on need for recovery (i.e., early symptoms of work-related mental and physical fatigue), physical activity and relaxation. Also, the effectiveness of the separate interventions was investigated.

Methods

In this 2×2 factorial design study, 412 office employees from a financial service provider participated. Participants were allocated to the combined social and physical intervention, to the social intervention only, to the physical intervention only or to the control group. The primary outcome measure was need for recovery. Secondary outcomes were work-related stress (i.e., exhaustion, detachment and relaxation), small breaks, physical activity (i.e., stair climbing, active commuting, sport activities, light/moderate/vigorous physical activity) and sedentary behavior. Outcomes were measured by questionnaires at baseline, 6 and 12 months follow-up. Multilevel analyses were performed to investigate the effects of the three interventions.

Results

In all intervention groups, a non-significant reduction was found in need for recovery. In the combined intervention (n = 92), exhaustion and vigorous physical activities decreased significantly, and small breaks at work and active commuting increased significantly compared to the control group. The social intervention (n = 118) showed a significant reduction in exhaustion, sedentary behavior at work and a significant increase in small breaks at work and leisure activities. In the physical intervention (n = 96), stair climbing at work and active commuting significantly increased, and sedentary behavior at work decreased significantly compared to the control group.

Conclusion

None of the interventions was effective in improving the need for recovery. It is recommended to implement the social and physical intervention among a population with higher baseline values of need for recovery. Furthermore, the intervention itself could be improved by increasing the intensity of the intervention (for example weekly GMI-sessions), providing physical activity opportunities and exercise schemes, and by more drastic environment interventions (restructuring entire department floor).

Trial Registration

Nederlands Trial Register NTR2553

The development of the Be Active & Relax "Vitality in Practice" (VIP) project and design of an RCT to reduce the need for recovery in office employees

Background

There is strong evidence to suggest that multiple work-related health problems are preceded by a higher need for recovery. Physical activity and relaxation are helpful in decreasing the need for recovery. This article aims to describe (1) the development and (2) the design of the evaluation of a daily physical activity and relaxation intervention to reduce the need for recovery in office employees.

Methods/Design

The study population will consist of employees of a Dutch financial service provider. The intervention was systematically developed, based on parts of the Intervention Mapping (IM) protocol. Assessment of employees needs was done by combining results of face-to-face interviews, a questionnaire and focus group interviews. A set of theoretical methods and practical strategies were selected which resulted in an intervention program consisting of Group Motivational Interviewing (GMI) supported by a social media platform, and environmental modifications. The Be Active & Relax program will be evaluated in a modified 2 X 2 factorial design. The environmental modifications will be pre-stratified and GMI will be randomised on department level. The program will be evaluated, using 4 arms: (1) GMI and environmental modifications; (2) environmental modifications; (3) GMI; (4) no intervention (control group). Questionnaire data on the primary outcome (need for recovery) and secondary outcomes (daily physical activity, sedentary behaviour, relaxation/detachment, work- and health-related factors) will be gathered at baseline (T0), at 6 months (T1), and at 12 months (T2) follow-up. In addition, an economic and a process evaluation will be performed.

Discussion

Reducing the need for recovery is hypothesized to be beneficial for employees, employers and society. It is assumed that there will be a reduction in need for recovery after 6 months and 12 months in the intervention group, compared to the control group. Results are expected in 2013.

Trial registration

Netherlands Trial Register (NTR): NTR2553

Motivational intervention to reduce cannabis use in young people with psychosis: a randomized controlled trial

BACKGROUND

Cannabis use has a negative impact on psychosis. Studies are needed to explore the efficacy of psychological interventions to reduce cannabis use in psychosis. Our aim is to study the efficacy of a specific motivational intervention on young cannabis users suffering from psychosis.

METHODS

Participants (aged less than 35 years) were randomly assigned to treatment as usual (TAU) alone, or treatment as usual plus motivational intervention (MI + TAU). TAU was comprehensive and included case management, early intervention and mobile team when needed. Assessments were completed at baseline and at 3, 6 and 12 months follow-up.

RESULTS

Sixty-two participants (32 TAU and 30 MI + TAU) were included in the study. Cannabis use decreased in both groups at follow-up. Participants who received MI in addition to TAU displayed both a greater reduction in number of joints smoked per week and greater confidence to change cannabis use at 3 and 6 months follow-up, but differences between groups were nonsignificant at 12 months.

CONCLUSIONS

MI is well accepted by patients suffering from psychosis and has a short-term impact on cannabis use when added to standard care. However, the differential effect was not maintained at 1-year follow-up. MI appears to be a useful active component to reduce cannabis use which should be integrated in routine clinical practice.

Motivational interviewing in internet groups: a pilot study for weight loss

Motivational interviewing is a technique for developing and maintaining motivation. This pilot study examined the feasibility and acceptability of motivational interviewing in online weight-loss treatment groups. Twenty women participated in the 8-week minimal contact intervention, received weekly e-mailed lessons, and were randomized to two online groups using motivational interviewing, either with or without a discussion of values. Acceptability of format and content was measured following the second online group. Self-reported weight and motivation were measured at baseline and 8 weeks. Qualitative analysis of group transcripts examined self-motivational statements uttered by participants during online groups. Eighty-four percent of participants reported willingness to participate again and were comfortable with the discussion topics. The average number of self-motivational statements uttered by participants did not differ by group (P=0.85) and was correlated with an increase in autonomous motivation during the 8 weeks (r=0.58, P=0.05). Higher autonomous motivation at follow-up was associated with greater weight loss (r=0.51, P<0.05). This study suggests that motivational interviewing techniques are acceptable and may be useful for targeting and maintaining motivation in online weight-loss groups.

The use of motivational interviewing in weight loss

Within the past two decades, motivational interviewing has emerged as a useful strategy to help individuals develop motivation to change health behavior and sustain those efforts. This article reviews the preliminary but burgeoning literature that supports the effectiveness of motivational interviewing strategies in promoting positive changes in a variety of health behaviors, including dietary change, activity increases, and regimen adherence. A variety of adaptations of the motivational interviewing process are discussed as relevant to making this treatment strategy increasingly applicable to a variety of health care settings.

Of treatment systems and depression: an overview of quality-improvement opportunities in hospital-based psychiatric care

A clinical perspective on depression tends to focus on therapy and on medications or psychological interventions that may be helpful to individual patients. A broader view on the treatment enterprise, however, suggests that there are other dimensions to treatment and that opportunities for improving the quality of care and patient outcomes are not limited to innovation in therapeutics. This article examines several of the nonclinical facets of inpatient care, using the frame of a conceptual pyramid to explore the relationships between therapy and its professional, organizational, care-management, and economic concomitants. By drawing on a conceptual pyramid that elucidates several nonclinical dimensions of inpatient treatment for depression, we describe the potential for corresponding quality improvement activities among psychiatric providers. The pyramid suggests that there are multiple opportunities for future interventions to promote quality in inpatient psychiatric care, that those opportunities are considerably more varied than a purely clinical perspective might recognize, and that interventions in nonclinical aspects of the treatment system have the potential to cascade "downward" to affect clinical outcomes over time.

Translation as a function of modality: the potential of brief interventions

The purpose of this article is to examine the potential of brief intervention (BI) as a modality for translating health behavior intervention research into practice. We discuss common definitions of BI, applications within common models of translation research, effects of BI on a range of health behaviors and across various populations, current and potential mechanisms, and uses for dissemination to practice. A number of advantages of BI suggest they are well suited for translating behavioral research. In addition, findings from 13 systematic reviews of BI effects show their potential versatility. Basic research on motivation, decision making, and persuasion may be applied to the design of BIs (Type 1 translation). Suggestions for translating BI research into practice are discussed (Type 2 translation). The article concludes that efforts to use BIs to translate research into practice are currently underdeveloped. Recommendations are provided for using BI in translating research into practice.

Motivational interviewing and clinical psychiatry

OBJECTIVES

Our objectives were as follows: 1) to survey the literature on motivational interviewing (MI), "a client-centered yet directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence" and a well-established method of brief intervention, especially in the field of addictions treatment; 2) to review hypothesis about its mode of action; and 3) to discuss its possible impact on clinical psychiatry, in particular, on teaching communication skills.

METHOD

Literature reviews and metaanalyses of numerous clinical trials of MI for addictions treatment have already been published and are briefly summarised. So far, no literature survey exists for MI applied to psychiatric patients. This review is limited to a synthesis of the articles relevant to psychiatry and to comments based on our team's experiences with MI.

RESULTS

There is no evidence that MI achieves better results than our other established techniques for treating addictions; it may simply work faster. The explanation for the method's rapid effectiveness remains speculative. Outcomes concerning the application of MI to psychiatric patients, although preliminary, are promising. Methods of assessing the integrity of MI treatment are more developed than in most psychotherapies, which permits the learning progress of trainees to be measured.

CONCLUSIONS

MI offers a complement to usual psychiatric procedures. It may be worthwhile to teach it, not only for addictions but also for other broad treatment issues, such as enhancing patients' medication compliance and professionals' communication skills. Questions remain concerning MI's feasibility in psychiatry settings.

Motivational interviewing and clinical psychiatry

OBJECTIVES

Our objectives were as follows: (1) to survey the literature on motivational interviewing (MI), "a client-centered yet directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence" and a well-established method of brief intervention, especially in the field of addictions treatment; (2) to review hypotheses about its mode of action; and (3) to discuss its possible impact on clinical psychiatry, in particular, on teaching communications skills.

METHOD

Literature reviews and metaanalyses of numerous clinical trials of MI for addictions treatment have already been published and are briefly summarized. So far, no literature survey exists for MI applied to psychiatric patients. This review is limited to a synthesis of the articles relevant to psychiatry and to comments based on our team's experiences with MI.

RESULTS

There is no evidence that MI achieves better results than other established techniques for treating addictions; it may simply work faster. The explanation for the method's rapid effectiveness remains speculative. Outcomes concerning the application of MI to psychiatric patients, although preliminary, are promising. Methods of assessing the integrity of MI treatment are more developed than in most psychotherapies, which permits the learning progress of trainees to be measured.

CONCLUSIONS

MI offers a complement to usual psychiatric procedures. It may be worthwhile to teach it, not only for addictions but also for other broad treatment issues, such as enhancing patients' medication compliance and professionals' communication skills. Questions remain concerning MI's feasibility in psychiatry settings.

Readiness for mental health treatment and for changing alcohol use in patients with comorbid psychiatric and alcohol disorders: are they congruent?

Patients with comorbid psychiatric and alcohol disorders may be ready to change one problem but not the other. This study compared 132 dually diagnosed patients' readiness for mental health treatment to their readiness to change alcohol use. The patients completed a measure of readiness to change alcohol use [the University of Rhode Island Change Assessment Scale-Alcohol (URICA-A)] and the new Readiness for Mental Health Treatment measure. Confirmatory factor analysis (CFA) reveals that the measures have similar factor structures, but correlation and cluster analyses suggest that separate levels of patient motivation exist for mental health treatment and changing alcohol use. The newly developed mental health treatment measure will help clinicians tailor interventions to their patients' needs.

Motivational interviewing in health settings: a review

There is evidence that patient-centred approaches to health care consultations may have better outcomes than traditional advice giving, especially when lifestyle change is involved. Motivational interviewing (MI) is a patient-centred approach that is gathering increased interest in health settings. It provides a way of working with patients who may not seem ready to make the behaviour changes that are considered necessary by the health practitioner. The current paper provides an overview of MI, with particular reference to its application to health problems.

Tobacco smoking: current concepts in etiology and treatment

Tobacco smoking is the most important preventable cause of death and disease. Despite an increased awareness of the addictive nature of smoking and availability of effective treatments, smoking continues to be widespread among individuals with psychiatric disorders. Moreover, mental health professionals remain reluctant to address smoking among their patients for a variety of reasons. Recent research has provided a wealth of data that have shaped the concept of tobacco smoking as a chronic addictive disorder and also demonstrated the efficacy of smoking cessation interventions. This paper reviews the important factors that contribute to smoking and the various pharmacological and psychosocial interventions for smoking cessation from a biopsychosocial perspective. It also makes recommendations for the rational use of these interventions to treat nicotine dependence in individuals with psychiatric disorders.

Dual Diagnosis Motivational Interviewing: a modification of Motivational Interviewing for substance-abusing patients with psychotic disorders

Motivational Interviewing (MI) is a brief treatment approach for helping patients develop intrinsic motivation to change addictive behaviors. While initially developed to target primary substance using populations, professionals are increasingly recognizing the promise this approach has for addressing the motivational dilemmas faced by patients who have co-occurring psychiatric and psychoactive substance use disorders. Unfortunately, this recognition has not lead to a clear explication of how MI might be adopted for specific diagnostic populations of dually diagnosed patients. In this article we describe how we have applied the principles and practices of MI to patients who have psychotic disorders and co-occurring drug or alcohol use problems. Specifically, we provide two supplemental guidelines to augment basic MI principles (adopting an integrated dual diagnosis approach, accommodating cognitive impairments and disordered thinking). We present recommended modifications to primary MI skill sets (simplifying open-ended questions, refining reflective listening skills, heightening emphasis on affirmation, integrating psychiatric issues into personalized feedback and decisional balance matrices). Finally, we highlight other clinical considerations (handling psychotic exacerbation and crisis events, recommended professional qualifications) when using MI with psychotic disordered dually diagnosed patients.