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Schwenker R, Dietrich CE, Hirpa S, Nothacker M, Smedslund G, Frese T, Unverzagt S. Motivational interviewing for substance use reduction. Cochrane Database Syst Rev 2023; 12:CD008063. [PMID: 38084817 PMCID: PMC10714668 DOI: 10.1002/14651858.cd008063.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Substance use is a global issue, with around 30 to 35 million individuals estimated to have a substance-use disorder. Motivational interviewing (MI) is a client-centred method that aims to strengthen a person's motivation and commitment to a specific goal by exploring their reasons for change and resolving ambivalence, in an atmosphere of acceptance and compassion. This review updates the 2011 version by Smedslund and colleagues. OBJECTIVES To assess the effectiveness of motivational interviewing for substance use on the extent of substance use, readiness to change, and retention in treatment. SEARCH METHODS We searched 18 electronic databases, six websites, four mailing lists, and the reference lists of included studies and reviews. The last search dates were in February 2021 and November 2022. SELECTION CRITERIA We included randomised controlled trials with individuals using drugs, alcohol, or both. Interventions were MI or motivational enhancement therapy (MET), delivered individually and face to face. Eligible control interventions were no intervention, treatment as usual, assessment and feedback, or other active intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, and assessed the certainty of evidence with GRADE. We conducted meta-analyses for the three outcomes (extent of substance use, readiness to change, retention in treatment) at four time points (post-intervention, short-, medium-, and long-term follow-up). MAIN RESULTS We included 93 studies with 22,776 participants. MI was delivered in one to nine sessions. Session durations varied, from as little as 10 minutes to as long as 148 minutes per session, across included studies. Study settings included inpatient and outpatient clinics, universities, army recruitment centres, veterans' health centres, and prisons. We judged 69 studies to be at high risk of bias in at least one domain and 24 studies to be at low or unclear risk. Comparing MI to no intervention revealed a small to moderate effect of MI in substance use post-intervention (standardised mean difference (SMD) 0.48, 95% confidence interval (CI) 0.07 to 0.89; I2 = 75%; 6 studies, 471 participants; low-certainty evidence). The effect was weaker at short-term follow-up (SMD 0.20, 95% CI 0.12 to 0.28; 19 studies, 3351 participants; very low-certainty evidence). This comparison revealed a difference in favour of MI at medium-term follow-up (SMD 0.12, 95% CI 0.05 to 0.20; 16 studies, 3137 participants; low-certainty evidence) and no difference at long-term follow-up (SMD 0.12, 95% CI -0.00 to 0.25; 9 studies, 1525 participants; very low-certainty evidence). There was no difference in readiness to change (SMD 0.05, 95% CI -0.11 to 0.22; 5 studies, 1495 participants; very low-certainty evidence). Retention in treatment was slightly higher with MI (SMD 0.26, 95% CI -0.00 to 0.52; 2 studies, 427 participants; very low-certainty evidence). Comparing MI to treatment as usual revealed a very small negative effect in substance use post-intervention (SMD -0.14, 95% CI -0.27 to -0.02; 5 studies, 976 participants; very low-certainty evidence). There was no difference at short-term follow-up (SMD 0.07, 95% CI -0.03 to 0.17; 14 studies, 3066 participants), a very small benefit of MI at medium-term follow-up (SMD 0.12, 95% CI 0.02 to 0.22; 9 studies, 1624 participants), and no difference at long-term follow-up (SMD 0.06, 95% CI -0.05 to 0.17; 8 studies, 1449 participants), all with low-certainty evidence. There was no difference in readiness to change (SMD 0.06, 95% CI -0.27 to 0.39; 2 studies, 150 participants) and retention in treatment (SMD -0.09, 95% CI -0.34 to 0.16; 5 studies, 1295 participants), both with very low-certainty evidence. Comparing MI to assessment and feedback revealed no difference in substance use at short-term follow-up (SMD 0.09, 95% CI -0.05 to 0.23; 7 studies, 854 participants; low-certainty evidence). A small benefit for MI was shown at medium-term (SMD 0.24, 95% CI 0.08 to 0.40; 6 studies, 688 participants) and long-term follow-up (SMD 0.24, 95% CI 0.07 to 0.41; 3 studies, 448 participants), both with moderate-certainty evidence. None of the studies in this comparison measured substance use at the post-intervention time point, readiness to change, and retention in treatment. Comparing MI to another active intervention revealed no difference in substance use at any follow-up time point, all with low-certainty evidence: post-intervention (SMD 0.07, 95% CI -0.15 to 0.29; 3 studies, 338 participants); short-term (SMD 0.05, 95% CI -0.03 to 0.13; 18 studies, 2795 participants); medium-term (SMD 0.08, 95% CI -0.01 to 0.17; 15 studies, 2352 participants); and long-term follow-up (SMD 0.03, 95% CI -0.07 to 0.13; 10 studies, 1908 participants). There was no difference in readiness to change (SMD 0.15, 95% CI -0.00 to 0.30; 5 studies, 988 participants; low-certainty evidence) and retention in treatment (SMD -0.04, 95% CI -0.23 to 0.14; 12 studies, 1945 participants; moderate-certainty evidence). We downgraded the certainty of evidence due to inconsistency, study limitations, publication bias, and imprecision. AUTHORS' CONCLUSIONS Motivational interviewing may reduce substance use compared with no intervention up to a short follow-up period. MI probably reduces substance use slightly compared with assessment and feedback over medium- and long-term periods. MI may make little to no difference to substance use compared to treatment as usual and another active intervention. It is unclear if MI has an effect on readiness to change and retention in treatment. The studies included in this review were heterogeneous in many respects, including the characteristics of participants, substance(s) used, and interventions. Given the widespread use of MI and the many studies examining MI, it is very important that counsellors adhere to and report quality conditions so that only studies in which the intervention implemented was actually MI are included in evidence syntheses and systematic reviews. Overall, we have moderate to no confidence in the evidence, which forces us to be careful about our conclusions. Consequently, future studies are likely to change the findings and conclusions of this review.
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Affiliation(s)
- Rosemarie Schwenker
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Carla Emilia Dietrich
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Selamawit Hirpa
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany, Berlin, c/o Philipps University Marburg, Berlin & Marburg, Germany
| | | | - Thomas Frese
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
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Omar Y. Introduction to the Special Issue on Exploring the Versatility of Motivational Interviewing. J Cogn Psychother 2021; 35:JCPSY-D-21-00004. [PMID: 33833087 DOI: 10.1891/jcpsy-d-21-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence indicates that motivation early in treatment is critical to treatment outcome, and motivational interviewing (MI) has addressed this finding by helping individuals work through ambivalence about change. Not only has it demonstrated improvements in treatment outcome across treatment populations and settings, it has been adapted with success into brief motivational interventions. This special issue explores the use of MI with populations at great risk for ambivalence in therapy, including college students violating campus policy, individuals who have been trafficked, and individuals in exposure therapy. The papers further highlight the versatility of MI-based interventions, as well as their limitations, that may help inform future directions for adapting MI as we move toward digital and web-based interventions.
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Gowin J, Sloan ME, Swan JE, Momenan R, Ramchandani VA. The relationship between delay discounting and alcohol dependence in individuals with and without comorbid psychopathology. Psychopharmacology (Berl) 2019; 236:775-785. [PMID: 30456539 PMCID: PMC6401281 DOI: 10.1007/s00213-018-5113-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/05/2018] [Indexed: 01/12/2023]
Abstract
RATIONALE Alcohol use disorder (AUD) has been associated with greater discounting of delayed monetary rewards, but it is unclear whether this association is primarily related to alcohol consumption or is secondary to the presence of psychiatric comorbidities. It is also unclear if steeper rates of discounting are associated with greater AUD severity. OBJECTIVE We sought to determine whether the presence of comorbid psychiatric disorders affected the relationship between AUD and delay discounting. We also examined whether more severe AUD was associated with greater delay discounting. METHODS In this cross-sectional study, 793 adults completed a delay discounting task. Subjects were divided into four groups based on diagnosis: current AUD with psychiatric comorbidities (N = 226), current AUD without psychiatric comorbidities (N = 203), past AUD (N = 69), and healthy controls (N = 295). In those with AUD, we investigated the relationship between delay discounting and alcohol dependence symptom count and recent drinking history. We also compared individuals seeking treatment to non-treatment seeking individuals. Psychiatric comorbidities examined included mood disorders, anxiety disorders, and substance use disorders. RESULTS After adjusting for age, sex, income, and education, individuals with current AUD showed significantly higher rates of delay discounting than healthy controls and individuals with a past diagnosis of AUD. The presence of comorbid psychiatric diagnoses was not associated with steeper discounting. Among those with AUD, there was no evidence for a continuous relationship between delay discounting and AUD severity or alcohol consumption. Finally, non-treatment seekers with AUD had steeper delay discounting than treatment seekers. CONCLUSIONS Individuals with AUD show steeper delay discounting than healthy adults, but the effect is small and there is no added effect from comorbid psychopathology or increased AUD severity. This suggests that steeper delay discounting may have a more limited effect on human alcohol use than previously supposed.
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Affiliation(s)
- Joshua Gowin
- Department of Radiology, University of Colorado School of Medicine, Denver, CO, USA.
- Section on Human Psychopharmacology, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, Building 10, Room 2-2352, Bethesda, MD, 20892-1540, USA.
| | - Matthew E Sloan
- Section on Human Psychopharmacology, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, Building 10, Room 2-2352, Bethesda, MD, 20892-1540, USA
| | - Julia E Swan
- Section on Human Psychopharmacology, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, Building 10, Room 2-2352, Bethesda, MD, 20892-1540, USA
| | - Reza Momenan
- Clinical NeuroImaging Research Core, Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Vijay A Ramchandani
- Section on Human Psychopharmacology, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, Building 10, Room 2-2352, Bethesda, MD, 20892-1540, USA
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Pattanaik R, Samantaray NN, Mohapatra J. Application of transtheoretical model in management of individual with alcohol dependence: A case study. Ind Psychiatry J 2019; 28:148-151. [PMID: 31879462 PMCID: PMC6929224 DOI: 10.4103/ipj.ipj_50_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 06/27/2019] [Accepted: 09/24/2019] [Indexed: 11/17/2022] Open
Abstract
Studies have focused on the efficacy of transtheoretical model in the management of substance dependence, but not much have focused on the changes with respect to the patient's mood, life skills, and interpersonal relationship issues that take place during the therapy. The present study explores a case by using motivational interviewing and relapse prevention strategies to qualitatively record the applicability of the transtheoretical model in terms of readiness to change, action taken, relationship conflicts, assertiveness, and depression in an individual with alcohol dependence. The intervention was carried out over 3 months for ten sessions followed by follow-up for 8 months. The results indicated improvement in the patient in the dimensions of level of action taken for increasing abstinence period, decreasing the level of depression, enhancing readiness to change, and improving assertiveness and improvement in marital adjustment with spouse, which were observed and reported during the post follow-up sessions.
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Affiliation(s)
- Romalin Pattanaik
- Department of Clinical Psychology, Mental Health Institute, SCB MCH, Cuttack, Odisha, India
| | | | - Jashobanta Mohapatra
- Department of Clinical Psychology, Mental Health Institute, SCB MCH, Cuttack, Odisha, India
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Praharaj SK, Munoli RN, Sharma PSVN. Life events in past one year in alcohol-dependent patients presenting with relapse. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1348560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stuart GL, Ramsey SE, Moore TM, Kahler CW, Farrell LE, Recupero PR, Brown RA. Marital Violence Victimization and Perpetration Among Women Substance Abusers. Violence Against Women 2016. [DOI: 10.1177/107780102400447078] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study reports descriptive data assessing the impact of an intensive outpatient treatment for alcohol dependence on alcohol use, marital violence, psychological abuse, and marital satisfaction among 10 heterosexual female patients and their partners. Patients received 5 to 6 days of substance abuse treatment in a partial hospital program. Patient and partner assessments were conducted at baseline, 6-month follow-up, and 12-month follow-up. Results revealed decreased alcohol use in female patients as well as declines in the prevalence and frequency of husband-to-wife marital violence over time. Men evidenced no changes in their psychological abuse or marital satisfaction. Results also showed decreases in the prevalence and frequency of wife-to-husband violence and psychological abuse. Female patients reported no changes in their marital satisfaction. Overall, the study suggests that marital violence victimization and perpetration by female patients and their male partners declined following the females' substance abuse treatment. The clinical implications of the findings are discussed
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Affiliation(s)
| | - Susan E. Ramsey
- Brown University School of Medicine and Rhode Island Hospital
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Andretta I, Meyer E, Kuhn R, Rigon M. A Entrevista Motivacional no Brasil: Uma Revisão Sistemática. ACTA ACUST UNITED AC 2014. [DOI: 10.15603/2176-1019/mud.v22n2p15-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Greenfield SF, Sugarman DE, Freid CM, Bailey GL, Crisafulli MA, Kaufman JS, Wigderson S, Connery HS, Rodolico J, Morgan-Lopez AA, Fitzmaurice GM. Group therapy for women with substance use disorders: results from the Women's Recovery Group Study. Drug Alcohol Depend 2014; 142:245-53. [PMID: 25042759 PMCID: PMC4150678 DOI: 10.1016/j.drugalcdep.2014.06.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/18/2014] [Accepted: 06/21/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND This Stage II trial builds on a Stage I trial comparing the single-gender Women's Recovery Group (WRG) to mixed-gender Group Drug Counseling (GDC) that demonstrated preliminary support for the WRG in treating women with substance use disorders. The Stage II trial aims were to (1) investigate effectiveness of the WRG relative to GDC in a sample of women heterogeneous with respect to substance of abuse and co-occurring psychiatric disorders, and (2) demonstrate the feasibility of implementing WRG in an open-enrollment group format at two sites. METHOD In this randomized clinical trial, participants were included if they were substance dependent and had used substances within the past 60 days (n=158). Women were randomized to WRG (n=52) or GDC (n=48); men were assigned to GDC (n=58). Substance use outcomes were assessed at months 1-6 and 9. RESULTS Women in both the WRG and GDC had reductions in mean number of substance use days during treatment (12.7 vs 13.7 day reductions for WRG and GDC, respectively) and 6 months post-treatment (10.3 vs 12.7 day reductions); however, there were no significant differences between groups. CONCLUSIONS The WRG demonstrated comparable effectiveness to standard mixed-gender treatment (i.e., GDC) and is feasibly delivered in an open-group format typical of community treatment. It provides a manual-based group therapy with women-focused content that can be implemented in a variety of clinical settings for women who are heterogeneous with respect to their substance of abuse, other co-occurring psychiatric disorders, and life-stage.
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Affiliation(s)
- Shelly F Greenfield
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States.
| | - Dawn E Sugarman
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States
| | - Cathryn M Freid
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States
| | - Genie L Bailey
- Brown University, Department of Psychiatry and Human Behavior, Providence, RI 02912, United States; Stanley Street Treatment and Resources, Fall River, MA 02720, United States
| | - Michele A Crisafulli
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD 21250, United States
| | - Julia S Kaufman
- Miami University, Department of Psychology, Oxford, OH 45056, United States
| | - Sara Wigderson
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States
| | - Hilary S Connery
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| | - John Rodolico
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| | - Antonio A Morgan-Lopez
- RTI International, Risk Behavior and Family Research Program, Research Triangle Park, NC 27709, United States
| | - Garrett M Fitzmaurice
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
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Cucciare MA, Simpson T, Hoggatt KJ, Gifford E, Timko C. Substance use among women veterans: epidemiology to evidence-based treatment. J Addict Dis 2013; 32:119-39. [PMID: 23815420 DOI: 10.1080/10550887.2013.795465] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
An increasing percentage of women are U.S. Military Veterans. We review the substance misuse rates and comorbidities and the risk factors for and consequences of substance use among women Veterans. Women Veterans may have higher rates of substance misuse and comorbid psychiatric and medical disorders than male Veterans and women who are not Veterans. Studies support the AUDIT-C as a scaled marker of alcohol-related risk among female Veterans, but validated drug screening instruments are needed. We discuss evidence-based approaches in terms of treating women Veterans' substance misuse in primary and specialty care settings, along with knowledge gaps and potential research priorities to improve care in this special population.
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Affiliation(s)
- Michael A Cucciare
- Center for Health Care Evaluation , Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA.
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Combined MI + CBT for Depressive Symptoms and Binge Drinking Among Young Adults: Two Case Studies. J Cogn Psychother 2013; 27:235-257. [PMID: 25170188 DOI: 10.1891/0889-8391.27.3.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are high rates of comorbidity between heavy drinking and depressive symptoms among college students, often resulting in severe alcohol-related consequences. No empirically supported treatment exists that concurrently addresses both of these problems in this population. Research with college students has demonstrated that brief motivational interventions (BMIs) reduce heavy drinking and alcohol-related consequences, and that cognitive behavioral therapy for depression (CBT-D) is effective in reducing depressive symptoms. Thus, a program combining BMI and CBT-D appears ideal for college students with co-occurring binge drinking and depressive symptoms. This manuscript presents the rationale and format of a BMI + CBT-D treatment protocol for this population, and provides a case example of a female college student who received the protocol and experienced improvement in depressive symptoms, a reduction in alcohol use and alcohol-related negative consequences, and an increase in readiness to change alcohol consumption. We discuss theoretical and clinical implications of these findings, and suggest directions for future research.
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Guan M, Han B. Marital distress and disease progression: A systematic review. Health (London) 2013. [DOI: 10.4236/health.2013.510216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bouma R, Halford WK, Young RM. Evaluation of the Controlling Alcohol and Relationship Enhancement (CARE) Program With Hazardous Drinkers. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.21.4.229.66106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractWe assessed the effects of the Controlling Alcohol and Relationship Enhancement (CARE) program, an early intervention combining reduction of hazardous alcohol consumption and enhancement of couple relationships. Thirty-seven hazardous drinking couples were randomly allocated to either the CARE program or to a control condition. CARE couples improved their communication more than controls, but couples in both conditions reduced hazardous drinking to a similar extent. CARE is a potentially useful means of promoting positive relationship communication in hazardous drinking couples.
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Smedslund G, Berg RC, Hammerstrøm KT, Steiro A, Leiknes KA, Dahl HM, Karlsen K. Motivational interviewing for substance abuse. Cochrane Database Syst Rev 2011; 2011:CD008063. [PMID: 21563163 PMCID: PMC8939890 DOI: 10.1002/14651858.cd008063.pub2] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are 76.3 million people with alcohol use disorders worldwide and 15.3 million with drug use disorders. Motivational interviewing (MI) is a client-centred, semi-directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The intervention is used widely, and therefore it is important to find out whether it helps, harms or is ineffective. OBJECTIVES To assess the effectiveness of motivational interviewing for substance abuse on drug use, retention in treatment, readiness to change, and number of repeat convictions. SEARCH STRATEGY We searched 18 electronic databases, 5 web sites, 4 mailing lists, and reference lists from included studies and reviews. Search dates were November 30, 2010 for Cochrane Library, Medline, Embase and PsychINFO. SELECTION CRITERIA Randomized controlled trials with persons dependent or abusing substance. Interventions were MI or motivational enhancement therapy. The outcomes were extent of substance abuse, retention in treatment, motivation for change, repeat conviction. DATA COLLECTION AND ANALYSIS Three authors independently assessed studies for inclusion, and two authors extracted data. Results were categorized into (1) MI versus no-treatment control, (2) MI versus treatment as usual, (3) MI versus assessment and feedback, and (4) MI versus other active treatment. Within each category, we computed meta-analyses separately for post-intervention, short, medium and long follow-ups. MAIN RESULTS We included 59 studies with a total of 13,342 participants. Compared to no treatment control MI showed a significant effect on substance use which was strongest at post-intervention SMD 0.79, (95% CI 0.48 to 1.09) and weaker at short SMD 0.17 (95% CI 0.09 to 0.26], and medium follow-up SMD 0.15 (95% CI 0.04 to 0.25]). For long follow-up, the effect was not significant SMD 0.06 (95% CI-0.16 to 0.28). There were no significant differences between MI and treatment as usual for either follow-up post-intervention, short and medium follow up. MI did better than assessment and feedback for medium follow-up SMD 0.38 (95% CI 0.10 to 0.66). For short follow-up, there was no significant effect . For other active intervention there were no significant effects for either follow-up.There was not enough data to conclude about effects of MI on the secondary outcomes. AUTHORS' CONCLUSIONS MI can reduce the extent of substance abuse compared to no intervention. The evidence is mostly of low quality, so further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
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Affiliation(s)
- Geir Smedslund
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Rigmor C Berg
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Karianne T Hammerstrøm
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Asbjørn Steiro
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Kari A Leiknes
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Helene M Dahl
- Institute of Clinical MedicineDepartment of Clinical PsychiatryUniversity of Tromsø, Asgard,TromsøNorway9291
| | - Kjetil Karlsen
- Institute of Clinical MedicineDepartment of Clinical PsychiatryUniversity of Tromsø, Asgard,TromsøNorway9291
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Magill M, Ray LA. Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. J Stud Alcohol Drugs 2009; 70:516-27. [PMID: 19515291 DOI: 10.15288/jsad.2009.70.516] [Citation(s) in RCA: 325] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This meta-analysis examined 53 controlled trials of cognitive-behavioral treatment (CBT) for adults diagnosed with alcohol- or illicit-drug-use disorders. The aims were to provide an overall picture of CBT treatment efficacy and to identify client or treatment factors predictive of CBT effect magnitude. METHOD The inverse variance weighted effect size (Hedges' g) was calculated for each study and pooled using fixed and random effects methods. Potential study-level moderators were assessed in subgroup analyses by primary drug, type of CBT, and type of comparison condition. In addition, seven client and treatment variables were examined in meta-regression analyses. RESULTS Across studies, CBT produced a small but statistically significant treatment effect (g = 0.154, p < .005). The pooled effect was somewhat lower at 6-9 months (g = 0.1 15, p < .005) and continued to diminish at 12-month follow-up (g = 0.096, p < .05). The effect of CBT was largest in marijuana studies (g = 0.513, p < .005) and in studies with a no-treatment control as the comparison condition (g = 0.796, p < .005). Meta-regression analyses indicated that the percentage of female participants was positively associated and the number of treatment sessions was negatively associated with effect size. CONCLUSIONS The findings demonstrate the utility of CBT across a large and diverse sample of studies and under rigorous conditions for establishing efficacy. CBT effects were strongest with marijuana users, when CBT was compared with no treatment, and may be larger with women than with men and when delivered in a brief format.
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Affiliation(s)
- Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Box G S121-4, Providence, Rhode Island 02912, USA.
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Pilot study of interpersonal psychotherapy versus supportive psychotherapy for dysthymic patients with secondary alcohol abuse or dependence. J Nerv Ment Dis 2008; 196:468-74. [PMID: 18552624 DOI: 10.1097/nmd.0b013e31817738f1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Interpersonal psychotherapy (IPT) has demonstrated efficacy for depression but yielded negative results for substance disorders. Alcohol abuse frequently complicates mood disorders. This pilot study compared IPT with brief supportive psychotherapy (BSP) for dysthymic disorder and alcohol abuse. We hypothesized that effect sizes would suggest greater IPT efficacy for both diagnoses, despite limited statistical power. Subjects with primary DSM-IV dysthymic disorder and secondary alcohol abuse/dependence were randomly assigned 16 weeks of IPT (N = 14) or BSP (N = 12). Patients in both treatments reported improved depressive symptoms and alcohol abstinence. IPT had a large and BSP a moderate effect size in depression, whereas BSP had a moderate and IPT a small effect size in percentage of days abstinent. This pilot study offers initial data on IPT and BSP for comorbid chronic depression and alcohol abuse/dependence. Results suggest IPT may have specific antidepressant benefits for dysthymic alcoholic patients but not in treating alcoholism.
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Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness. Am J Prev Med 2008; 34:143-152. [PMID: 18201645 DOI: 10.1016/j.amepre.2007.09.035] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 08/21/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The U.S. Preventive Services Task Force (USPSTF) has recommended screening and behavioral counseling interventions in primary care to reduce alcohol misuse. This study was designed to develop a standardized rating for the clinically preventable burden and cost effectiveness of complying with that recommendation that would allow comparisons across many recommended services. METHODS A systematic review of the literature from 1992 through 2004 to identify relevant randomized controlled trials and cost-effectiveness studies was completed in 2005. Clinically preventable burden (CPB) was calculated as the product of effectiveness times the alcohol-attributable fraction of both mortality and morbidity (measured in quality-adjusted life years or QALYs), for all relevant conditions. Cost effectiveness from both the societal perspective and the health-system perspective was estimated. These analyses were completed in 2006. RESULTS The calculated CPB was 176,000 QALYs saved over the lifetime of a birth cohort of 4,000,000, with a range in sensitivity analysis from -43% to +94% (primarily due to variation in estimates of effectiveness). Screening and brief counseling was cost-saving from the societal perspective and had a cost-effectiveness ratio of $1755/QALY saved from the health-system perspective. Sensitivity analysis indicates that from both perspectives the service is very cost effective and may be cost saving. CONCLUSIONS These results make alcohol screening and counseling one of the highest-ranking preventive services among the 25 effective services evaluated using standardized methods. Since current levels of delivery are the lowest of comparably ranked services, this service deserves special attention by clinicians and care delivery systems.
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Affiliation(s)
- Leif I Solberg
- HealthPartners Research Foundation, Minneapolis, Minnesota 55440-1524, USA.
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Abstract
Motivational interviewing (MI) is a client-centered, directive therapeutic style to enhance readiness for change by helping clients explore and resolve ambivalence. An evolution of Rogers's person-centered counseling approach, MI elicits the client's own motivations for change. The rapidly growing evidence base for MI is summarized in a new meta-analysis of 72 clinical trials spanning a range of target problems. The average short-term between-group effect size of MI was 0.77, decreasing to 0.30 at follow-ups to one year. Observed effect sizes of MI were larger with ethnic minority populations, and when the practice of MI was not manual-guided. The highly variable effectiveness of MI across providers, populations, target problems, and settings suggests a need to understand and specify how MI exerts its effects. Progress toward a theory of MI is described, as is research on how clinicians develop proficiency in this method.
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Affiliation(s)
- Jennifer Hettema
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico 87131-1161, USA.
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Biuso TJ, Butterworth S, Linden A. A Conceptual Framework for Targeting Prediabetes with Lifestyle, Clinical, And Behavioral Management Interventions. ACTA ACUST UNITED AC 2007; 10:6-15. [PMID: 17309360 DOI: 10.1089/dis.2006.628] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prediabetes is a condition that does not fall squarely into the primary or secondary prevention domain, and therefore tends to be inadequately addressed by interventions in either health promotion or disease management. Prediabetes is defined as having an impaired fasting glucose (fasting glucose of 100-125 mg/dL), impaired glucose tolerance (two-hour postprandial glucose of 140-199 mg/dL), or both. There is substantial evidence to suggest that even at these blood glucose levels, significant risk exists for both microand macrovascular complications. This paper introduces a conceptual framework of care for prediabetes that includes both screening and the provision of up-to-date clinical therapies in conjunction with an evidence-based health coaching intervention. In combination, these modalities represent the most effective means for delaying or even preventing the onset of diabetes in a prediabetes population. This paper concludes with a brief example in which these principles are applied to a hypothetical patient.
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Affiliation(s)
- Thomas J Biuso
- Regional Hospitalist Program Director, Apogee Medical, Tucson, Arizona, USA
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Greenfield SF, Brooks AJ, Gordon SM, Green CA, Kropp F, McHugh RK, Lincoln M, Hien D, Miele GM. Substance abuse treatment entry, retention, and outcome in women: a review of the literature. Drug Alcohol Depend 2007; 86:1-21. [PMID: 16759822 PMCID: PMC3532875 DOI: 10.1016/j.drugalcdep.2006.05.012] [Citation(s) in RCA: 649] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 05/02/2006] [Accepted: 05/09/2006] [Indexed: 11/22/2022]
Abstract
This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.
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Butterworth SW, Linden A, McClay W. Health Coaching as an Intervention in Health Management Programs. ACTA ACUST UNITED AC 2007. [DOI: 10.2165/00115677-200715050-00004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Vasilaki EI, Hosier SG, Cox WM. The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol Alcohol 2006; 41:328-35. [PMID: 16547122 DOI: 10.1093/alcalc/agl016] [Citation(s) in RCA: 323] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIMS (1) To examine whether or not motivational interviewing (MI) is more efficacious than no intervention in reducing alcohol consumption; (2) to examine whether or not MI is as efficacious as other interventions. METHOD A literature search followed by a meta-analytic review of randomized control trials of MI interventions. Aggregated between-group effect sizes and confidence intervals were calculated for each study. RESULTS Literature search revealed 22 relevant studies, of which nine compared brief MI with no treatment, and met methodological criteria for inclusion. In these, the aggregate effect size was 0.18 (95% C.I. 0.07, 0.29), but was greater 0.60 (95% C.I. 0.36, 0.83) when, in a post-hoc analysis, the follow-up period was three months or less. Its efficacy also increased when dependent drinkers were excluded. There were nine studies meeting methodological criteria for inclusion which compared brief MI with another treatment (one of a diverse set of interventions), yielding an aggregate effect size of 0.43(95% C.I. 0.17, 0.70). The literature review pointed to several factors which may influence MI's long-term efficacy effectiveness of MI. CONCLUSIONS Brief MI is effective. Future studies should focus on possible predictors of efficacy such as gender, age, employment status, marital status, mental health, initial expectations, readiness to change, and whether the population is drawn from treatment-seeking or non-treatment-seeking populations. Also, the components of MI should be compared to determine which are most responsible for maintaining long-term changes.
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Berglund M, Thelander S, Salaspuro M, Franck J, Andréasson S, Ojehagen A. Treatment of alcohol abuse: an evidence-based review. Alcohol Clin Exp Res 2004; 27:1645-56. [PMID: 14574236 DOI: 10.1097/01.alc.0000090144.99832.19] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article represents the proceedings of a symposium at the 2002 annual meeting of the Research Society on Alcoholism in San Francisco, CA, organized and cochaired by Mats Berglund and Sten Thelander. The presentations were (1) Preventive interventions against hazardous consumption of alcohol, by Mikko Salaspuro; (2) Treatment of alcohol withdrawal, by Johan Franck; (3) Psychosocial treatment for alcohol problems, by Sven Andréasson and Agneta Ojehagen; and (4) Pharmacological treatment of alcohol dependence, by Mats Berglund.
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Affiliation(s)
- Mats Berglund
- Department of Clinical Alcohol Research, Malmö University Hospital, Malmö, Sweden.
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Patten CA, Offord KP, Hurt RD, Sanderson Cox L, Thomas JL, Quigg SM, Croghan IT, Wolter TD, Decker PA. Training support persons to help smokers quit: a pilot study. Am J Prev Med 2004; 26:386-90. [PMID: 15165654 DOI: 10.1016/j.amepre.2004.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evaluate the feasibility, acceptability, and potential efficacy of a skills-training intervention for adults interested in helping someone to stop smoking (i.e., support persons). METHODS Sixty adult support persons (77% female) were directly recruited from the community and randomly assigned to this intervention (manual plus five weekly group-based sessions) or a control condition (one-page leaflet). All intervention and outcome assessments occurred through the support persons. Assessments occurred at weeks 0 (baseline), 6 (end of treatment), 12, and 24. The study was conducted from 1998 to 2001; data collection occurred from 1999 to 2000. Outcomes were ratings of treatment acceptability, recruitment and retention rates, supportive behaviors provided to the smoker, and smoking behavior change in the smoker as reported by the support person. RESULTS Support persons were recruited in a timely manner and study retention rates were high. Support persons in skills training showed significant increases in their supportive behavior scores compared with control subjects at weeks 6 and 12. Although not statistically significant, the skills-training intervention was associated with more quit attempts, greater improvement in stage of change, and higher 7-day point prevalence abstinence rates in the smokers than the control condition. CONCLUSIONS A skills training intervention for support persons is feasible and acceptable. Further studies are needed to test the efficacy of this approach for smoking cessation.
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Affiliation(s)
- Christi A Patten
- Nicotine Research Program, Departmetn of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Kelly AB, Witkiewitz K. Accessibility of alcohol-related attitudes: a cross-lag panel model with young adults. Alcohol Clin Exp Res 2003; 27:1241-50. [PMID: 12966317 DOI: 10.1097/01.alc.0000080665.27717.4b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the alcohol literature, most cognition research has focused on alcohol expectancies. Overall scores on alcohol expectancy questionnaires predict longitudinal changes in drinking behavior. However, the association between expectancy subscale scores and drinking behavior is inconsistent and modest. Attitudinal information may vary in accessibility (i.e., the ease or speed with which attitudinal information is evaluated), and more accessible (i.e., faster) attitudinal evaluations may predict heavier alcohol consumption. An alternative hypothesis arising from response competition theory is that heavy drinkers will show slow attitudinal evaluations, given that heavy drinkers frequently show mixed, inconsistent, or opposing alcohol-related beliefs. In this study we examined the degree to which speed of processing of alcohol-related evaluative judgments longitudinally predicted alcohol consumption in university students. METHODS Response latencies for alcohol- and non-alcohol-related attitudinal inquiries and measures of alcohol use were administered at two intervals 4 months apart. RESULTS The key findings were that response times for tension reduction and cognitive impairment items at time 1 positively predicted alcohol consumption at time 2. These results held after we accounted for autocorrelation in drinking and individual variability in reactivity. CONCLUSION For items relating to tension reduction, response times fit a response competition hypothesis better than the attitude accessibility hypothesis.
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Affiliation(s)
- Adrian B Kelly
- School of Applied Psychology, Griffith University Gold Coast, Australia.
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Kelly AB, Kowalyszyn M. The association of alcohol and family problems in a remote indigenous Australian community. Addict Behav 2003; 28:761-7. [PMID: 12726788 DOI: 10.1016/s0306-4603(02)00232-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While a large proportion of Aboriginal Australians do not consume alcohol, those who do frequently show severe alcohol problems. In European-derived samples, heavy alcohol use is associated with relationship distress, conflict, and violence. Because Aboriginal groups commonly have very different family structures, values, and obligations to European-derived families, the association of family and alcohol problems in Aboriginal Australians may be different from European-derived families. This self-report study is the first known published empirical study of family and alcohol problems among Aboriginal Australians. It involved 99 people from a remote community in the far North of Australia. The aims were to explore the association of family conflict, family cohesion, family independence, alcohol problems, and alcohol-related expectancies. Compared to those without alcohol problems, people with alcohol problems reported more family conflict and women with alcohol problems reported high family independence. Expectancies of negative affect change mediated the association of alcohol problems and family conflict. Family cohesion was unrelated to alcohol or family problems. Implications for detection of and interventions for alcohol and family problems are discussed.
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Affiliation(s)
- Adrian B Kelly
- School of Applied Psychology, Griffith University, PMB 50, Gold Coast Mail Centre, Queensland, Australia.
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DiClemente CC, Haug N, Bellino L, Whyte S. Psychotherapy and motivational enhancement. RECENT DEVELOPMENTS IN ALCOHOLISM : AN OFFICIAL PUBLICATION OF THE AMERICAN MEDICAL SOCIETY ON ALCOHOLISM, THE RESEARCH SOCIETY ON ALCOHOLISM, AND THE NATIONAL COUNCIL ON ALCOHOLISM 2003; 16:115-32. [PMID: 12638634 DOI: 10.1007/0-306-47939-7_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Carlo C DiClemente
- Department of Psychology, University of Maryland, Baltimore, Maryland 21250, USA
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Kelly AB, Halford WK, Young RM. Couple communication and female problem drinking: A behavioral observation study. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2002. [DOI: 10.1037/0893-164x.16.3.269] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Solomon J, Fioritti A. Motivational intervention as applied to systems change: the case of dual diagnosis. Subst Use Misuse 2002; 37:1833-51. [PMID: 12511054 DOI: 10.1081/ja-120014086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The concept of motivational interviewing is based on helping individual clients build and sustain a commitment to reach and carry out a decision to change. In this paper, the motivational interviewing model is applied to systems change. Different stages of involvement and readiness to change are identified within systems which closely resemble those found in individuals. When applied to a system, we call this process "Motivational Intervention." In this paper, the motivational intervention model is applied to a psychiatric system of health care delivery where large numbers of psychiatric patients are found to also have substance use-related problems. Several Italian health districts invited the authors to present a series of lectures and workshops in order to facilitate the incorporation of substance user treatment into existing psychiatric services. Using the motivational intervention model to determine where the system was in the process of change, we then identified the tasks necessary to facilitate further change.
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Affiliation(s)
- Joel Solomon
- Substance Abuse Services, Columbia Presbyterian Medical Center, 180 Fort Washington Ave., HP2-252, New York, NY 10032, USA.
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