Motivational Interviewing: Findings from Clinical Trials

1
Motivational InterviewingFindings from
Clinical Trials

• William R. Miller, Ph.D.
• Department of Psychology
• The University of New Mexico

2
Alcohol

3
Allsop et al., 1997Addiction, 9261-74

• Design Randomized clinical trial
• Population Alcohol abuse
• Nation Scotland
• N 60 adult outpatients
• MI 8 session group MI skills
• Comparison Group discussion TAU
• Follow-up 6 months

4
Allsop et al., 1997
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5
Bien et al., 1993Behavioural Cognitive
Psychotherapy, 21347-356

• Design Randomized clinical trial
• Population Outpatient alcohol (VA)
• Nation US (Albuquerque, NM)
• N 32 adults
• MI 1 session MET ( TAU)
• Comparison TAU
• Follow-up 6 months post discharge

6
Bien et al., 1993
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7
Bien et al., 1993
8
Borsari Carey, 2000Journal of Consulting
Clinical Psychology, 68728-733

• Design Randomized clinical trial
• Population Binge drinkers
• Nation US (Syracuse, NY)
• N 60 college students
• MI 1 session MET
• Comparison Assessment only
• Follow-up 6 weeks

9
Borsari Carey, 2000
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10
Brown Miller, 1993Psychology of Addictive
Behaviors, 7211-218

• Design Randomized clinical trial
• Population Inpatient alcohol
• Nation US (Albuquerque, NM)
• N 28 adults
• MI 1 session MET ( TAU)
• Comparison TAU
• Follow-up 3 months post discharge

11
Brown Miller, 1993
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12
Brown Miller, 1993
13
Dench Bennett, 2000Behavioural Cognitive
Psychotherapy, 28121-130

• Design Randomized clinical trial
• Population 6 week day treatment program
• Nation United Kingdom
• N 51 alcohol dependent patients
• MI 1 session
• Comparison Attention placebo education
• Follow-up 1 and 6 weeks

14
Dench Bennett, 2000
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15
Handmaker et al., 1999Journal of Studies on
Alcohol, 60285-287

• Design Randomized clinical trial
• Population Prenatal care clinics
• Nation US (Albuquerque, NM)
• N 42 pregnant drinkers
• MI 1-hour individual session
• Comparison Risk-alert letter
• Follow-up 2 months

16
Handmaker et al., 1999
All differences ns due to small sample size
(N34) Largest effects of MI observed with
heaviest drinkers
17
Heather et al., 1996Drug Alcohol Review,
1529-38

• Design Block assignment
• Population General hospital inpatients
• Nation Australia
• N 174 adult heavy drinkers
• MI 1 30-40 minute session
• Comparison Skills training or TAU
• Follow-up 6 months

18
Heather et al., 1996
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19
Kuchipudi et al., 1990Journal of Consulting
Clinical Psychology, 65531-541

• Design Randomized clinical trial
• Population Acute gastrointestinal ward
• Nation US (Hines, IL)
• N 114 alcohol-related admissions
• MI 5 sessions with 5 practitioners
• Comparison TAU
• Follow-up 16 weeks

20
Kuchipudi et al., 1990
ns
21
Kuchipudi et al., 1990Was it Motivational
Interviewing?

• Each patient talked to by five different
  clinicians
• Complete staff turnover 3 times in 5 months
• Emphasized the need for and benefits of
  alcoholism therapy
• Two prolonged sessions on available treatment
  programs
• The persons health and drinking were reviewed
  from the viewpoint and with the authority of the
  director of the unit

22
Marlatt et al., 1998Journal of Consulting and
Clinical Psychology, 66604-615

• Design Randomized clinical trial
• Population College students
• Nation US (Seattle, WA)
• N 348 heavy drinkers
• MI 1 individual session
• Comparison Assessment only
• Follow-up 2 years

23
Marlatt et al., 1998
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24
Miller et al., 1988Behavioural Psychotherapy,
16251-268

• Design Randomized clinical trial
• Population Self-referred problem drinkers
• Nation US (Albuquerque, NM)
• N 42 adults
• MI Assessment 1 MET session
• Comparison Confrontational counseling
• Waiting list (6 weeks)
• Follow-up 18 months

25
Miller et al., 1988
Waiting list was unchanged until receiving MET
26
Miller et al., 1993Journal of Consulting
Clinical Psychology, 61455-461

• Design Randomized clinical trial
• Population Self-referred problem drinkers
• Nation US (Albuquerque, NM)
• N 42 problem drinkers
• MI Assessment 1 MET session
• Comparison Confrontational counseling
• Waiting list (6 weeks)
• Follow-up 12 months

27
Miller et al., 1993
plt.02 relative to waiting list control
28
Miller et al., 1993
plt.02 relative to waiting list control
29
Miller et al., 1993
30
Miller et al., 1993
31
Monti et al., 1999Journal of Consulting and
Clinical Psychology, 67989-994

• Design Randomized clinical trial
• Population Emergency room
• Nation US (Providence, RI)
• N 94 adolescents (18-19)
• MI 1 session (35-40 min)
• Comparison Standard care
• Follow-up 6 months

32
Monti et al., 1999
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33
Murphy et al., 2001Psychology of Addictive
Behaviors, 15373-379

• Design Randomized clinical trial
• Population College Students
• Nation US (Auburn, AL)
• N 99 drinkers
• MI 1 session (50 min)
• Comparison Alcohol education No
  intervention
• Follow-up 9 months

34
Murphy et al., 2001
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Differences significant for heavy drinkers only
35
Project MATCH, 1997Journal of Studies on
Alcohol, 587-29

• Design Randomized clinical trial
• Population Outpatient and aftercare
• Nation US (9 sites)
• N 1,726 adults
• MI 4 session MET
• Comparison 12 session CBT or TSF
• Follow-up 15 months post-treatment

36
Project MATCH, 1997
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37
Project MATCH, 1998Alcoholism Clinical and
Experimental Research, 221300-1311
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On percent days abstinent, MET TSF gt CBT
38
Sellman et al., 2001Journal of Studies on
Alcohol, 62389-396

• Design Randomized clinical trial
• Population Mild/moderate dependence
• Nation New Zealand
• N 125 alcohol outpatients
• MI MET 4 sessions
• Comparison Nondirective reflective listening
• Control No further counseling
• Follow-up 6 months post-treatment

39
Sellman et al., 2001
ns
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ns
40
Senft et al., 1997American Journal of Preventive
Medicine, 13464-470

• Design Randomized clinical trial
• Population Primary care
• Nation US (Portland, OR)
• N 516 adults
• MI 1 session, 15 min ( TAU)
• Comparison TAU
• Follow-up 12 months

41
Senft et al., 1997
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ns
42
Senft et al., 1997
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43
Drug Abuse

44
Baker et al., 2001Addiction, 961279-1287

• Design Randomized clinical trial
• Population Regular amphetamine users
• Nation Australia
• N 64 adults
• MI 2 individual sessions book
• 4 session MI skill training
• Comparison Self-help book
• Follow-up 6 months

45
Baker et al., 2001
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46
Lincourt et al., in pressAddictive Behavior

• Design Quasi-experiment (attendance)
• Population Mandated outpatient treatment
• Nation US (New York)
• N 167 adults (substance abuse)
• MI 6 session group TAU
• Comparison TAU
• Follow-up End of treatment

47
Lincourt et al., in press
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48
Longshore et al., 1999Substance Use Misuse,
341223-1241

• Design Quasi-experiment (attendance)
• Population Mandated outpatient treatment
• Nation US (Los Angeles, CA)
• N 222 African-American drug users
• MI 1 session
• Comparison Needs assessment
• Follow-up End of treatment

49
Longshore et al., 1999

• MI group rated (non-blind) significantly higher
• Treatment involvement (self-report plt.04)
• Motivation for change (self-report plt.05)
• Treatment participation (clinician rating
  plt.0001)
• Self-disclosure (clinician rating plt.0001)
• Preparation for change (clinician rating
  plt.0003)

50
Saunders et al., 1995Addiction, 90415-424

• Design Randomized clinical trial
• Population Methadone maintenance clinic
• Nation Australia (Perth, WA)
• N 122 adults
• MI 1 session (1 hour)
• Comparison Educational control
• Follow-up 6 months

51
Saunders et al., 1995
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52
Saunders et al., 1995MI vs. Educational Control
Group

• The MI group showed greater
• Immediate (1 week) advance to contemplation stage
  (plt.03)
• Positive view of abstinence at 3 months(plt.05)
• Reduction in drug-related problems at 6 months
  (plt.04)
• Time to relapse to heroin use (plt.05)

53
Schneider et al., 2000Journal of Behavioral
Health Services and Research, 2760-74

• Design Quasi-experimental
• Population Employee assistance programs
• Nation US (Boston, MA)
• N 89 clients with substance abuse
• MI 2 session MET
• Comparison 2 session confrontation/feedback
• Follow-up 3 and 9 months

54
Schneider et al., 2000
ns
55
Schneider et al., 2000
ns
56
Stephens et al., 2000Journal of Consulting
Clinical Psychology, 68898-908

• Design Randomized clinical trial
• Population Recruited by newspaper
• Nation US (Seattle, WA)
• N 291 marijuana users
• MI 2 sessions MET (90 min)
• Comparison 14 sessions group behavior therapy
  (2 hours)
• Waiting list (4 months)
• Follow-up 16 months

57
Stephens et al., 2000
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58
Stephens et al., 2000
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59
Stephens et al., 2000
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60
Stephens et al., 2000
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61
Stotts et al., 2001Journal of Consulting
Clinical Psychology, 69858-862

• Design Randomized clinical trial
• Population Outpatient cocaine detoxification
• Nation US (Houston, TX)
• N 105 cocaine dependent
• MI 2 sessions MET (1 hour)
• Comparison Detoxification only
• Follow-up 12 weeks post-detox

62
Stotts et al., 2001
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63
Stotts et al., 2001
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64
Dual Diagnosis

65
Daley et al, 1998American Journal of Psychiatry,
1551611-1613

• Design Consecutive assignment
• Population Discharge from treatment
• Nation US (Pittsburgh, PA)
• N 23 adults (cocainedepression)
• MI 5 individual 4 group sessions
• Comparison TAU
• Follow-up 1 year

66
Daley et al., 1998
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67
Daley Zuckoff, 1998Social Work, 43470-473

• Design Consecutive cohorts
• Population Dual diagnosis inpatients
• Nation US (Pittsburgh, PA)
• N Nearly 100
• MI 1 pre-discharge session
• Comparison TAU (no MI)
• Follow-up Proximal

68
Daley Zuckoff, 1998
69
Martino et al., 2000American Journal on
Addictions, 988-91

• Design Randomized clinical trial
• Population Partial hospital program
• Nation US (New Haven, CT)
• N 23 dual diagnosis patients
• MI 1 session (45-60 min)
• Comparison TAU
• Follow-up End of treatment (12 wk)

70
Martino et al., 2000
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71
Smoking

72
Colby et al., 1998Journal of Consulting
Clinical Psychology, 66574-578

• Design Randomized clinical trial
• Population Hospital emergency room
• Nation US (Providence, RI)
• N 40 adolescent smokers
• MI 1 MET session with 4 videos
• Comparison Brief advice
• Follow-up 3 months

73
Colby et al., 1998
ns ES .28
74
Stotts et al., 2002Addictive Behaviors,
27275-292

• Design Randomized clinical trial
• Population 21 prenatal care clinics
• Nation USA (Houston and Dallas, TX)
• N 269 resistant pregnant smokers
• MI 2 MI phone calls (20-30 min)
• Comparison TAU
• Follow-up to 6 months post-partum

75
Stotts et al., 2002
ns
76
Stotts et al., 2002
P lt .05
P lt .01
77
Cardiovascular Health

78
Scales, 1998Doctoral dissertation, University of
New Mexico

• Design Randomized clinical trial
• Population Cardiovascular rehab
• Nation US (Albuquerque, NM)
• N 61
• MI TAU MET (1 hr) skills based health ed
  (90 min)
• Comparison TAU traditional rehab
• Follow-up 12 weeks

79
Scales, 1998

• Significantly greater decrease in MI group,
  compared with TAU, in linear combination of three
  risk scores
• Perceived stress
• Physical activity
• Dietary fat
• All three contributed to the significant
  difference, but only stress was significant in a
  univariate test

80
Scales, 1998
p lt .005
81
Woollard et al., 1995Clinical Experimental
Pharmacology Physiology, 22466-468

• Design Randomized clinical trial
• Population General practice
• Nation Australia (Perth, WA)
• N 166 patients with hypertension
• MI High 6 nurse sessions (45 min)
• Low 1 session 5 phone (15 min)
• Comparison TAU
• Follow-up 18 weeks

82
Woollard et al., 1995
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83
Woollard et al., 1995
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84
Diabetes

85
Smith et al., 1997Diabetes Care, 2052-54

• Design Randomized clinical trial
• Population Recruited by newspaper
• Nation US (Birmingham, AL)
• N 22 older obese women
• MI 3 sessions MI TAU
• Comparison TAU (behavior therapy)
• Follow-up Post-treatment

86
Smith et al., 1997
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87
Smith et al., 1997
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ns
88
Eating Disorders

89
Treasure et al., 1999Behaviour Research
Therapy, 37405-418

• Design Randomized clinical trial
• Population Bulimia
• Nation UK (London, Maudsley)
• N 125 outpatients
• MI 4 session MET
• Comparison 4 session behavior therapy
• Follow-up 4 weeks

90
Treasure et al., 1999

• No significant differences between MI and
  behavior therapy at 4 weeks on
• Drop-out rate
• Binge eating
• Vomiting
• Laxative abuse

91
Gambling

92
Hodgins et al., 2001Journal of Consulting
Clinical Psychology, 6950-57

• Design Randomized clinical trial
• Population Problem gambling
• Nation Canada (Calgary, Alberta)
• N 102 adults
• MI 1 phone session (20-45 min)
• Comparison Mailed self-help book
• Waiting list control
• Follow-up 12 months

93
Hodgins et al., 2001
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94
Health Promotion

95
Resnicow et al, 2001American Journal of Public
Health, 91, 1686-1693.

• Design Randomized Clinical Trial
• Population Adults recruited through Black
  Churches
• Nation US (Atlanta, GA)
• N 861 adults
• MI 3 telephone contacts by trained dietitians
• Comparison 1) Health Education only, 2)
  Self-help materials plus one non-MI phone
  call
• Main Outcome Self-reported fruit vegetable
  intake (F V)
• Follow-up 1 year

96
Resnicow et al, 2001

MI Group different plt.01 than Groups 1 2
97
Thevos et al, 2000Health Promotion
International, 15207-214

• Design Comparison zones
• Population Households
• Nation Zambia, Africa
• N 332 households
• MI Health visitor consults
• Comparison Health education
• Follow-up 6 months

98
Thevos et al., 2000
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99
HIV Risk

100
Carey et al., 1997Journal of Consulting
Clinical Psychology, 65531-541

• Design Randomized clinical trial
• Population Women at risk for HIV
• Nation US (Syracuse, NY)
• N 102 women from community
• MI 4 group MET sessions
• Comparison Attention placebo group
• Follow-up 3 months

101
Carey et al., 1997MI vs. Educational Control
Group

• The MI group showed greater
• HIV knowledge (plt.0001)
• Perception of HIV risk (plt.001)
• Intention to protect (plt.003)
• Communication with partner (plt.05)
• And significantly lower rates of
• Unprotected intercourse (plt.01)
• Substance abuse before sex (plt.001)

102
Carey et al., 2000Health Psychology, 193-11

• Design Randomized clinical trial
• Population Women at risk for HIV
• Nation US (Syracuse, NY)
• N 102 women from community
• MI 4 group MET sessions
• Comparison Attention placebo group
• Follow-up 3 and 12 weeks

103
Carey et al., 2000MI vs. Educational Control
Group

• The MI group showed greater
• HIV knowledge (plt.003)
• Intention to protect (plt.001)
• And significantly lower rates of
• Unprotected intercourse (plt.001)
• among women with imperfect intentions

104
Mental Disorders

105
Kemp et al., 1998British Journal of Psychiatry,
172413-419

• Design Randomized clinical trial
• Population Acute psychiatric unit
• Nation UK (London, Maudsley Hospital)
• N 74 patients with psychosis
• MI 4-6 session Compliance Therapy
• Comparison 4-6 session supportive therapy
• Follow-up 18 months

106
Kemp et al., 1998Clinician (Non-blind) Ratings
of Improvement

• MI group rates significantly higher on
• Insight
• Global functioning
• Attitudes toward drug use
• Compliance

107
Kemp et al., 1998

• MI group showed lower rates of
• Treatment drop-out
• 28 vs. 43 (ns)
• Readmission
• Relative risk of controls 2.2

108
Swanson et al., 1999Journal of Nervous Mental
Disease, 187630-635

• Design Randomized clinical trial
• Population Psychiatric inpatients
• Nation US (New York)
• N 121 inpatients
• MI 2 sessions (15, 60 min) TAU
• Comparison TAU
• Follow-up Transition to aftercare

109
Swanson et al., 1999
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