Training High School Counselors on the Use of Motivational Interviewing to Screen for Substance Abuse

Abstract

Interdisciplinary faculty implemented a project to enhance school personnel's knowledge and skills in screening and motivational interviewing for substance abuse in two Boston high schools.     

Boosting a Teen Substance Use Prevention Program with Motivational Interviewing

A brief motivational interviewing (MI) intervention may be a viable adjunct to school-based substance abuse prevention programs. This article describes the development and implementation of a brief MI intervention with 573 adolescents (mean age 16.8; 40.3% female, 68% Latino) enrolled in eight continuation high schools in Southern California. Study participants were assigned to the MI condition in a randomized controlled trial of Project Toward No Drug Abuse. Data are provided on dosage, topics discussed, and quality of MI determined with the Motivational Interviewing Skill Code (MISC). Results suggest that the protocol was feasible and implemented with adequate fidelity. The study's limitations are noted.     

Addressing Adolescent Substance Use: Teaching Screening,Brief Intervention,and Referral to Treatment (SBIRT) and Motivational Interviewing (MI) to Residents

Background: The American Academy of Pediatrics Committee on Substance Use recommends screening, brief intervention, and referral to treatment (SBIRT) at every adolescent preventive and all appropriate urgent visits. We designed an SBIRT curriculum as part of the adolescent block of a pediatric residency that combined online modules with an in-person workshop, faculty feedback on resident interactions with patients, and resident self-reflection on their motivational interviewing (MI) skills. Methods: To evaluate the curriculum, we measured resident satisfaction and self-reported confidence in using SBIRT and MI with teens using a retrospective pre/post questionnaire. We used qualitative analysis to evaluate the written comments from faculty observations of patient-trainee interactions and comments from resident self-reflection(s) on patient interactions. Results: Thirty-two residents completed the curriculum. Residents reported high satisfaction with the training. Comparing retrospective pre/post scores on the survey of resident self-reported confidence, measures increased significantly in all domains, including for both alcohol and other drug use. Regarding self-reported MI, skillfulness also increased significantly. Analysis of specific faculty feedback to residents revealed subthemes such as normalizing confidentiality and focusing more on the patient's perspectives on substance use. Resident reflections on their own abilities with SBIRT/MI focused on using the ruler tool and on adapting the MI style of shared decision-making. Conclusions: A curriculum that combines online training, small-group practice, clinical observations, and self-reflection is valued by residents and can increase resident self-reported confidence in using SBIRT and MI in adolescent encounters. Future studies should examine to what extent confidence predicts performance using standardized measures of MI skillfulness in patient encounters.     

Motivational Interviewing Delivered by Existing Prison Staff: A Randomized Controlled Study of Effectiveness on Substance Use After Release

A sample of 296 drug-using inmates in 14 Swedish prisons was randomized during 2004–2006 into three intervention groups; Motivational Interviewing delivered by counselors with workshop-only training, or by counselors with workshop training followed by peer group supervision, and controls. Drug and alcohol use was measured by the Addiction Severity Index (ASI) at intake and at 10 months after release. Complete data from 114 clients were analyzed by a stepwise regression analysis. All three groups reduced alcohol and drug use. Limitations in the study are discussed and future research is suggested. The study is financed by grants from the Research Committee of the National Prison and Probation Administration.     

Stages of Change Model has Limited Value in Explaining the Change in Use of Cannabis among Adolescent Participants in an Efficacious Motivational Interviewing Intervention

Previously, a Dutch randomized controlled trial evaluating an intervention aimed at changing adolescents’ cannabis use, called Moti-4, has shown its efficacy. A secondary analysis of the Moti-4 data investigated the process of change specified by the Stage of Change (SOC) model in cannabis use during the trial. Seventy-one Moti-4 participants and 60 controls were recruited for the study with a pre-test, post-test (T1), and six-month follow-up (T2). All participants showed signs of problematic cannabis use. No contribution of the Moti-4 intervention to a change in SOC between T1 and T2 was found. Although motivation for treatment and motivation for change can be conceived as independent predictors of treatment outcome, the SOC a person is in does not mediate the effect of the intervention on change in cannabis use. However, a reduction in cannabis use was associated with a positive change in “action willingness,” in line with the SOC model. In contrast to model expectations, a higher score on “contemplation” is associated with a higher cannabis consumption. Results highlight both the limitations and usefulness of the SOC model. Future interventions may focus more on the stage of “action willingness,” as well as on perceived social norms.     

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 affirmations, 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.     

Predictors and Moderators of Aftercare Appointment-Keeping Following Brief Motivational Interviewing Among Patients With Psychiatric Disorders or Dual Diagnosis

Objective: Non-adherence to psychiatric and substance abuse treatment recommendations, especially with regard to aftercare outpatient appointment-keeping following hospitalizations, exacts a high cost on mental health spending and prevents patients from receiving therapeutic doses of treatment. Our primary objective was to evaluate the relationship between potential predictors and moderators of aftercare appointment-keeping among a group of adult patients immediately following hospitalization for severe psychiatric disorders or dual diagnosis. Methods: Candidate predictors and moderator variables included demographics, psychiatric status, psychiatric symptom severity, and inpatient group adherence, while aftercare appointment-keeping was defined as attendance at the first aftercare appointment. Participants were 121 adult inpatients with a psychiatric disorder or dual diagnosis originally enrolled in an earlier randomized controlled trial comparing standard treatment with standard treatment plus brief motivational interviewing for increasing adherence. Results: Results indicated that, across treatment conditions, those who were female, did not have dual diagnosis, were older (older than 33 years), and were less educated (<high school) attended their first aftercare appointment at significantly higher rates than their counterparts. A treatment-by-gender interaction was noted, where only men were significantly more likely to keep their first aftercare appointment if they received standard treatment plus brief motivational interviewing, compared to standard treatment alone (OR = 9.58, p < .001). Conclusions: Findings suggest that gender, dual diagnosis status, age and education may be an important predictors of aftercare treatment adherence and that gender may be a moderator of motivational interviewing among individuals with psychiatric disorders or dual diagnosis.     

Six-Month Outcomes of a Randomized,Motivational Tele-intervention for Change in the Codependent Behavior of Family Members of Drug Users

Families of substance abusers may develop maladaptive strategies, such as codependency, to address drug-related problems. It is important for families to receive specialist treatment in order to contribute to the recovery process. The Tele-intervention Model and Monitoring of Families of Drug Users (TMMFDU), based on motivational interviewing and stages of change, aims to encourage the family to change the codependents' behaviors. A randomized clinical trial was carried out to verify the change in codependent behavior after intervention with 6 months of follow-up. Three hundred and twenty-five families with high or low codependency scores were randomized into the intervention group (n = 163) or the usual treatment (UT) (n = 162). After 6 months of follow-up, the family members of the TMMFDU group were twice as likely to modify their codependency behavior when compared to the UT group (OR 2.08 CI 95% 1.18–3.65). TMMFDU proved to be effective in changing codependent behaviors among compliant family members of drug users.     

The Effects of Interventions to Prevent Substance Use Among Adolescents: A Systematic Review

The aim of this systematic review is to describe and evaluate the effects of interventions used for preventing or reducing substance use among adolescents under 18 years of age. Studies (N = 27) available in CINAHL and PubMed from 2007 to 2010 were included. Results showed that family-based interventions and combined interventions have significant outcomes for substance use among adolescents. Similarly, school-based interventions were effective in providing knowledge about substance use, which eventually reduced the substance use. Further research should be conducted in different cultures as well as on computer-based interventions targeting both genders.     

Effects of a Single Lyric Analysis Intervention on Withdrawal and Craving With Inpatients on a Detoxification Unit: A Cluster-Randomized Effectiveness Study

Background: For patients hospitalized on inpatient detoxification units, reducing negative symptoms such as withdrawal and craving is a key treatment area. Although lyric analysis is a commonly utilized music therapy intervention for clients in substance abuse rehabilitation, there is a lack of randomized controlled music therapy studies systematically investigating how lyric analysis interventions can affect patients on a detoxification unit. Objective: The purpose of this cluster-randomized effectiveness study was to measure the effects of single-session group lyric analysis interventions on withdrawal and craving with patients on a detoxification unit. A secondary purpose of this study was to determine if relationships existed between treatment effects and participants’ familiarity with the song. Methods: Participants (N = 144) were cluster-randomized to experimental (posttest only) or wait-list control (pretest only) conditions to provide treatment to all participants in an inclusive single-session design. Results: Although participants in the experimental condition had lower withdrawal and craving means than participants in the control condition, these differences were not significant. Familiarity of the song in the lyric analysis was not related to withdrawal or craving. Conclusion: Group-based lyric analysis interventions may be effective for temporarily relieving withdrawal and craving in patients on a detoxification unit. Familiarity of the song did not affect results. Implications for clinical practice, suggestions for future research, and limitations are provided.     

Social Support,Family Empowerment,Substance Use,and Perceived Parenting Competency during Pregnancy for Women with Substance Use Disorders

Background: Parenting self-efficacy has been linked to positive parent and child outcomes however, little research exists on factors that influence parenting self-efficacy among pregnant women with substance use disorders. Objectives: This study explored substance use severity, social support, and family empowerment as predictors of parenting self-efficacy among pregnant women (N = 71) entering SUD treatment. Methods: The study used a quantitative cross-sectional design. Results: Statistically significant positive correlations emerged between social support and parenting self-efficacy as well as family empowerment and parenting self-efficacy. Family empowerment and social support were also correlated. A backward elimination regression analysis revealed family empowerment to be the strongest predictor of parenting self-efficacy. No relationships were found among substance use severity and the study variables. Conclusions: When promoting parenting self-efficacy, both social support and family empowerment are important domains to consider for treatment planning and resource development among pregnant women with substance use disorders.     

Baylor Pediatric SBIRT Medical Residency Training Program: Model Description and Evaluation

ABSTRACT. Background: The Baylor College of Medicine SBIRT Medical Residency Training Program is a multilevel project that trains residents and faculty in evidenced-based screening, brief intervention, and referral to treatment methods for alcohol and substance use problems. Methods: This paper describes the training program created for pediatric residents and provides an evaluation of the program. Ninety-five first-year pediatric residents participated in the training program. They were assessed on satisfaction with the program, self-rated skills, observed competency, and implementation into clinical practice. Results: The program was successfully incorporated into the residency curricula in two pediatric residencies. Evaluations indicate a high degree of satisfaction with the program, self-reported improvement in SBIRT skills, observed proficiency in SBIRT skills, and utilization of SBIRT skills in clinical practice. Conclusions: SBIRT skills training can be incorporated into pediatric residency training, and residents are able to learn and implement the skills in clinical practice.     

Book Review: Adolescents, Alcohol and Substance Abuse: Reaching Teens Through Brief Interventions. Edited by Peter M. Monti, Suzanne M. Colby, and Tracy A. O'Leary, New York, The Guilford Press, 2001, 350 pp., ISBN 1-57230-658-0 (Hardback)

The book reviewed in this article discusses the use of brief interventions in the treatment of adolescent substance abuse. Topics covered include the developmental context within which adolescent substance use occurs, the use of the harm reduction approach to reduce substance use, current assessment instruments, and the role of cognitive and genetic factors in the etiology of substance abuse. Examples of specific brief interventions with adolescents are described and possible avenues for future transdisciplinary research are explored. This expansive sourcebook will be of value to clinicians and academicians alike.     

Screening and Brief Interventions for Illicit Drug Use and Alcohol Use in Methadone Maintained Opiate-Dependent Patients: Results of a Pilot Cluster Randomized Controlled Trial Feasibility Study

Background and Objectives: The present study evaluated the effectiveness of a single clinician delivered brief intervention (BI) to reduce problem alcohol use and illicit substance use in an opiate-dependent methadone maintained cohort of patients attending for treatment. Methods: Four addiction treatment centers were randomly assigned to either treatment as usual (TAU; control group) or BI (intervention group). Clinicians screened patients using the alcohol, smoking, and substance involvement screening test (ASSIST) screening tool at baseline and again at three-month follow up. Fidelity checks were performed to ensure that training was delivered effectively and uniformly across all study sites. Feasibility of administering a BI within daily practice was assessed through intervention fidelity checks, patient satisfaction questionnaires and process evaluation. Results: A total of 465 patients were screened (66% of the overall eligible population) with a total of 433 (93%) ASSIST positive cases. Randomization was effective, with no differences in the control versus the intervention arms at baseline for key demographic or clinical indicators including substance us. There was a statistically significant difference between global risk score for the intervention (x = 39.36, sd = 25.91) group and the control group (x = 45.27, SD = 27.52) at 3-month follow-up (t(341) = ?2.07, p < .05). Conclusions: This trial provides the first evidence that a single clinician delivered BI can result in a reduction in substance use within a methadone maintained opiate-dependent cohort, and this effect is sustained at three month follow up.     

Web-Based Intervention to Reduce Substance Abuse and Depression: A Three Arm Randomized Trial in Mexico

Background: Web-based cognitive-behavioral interventions to reduce substance use can be a useful low-cost treatment for a large number of people, and an attractive option in countries where a greater availability of treatment is needed. Objective: To evaluate the feasibility and initial effectiveness of a web-based cognitive-behavioral intervention for the reduction of substance use and depression compared with treatment as usual, with and without a printed self-help manual. Method: Individuals seeking outpatient treatment for substance use were randomly assigned to one of the following: (1) the web-based Help Program for Drug Abuse and Depression (n = 23); (2) an in-person session with an addiction therapist and use of the Alcohol, Smoking, and Substance Involvement Screening Test Self-Help Strategies guide, followed by treatment as usual (n = 25), or (3) treatment ordinarily offered in the participating treatment centers (n = 26). The study took place in 2013–2014 (trial registration: ISRCTN25429892), and participants completed baseline, posttreatment, and 1-month follow-up evaluation interviews. Results: Treatment retention and data availability were comparable in all three conditions. A reduction was observed from baseline to follow-up in average days of use [F(1,28) = 29.70, p < 0.001], severity of use [F(2,28) = 143.66, p < 0.001], and depressive symptomatology [F = (4)16.40, p < 0.001], independent of the type of treatment provided. Conclusions: The findings suggest that the web-based intervention to reduce substance abuse is feasible, although it is not more effective than other intervention modalities; its effectiveness must be evaluated in a larger sample. Attrition was a main limitation; future studies must improve retention and assess cost-effectiveness.     

Parental Substance Use,Family Support and Outcome Following Treatment for Adolescent Psychoactive Substance Use Disorders

ABSTRACT

Families are found to play an important role in adolescent substance abuse. This study examined family variables that may influence adolescent substance use during the 6 months following inpatient treatment: (1) parental substance use; (2) family aftercare attendance; and, (3) adolescent ratings of family helpfulness. It was hypothesized that the effects of parental substance use on adolescent use would be mediated by family aftercare attendance and family helpfulness ratings. Adolescent inpatients (N = 103; M age = 16) were assessed during treatment and 6 months later. Results revealed no relationship between either parental substance use and family aftercare attendance or reports of family helpfulness. More frequent family aftercare attendance and higher ratings of helpfulness were associated with less adolescent use during follow-up. Findings highlight the importance of family behaviors on adolescent substance abuse treatment outcome.     

The Impact of Motivation to Change on Substance Use Among Adolescents in Treatment

ABSTRACT

Clinicians emphasize the importance of motivation to change for effecting recovery from substance abuse disorders. However, little is known about motivation to change substance-abusing behavior among adolescents or its impact on treatment outcomes. The present research examines motivation to change among youth admitted to publicly funded substance abuse services and its influence on treatment outcomes. Data are based on interviews with 129 youth between 12 and 18 years of age. Multilevel (HLM) analyses are used to assess the relationship between substance use and motivation to change at the time of treatment admission and roughly one year later. Results suggest that more serious substance users are motivated better to change at the outset of treatment and experience more rapid declines in substance use after treatment begins.     

A Smoking Intervention for Substance Abusing Adolescents: Outcomes,Predictors of Cessation Attempts,and Post-Treatment Substance Use

SUMMARY

Tobacco use is prevalent among youth with alcohol and other drug problems, yet this issue has been afforded limited research or clinical attention. The present study reports on findings for a cigarette smoking intervention for youth treated for substance abuse. Thirty-five adolescents, ages 13 to 18 (40% female), completed a cigarette-focused intervention and were followed-up at three months post-treatment. Six of the adolescents were abstinent from smoking at follow-up, while 17 had attempted cessation during the post-treatment period. Of baseline predictors examined, duration of smoking and intentions to quit predicted cessation attempts. Smoking cessation efforts had no negative impact on substance use outcomes. Findings were interpreted to provide support for the feasibility and utility of tobacco intervention in the context of adolescent substance abuse treatment.     

A Randomized Controlled Trial for Veterans with PTSD and Substance Use Disorder: Creating Change versus Seeking Safety

Background: Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur in military veterans and other populations. Objective: To conduct a randomized controlled trial to compare a new past-focused treatment (Creating Change; CC), to a well-established, evidence-based present-focused treatment for PTSD/SUD (Seeking Safety; SS), on symptoms of both disorders. CC guides patients to process the past through exploration of PTSD/SUD life themes and memories whereas SS focuses on coping skills in the present. Methods: Fifty-two male and female veterans with current PTSD/SUD were randomized (n = 26 per treatment) and assessed at baseline, end-of-treatment and 3-month follow-up. They received 17 individual one-hour sessions. Results: Intent-to-treat analyses indicated that both conditions improved over time, with no difference between conditions, on PTSD, alcohol use, and drug use (our primary outcomes) as well as mental health symptoms, quality of life, self-efficacy, and SUD cognitions. Effect sizes were medium except for alcohol use, which was large. Change over time reflected improvement from baseline to end-of-treatment, with gains sustained at follow-up, although alcohol use showed continued improvement from end-of-treatment to follow-up. Both treatments evidenced a strong safety profile; and attendance, alliance, and treatment satisfaction were also very strong. Conclusions/importance: CC has promise as a PTSD/SUD therapy with strong public health relevance and the potential to fill important gaps in the field. We used minimal exclusionary criteria to obtain a real-world sample, which was severe—predominantly substance-dependent with chronic PTSD and additional psychiatric diagnoses. Future research is warranted, especially on nonveteran samples and treatment mechanisms of action.     

Do Physical Abuse,Depression, and Parental Substance Use Influence Patterns of Substance Use Among Child Welfare Involved Youth? Substance Use Misuse

To date studies have not explored patterns of substance use exclusively among youth in the child welfare system. Consequently, little is known about polysubstance use among child welfare-involved youth. This study aimed to explore whether physical abuse, parental substance use, depression, and demographic characteristics predict distinct patterns of substance use among child welfare-involved youth using latent class analysis (LCA). The sample included 822 11–17 year olds who participated in the National Survey of Child and Adolescent Well-being (NSCAW II) study between March 2008 and September 2009. We found the following three classes: (1) polysubstance use, (2) alcohol and marijuana use, and (3) low use. Older youth and youth who experienced physical abuse were at greater risk of being in the polysubstance use class, while living with a biological parent reduced the likelihood of polysubstance use class membership. Youth in the alcohol and marijuana use class were more likely to be older and depressed. Results from this study illuminate important targets for interventions.