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					Motivational Interviewing:

 Findings from Clinical Trials




                   Updated: 10 December 2004
Alcohol
   Allsop et al., 1997
         Addiction, 92:61-74


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
Allsop et al., 1997




 p<.01   p<.04   p<.03
        Baer et al., 1992
Journal of Consulting and Clinical Psychology, 60:924-979

Design             Randomized clinical trial
Population         College Students
Nation             US (Seattle, WA))
N                  134 young adults
MI                 1 session (60 min)
Comparison         Two groups:
                   (1) six weekly cognitive behavioral
                   groups (90 minute ea)
                   (2) a six-unit self-help cognitive
                   behavioral manual
Follow-up          post-treatment (6 weeks),
                   short-term maintenance (3 & 6 months),
                   long-term maintenance (12 & 24 months)
          Baer et al., 1992

Comparative analyses exclude the self-help manual group
because of poor program completion and high drop-out in this
group

Overall reduction on the three dependent variables were
statistically significant at the three follow-up points.

Although CB group subjects reported slightly lower numbers on
all three drinking measures over time, differences between MI
and CB subjects were not statistically significant.

Significant interactive effects were noted for age, with increases
in drinking during the year subjects reached legal drinking
status.
Baer et al., 1992
Baer et al., 1992
Baer et al., 1992
Baer et al., 1992
       Bien et al., 1993
Behavioural & Cognitive Psychotherapy, 21:347-356


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
Bien et al., 1993




          p<.05
Bien et al., 1993
   Borsari & Carey, 2000
Journal of Consulting & Clinical Psychology, 68:728-733


  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
Borsari & Carey, 2000




   p<.006   p<.001   p<.05
 Brown & Miller, 1993
 Psychology of Addictive Behaviors, 7:211-218


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
Brown & Miller, 1993




           p<.001
Brown & Miller, 1993
Dench & Bennett, 2000
Behavioural & Cognitive Psychotherapy, 28:121-130


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
Dench & Bennett, 2000




  p<.001   p<.03   p<.01
Handmaker et al., 1999
  Journal of Studies on Alcohol, 60:285-287


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
Handmaker et al., 1999




All differences ns due to small sample size (N=34)
Largest effects of MI observed with heaviest drinkers
 Heather et al., 1996
     Drug & Alcohol Review, 15:29-38


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
Heather et al., 1996




   p<.05     p<.05
   Kuchipudi et al., 1990
Journal of Consulting & Clinical Psychology, 65:531-541


 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
Kuchipudi et al., 1990




         ns
 Kuchipudi et al., 1990
  Was 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 person’s health and drinking were
reviewed from the viewpoint and with the
authority of the director of the unit”
       Marlatt et al., 1998
Journal of Consulting and Clinical Psychology, 66:604-615


  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
Marlatt et al., 1998




p<.05   p<.001   p<.05   p<.05
    Miller et al., 1988
    Behavioural Psychotherapy, 16:251-268


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
   Miller et al., 1988




Waiting list was unchanged until receiving MET
        Miller et al., 1993
Journal of Consulting & Clinical Psychology, 61:455-461


  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
Miller et al., 1993




p<.02 relative to waiting list control
Miller et al., 1993




p<.02 relative to waiting list control
Miller et al., 1993
Miller et al., 1993
         Monti et al., 1999
Journal of Consulting and Clinical Psychology, 67:989-994


  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
Monti et al., 1999




 p<.05   p<.05   p<.01
    Murphy et al., 2001
  Psychology of Addictive Behaviors, 15:373-379


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
Murphy et al., 2001




                                p<.05
Differences significant for heavy drinkers only
Project MATCH, 1997
   Journal of Studies on Alcohol, 58:7-29


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
Project MATCH, 1997




 p<.04   p<.003
Project MATCH, 1998
Alcoholism: Clinical and Experimental Research,
                  22:1300-1311




                      p<.007

      On percent days abstinent, MET = TSF > CBT
  Sellman et al., 2001
   Journal of Studies on Alcohol, 62:389-396


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
Sellman et al., 2001




  ns    ns    p<.04
       Senft et al., 1997
American Journal of Preventive Medicine, 13:464-470


 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
Senft et al., 1997




       p<.04   ns
Senft et al., 1997




       p< .02   p<.04
         Smith et al., 2003
             Addiction, 98:43-52

Design       Randomized clinical trial
Population   Oral and maxillofacial surgery
             clinic out-patients
Nation       UK (Cardiff, Wales)
N            151 young males with alcohol-
             related facial injuries
MI           1 manual-guided session (+ TAU)
Comparison   TAU
Follow-up    3 months and one year
Alcohol (units)
                  Smith et al., 2003
Alcohol (units)
                  Smith et al., 2003
               Smith et al., 2003




                           RCP                                   AUDIT

RCP = Royal College of Physicians, Psychiatrists, and General Practitioners Recommended Health Limit
AUDIT = Alcohol Use Disorders Identification Test
Cardiovascular
Health
         Scales, 1998
Doctoral 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
        Scales, 1998
Significantly greater decrease in MI
group, compared with TAU, in linear
combination of three risk scores
l Perceived stress
l Physical activity
l Dietary fat

All three contributed to the significant
difference, but only stress was
significant in a univariate test
Scales, 1998




        p < .005
    Woollard et al., 1995
 Clinical & Experimental Pharmacology & Physiology,
                     22:466-468

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
Woollard et al., 1995




    p<.05     p<.05
Woollard et al., 1995




    p<.05     p<.05
Diabetes
   Smith et al., 1997
        Diabetes Care, 20:52-54


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
Smith et al., 1997




p<.01   p<.003   p<.05   p<.07
Smith et al., 1997




   p<.05     ns
Drug Abuse
          Aubrey, 1998
 Doctoral dissertation, University of New Mexico


Design          Randomized clinical trial
Population      Adolescent drug abuse treatment
Nation          US (Albuquerque, NM)
N               77 adolescents entering treatment
MI              1 individual session + TAU
Comparison      TAU
Follow-up       3 months
Aubrey, 1998
Aubrey, 1998
Aubrey, 1998
Aubrey, 1998
Aubrey, 1998
    Baker et al., 2001
             Addiction, 96:1279-1287


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
Baker et al., 2001




   p<.01     p<.05
    Baker et al., 2002
           Addiction, 97:1329-1337
    Acta Psychiatrica Scandinavica, 105:xx

Design         Randomized clinical trial
Population     Inpatient psychiatric hospital
Nation         Australia
N              160 adults with concomitant
               disorders
MI             30-45 minute individual session
Comparison     Self-help book and brief advice
Follow-up      12 months
Baker et al., 2002




           p<.04
Baker et al., 2002




       p<.02   ns
Lincourt et al., in press
             Addictive 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
Lincourt et al., in press




     p<.001     p<.005
  Longshore et al., 1999
     Substance Use & Misuse, 34:1223-1241


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
    Longshore et al., 1999
MI group rated (non-blind) significantly higher:
 Treatment involvement (self-report; p<.04)
 Motivation for change (self-report; p<.05)
 Treatment participation (clinician rating;
 p<.0001)
 Self-disclosure (clinician rating; p<.0001)
 Preparation for change (clinician rating;
 p<.0003)
Marijuana Treatment Project
  Research Group (2004)
Journal of Consulting and Clinical Psychology, 72:455-466


 Design           Randomized clinical trial
 Population       Inpatient or outpatient treatment
 Nation           US (3 sites)
 N                450 adult marijuana smokers
 MI               2 session MET
 Comparison       9-session MET + behavior therapy
 Control          4-month waiting list control
 Follow-up        15 months
Marijuana Treatment Project
  Research Group (2004)




     p<.001   ns   p<.001
Marijuana Treatment Project
  Research Group (2004)

      Marijuana Joints per Week




             p<.001
Miller, Yahne & Tonigan (2003)
Journal of Consulting and Clinical Psychology, 71:754-763


 Design          Randomized clinical trial
 Population      Inpatient or outpatient treatment
 Nation          US (Albuquerque, NM)
 N               208 drug dependent adults
 MI              1 session + TAU
 Comparison      TAU only
 Follow-up       12 months
    Miller et al. (2003)
Percent Days Abstinent from Alcohol/Drugs




    No significant additive effect of MI
 Saunders et al., 1995
             Addiction, 90:415-424


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
Saunders et al., 1995




    p<.03     p<.01
   Saunders et al., 1995
        MI vs. Educational Control Group


The MI group showed greater:
 Immediate (1 week) advance to
 contemplation stage (p<.03)
 Positive view of abstinence at 3
 months(p<.05)
 Reduction in drug-related problems at 6
 months (p<.04)
 Time to relapse to heroin use (p<.05)
  Schneider et al., 2000
Journal of Behavioral Health Services and Research,
                      27:60-74

 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
Schneider et al., 2000




               ns
Schneider et al., 2000




               ns
      Stein et al., 2002
             Addiction, 97:691-700

Design         Randomized clinical trial
Population     Needle exchange program
               recipients
Nation         US (Providence, RI)
N              187 active injection drug users
MI             2 sessions (60 min each)
                     - one month apart
Comparison     Assessment only
Follow-up      1 and 6 months
         Stein et al., 2002

MI subjects (based on observed percentage differences and
odds ratios) were more likely than controls to be abstinent at 6
months.

MI subjects reported lower mean heroin use frequency than
controls at 6 months.

MI subjects’ 37.5% reduction in drinking days is larger than that
of most brief alcohol intervention trials.

MI subjects with above median (>9) baseline drinking day
frequency were over two times more likely than controls to
report reductions of 7 or more days (p<.05) at 6 months.
Stein et al., 2002




  1 Month         6 Months                1 Month             6 Months
                              P<.01
        P<.05



                      P<.01




                                         P<.01


                                                 P<.01


                                                              P<.01


                                                                      P<.01
n. s.




            n = 187                                  n = 92

        Full Sample                   >9 Baseline Drinking Days
    Stephens et al., 2000
Journal of Consulting & Clinical Psychology, 68:898-908

 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
Stephens et al., 2000




     p<.001
Stephens et al., 2000




    p<.02      p<.01
Stephens et al., 2000




  p<.001   p<.001   p<.001
Stephens et al., 2000




 p<.04   p<.001
        Stotts et al., 2001
Journal of Consulting & Clinical Psychology, 69:858-862

 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
Stotts et al., 2001




   p<.03      p<.05
Stotts et al., 2001




   p<.05      p<.03
Dual Diagnosis
Barrowclough et al, 2001
 American Journal of Psychiatry, 158:1706-1713


Design          Randomized trial
Population      Schizophrenia or schizoaffective
                + substance use disorder
Nation          US
N               36 adults (marijuana)
MI              5 sessions + 24 CBT sessions
Comparison      24 CBT sessions
Follow-up       1 year
Barrowclough et al., 1998
    Daley et al, 1998
American Journal of Psychiatry, 155:1611-1613


Design         Consecutive assignment
Population     Discharge from treatment
Nation         US (Pittsburgh, PA)
N              23 adults (cocaine+depression)
MI             5 individual + 4 group sessions
Comparison     TAU
Follow-up      1 year
Daley et al., 1998




p<.001   p<.03   p<.01
Daley & Zuckoff, 1998
        Social Work, 43:470-473


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
Daley & Zuckoff, 1998
  Martino et al., 2000
   American Journal on Addictions, 9:88-91


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)
Martino et al., 2000




 p<.05   p<.05   p<.05
Eating Disorders
 Treasure et al., 1999
  Behaviour Research & Therapy, 37:405-418


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
   Treasure et al., 1999

No significant differences between MI and
 behavior therapy at 4 weeks on:
 Drop-out rate
 Binge eating
 Vomiting
 Laxative abuse
Gambling
    Hodgins et al., 2001
Journal of Consulting & Clinical Psychology, 69:50-57


 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
  Hodgins et al., 2001




p<.03   p<.04   p<.03   p<.05
Health
Promotion
   Resnicow et al, 2001
      American 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
Resnicow et al, 2001


                                               *




* MI Group different p<.01 than Groups 1 & 2
   Thevos et al, 2000
  Health Promotion International, 15:207-214


Design         Comparison zones
Population     Households
Nation         Zambia, Africa
N              332 households
MI             Health visitor consults
Comparison     Health education
Follow-up      6 months
Thevos et al., 2000




                 p<.001
HIV Risk
        Carey et al., 1997
Journal of Consulting & Clinical Psychology, 65:531-541


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


The MI group showed greater:
  HIV knowledge (p<.0001)
  Perception of HIV risk (p<.001)
  Intention to protect (p<.003)
  Communication with partner (p<.05)
And significantly lower rates of:
  Unprotected intercourse (p<.01)
  Substance abuse before sex (p<.001)
    Carey et al., 2000
       Health Psychology, 19:3-11


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


The MI group showed greater:
 HIV knowledge (p<.003)
 Intention to protect (p<.001)

And significantly lower rates of:
 Unprotected intercourse (p<.001)
  among women with imperfect intentions
Mental Health
     Kemp et al., 1998
    British Journal of Psychiatry, 172:413-419


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


MI group rates significantly higher on
 Insight
 Global functioning
 Attitudes toward drug use
 Compliance
        Kemp et al., 1998
MI group showed lower rates of:
 Treatment drop-out
     28% vs. 43% (ns)
 Readmission
     Relative risk of controls = 2.2
  Swanson et al., 1999
Journal of Nervous & Mental Disease, 187:630-635


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
Swanson et al., 1999




         p<.01
Smoking
        Colby et al., 1998
Journal of Consulting & Clinical Psychology, 66:574-578


 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
Colby et al., 1998




           ns; ES = .28
     Stotts et al., 2002
        Addictive Behaviors, 27:275-292


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
Stotts et al., 2002




  ns
Stotts et al., 2002




  P < .05   P < .01

				
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