Motivational Interviewing (MI) - Detailed Report

The overarching goals of MI are:

• to enhance internal motivation to change.
• to reinforce this motivation.
• to develop a plan to achieve change.

MI emphasizes two essential dimensions related to an individual's ambivalence to change:

• the importance of the change.
• the confidence that the change can be accomplished.

MI includes a number of open-ended questions encouraging the client to talk about circumstances surrounding his or her referral for evaluation as opposed to the standard substance abuse evaluation that includes administering a number of structured interviews asking closed-ended questions. Examples of the types of open-ended questions that might be used are as follows:

• What do you think are the reasons your caseworker referred you here today?
• What worries you about your substance use?
• How has your use of substances presented problems for you in the past?
• What kinds of things would need to happen to make you consider changing your substance use?
• What are the things that would prevent you from changing your substance use?
• What are your concerns about entering substance abuse treatment at this time?

Motivational Interviewing (MI) is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. For more information on the rating of a "1 - Well-Supported by Research Evidence," please see the Scientific Rating Scale.

Baer, J. S., Marlett, G. A., Kivlahan, D. R., Fromme, K., Larimer, M. E., & Williams, E. (1992). An experimental test of three methods of alcohol risk reduction with young adults. Journal of Consulting and Clinical Psychology, 60(6), 974-979.

Type of Study: Randomized controlled trial.
Number of participants: 134
Population:

Age Range: 21.2 years on average
Race/Ethnicity: 91% White, 4.5% Asian, less than 1% Black, Latin American, or Native American.
Status (e.g., foster care, CW): Student volunteers recruited through the media.

Location/Institution: Not given
Summary: (To include comparison groups, outcomes, measures, notable limitations) Volunteers were required to report at least one alcohol-related problem on the Michigan Alcoholism Screening Test (MAST). Participants were randomly assigned to receive meetings in a classroom format (six 90-minute sessions), six self-help reading units, or Motivational Interviewing (MI). After the interventions, drinking was monitored with the Daily Drinking Questionnaire at 3, 6, 12, and 24 months. Compliance varied across treatment conditions, with the fewest participants completing the self-help condition, and the most completing the MI condition. Due to lack of compliance, the self-help condition was not included in the final analysis. Participants in both of the remaining conditions showed reductions in drinking rates, which were maintained at two years, with the exception of a temporary increase when 20-year-old participants reached the legal drinking age. This study is limited by lack of an assessment-only control group.
Length of post-intervention follow-up: 2 years.

Baer, J. S., Kivlahan, D. R., Blume, A. W., McKnight, P., & Marlatt, G. A. (2001). Brief intervention for heavy drinking college students: 4-year follow-up and natural history. American Journal of Public Health, 91(8), 1310-1316.

Type of Study: Randomized controlled trial
Number of participants: 461
Population:

Age Range: Younger than 19 years at baseline
Race/Ethnicity: 84% White and 16% Other
Status (e.g., foster care, CW): Students recruited through a mailed questionnaire.

Location/Institution: University of Washington
Summary: (To include comparison groups, outcomes, measures, notable limitations) Students completing the questionnaire were included if they reported having 5 to 6 drinks on at least one occasion in the preceding month and reported at least 3 negative consequences from drinking on the Rutgers Alcohol Problems Inventory. An additional randomly selected set of respondents served as a comparison group. Participants in the intervention condition received individualized feedback sessions (Motivational Interviewing), and written information comparing their drinking patterns and consequences with their peers. Groups did not differ in drinking frequency, but the intervention group showed significant reductions in drinking quantity and negative consequences from drinking over the follow-up period. The authors note that the study is limited by the use of self-report measures of drinking.
Length of post-intervention follow-up: 4 years.

Carroll, K. M., Libby, B., Sheehan, J., & Hyland, N. (2001). Motivational interviewing to enhance treatment initiation in substance abusers: An effectiveness study. The American Journal on Addictions, 10, 335-339.

Type of Study: Randomized controlled trial.
Number of participants: 60
Population:

Age Range: 34 years on average
Race/Ethnicity: Standard: 86.2% Caucasian, 10.3% Hispanic, and 3.4% African American. MI: 80.6% Caucasian, 9.7% Hispanic, 6.5% African American, and 3.2% Other.
Status (e.g., foster care, CW): Individuals referred by child welfare caseworkers for a substance abuse evaluation.

Location/Institution: Connecticut
Summary: (To include comparison groups, outcomes, measures, notable limitations) Participants were randomly assigned to receive either standard treatment or enhanced (MI) treatment. Results showed that significantly more participants in the MI group went on to attend treatment sessions than in the standard group (59.3% versus 29.2%). However, this advantage did not persist beyond treatment initiation.
Length of post-intervention follow-up: None.

Mullins, S. M., Suarez, M., Ondersma, S. J., & Page, M. C. (2004). The impact of motivational interviewing on substance abuse treatment retention: A randomized control trial of women involved with child welfare. Journal of Substance Abuse Treatment, 27, 51-58.

Type of Study: Randomized controlled trial
Number of participants: 71
Population:

Age Range: 27.1 on average
Race/Ethnicity: 47.9% Caucasian, 32.4% African American, 12.7% Native American, and 7.0% Hispanic
Status (e.g., foster care, CW): Women enrolled in a 12-month treatment program for pregnant women using drugs following Child Protective Services referral.

Location/Institution: Not given
Summary: (To include comparison groups, outcomes, measures, notable limitations) Participants were randomly assigned to the Motivational Interviewing (MI) condition or to an education control condition. All participants also attended weekly psycho-educational and substance abuse groups and received random weekly urine testing. No differences were found between the MI and control conditions. The authors suggest that MI may have limited effectiveness with a coerced population.
Length of post-intervention follow-up: None.

Freyer-Adam, J., Coder, B., Baumeister, S. E., Bischof, G., Riedel, J, Paatsch, K. et al. (2008). Brief alcohol intervention for general hospital inpatients: A randomized controlled trial. Drug and Alcohol Dependence, 93(3), 233-243.

Type of Study: Randomized controlled trial
Number of participants: 595
Population:

Age Range: 18 to 64 years
Race/Ethnicity: Not given
Status (e.g., foster care, CW): Hospital inpatients with alcohol problems based on a positive screening result.

Location/Institution: Germany
Summary: (To include comparison groups, outcomes, measures, notable limitations) Participants were randomly assigned to a control group, or to one of two Motivational Interviewing (MI)groups: liaison service group or a physician-based group. Analysis showed that all groups reduced drinking and that there were no significant group differences. The MI treatment groups reported an increase in motivation to change drinking behavior.
Length of post-intervention follow-up: 12 months after baseline

The following research article was not included when rating the program on the CEBC Scientific Rating Scale:

Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91-111.

This article contains a meta-analysis of over 70 controlled trials of motivational interviewing. The review shows particularly strong evidence for the efficacy of MI with alcohol/drug abuse.

Chanut, F., Brown, T., & Dongier, M. (2005). Motivational interviewing and clinical psychiatry. Canadian Journal of Psychiatry, 50(9), 548-554.

Hohman, M., & Salsbury, L. (2009). Motivational interviewing and child welfare: What have we learned? ASPAC Advisor, 21(2), 2-6.

Moyers, T., Martin, T., Manuel, J., Hendrickson, S. M. L., & Miller, W. R. (2005). Assessing competence in the use of motivational interviewing. Journal of Substance Abuse Treatment, 28, 19-26.

Rollnick, S., & Miller, W. R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325-334.