A multisite randomized effectiveness trial of motivational enhancement therapy for Spanish-speaking substance users.

Abstract

Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of motivational enhancement therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week therapy phase, there were no significant Treatment Condition ϫ Time interactions nor Site ϫ Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude.

Characteristics of a Treatment-Seeking Population in Outpatient Addiction Treatment Centers in Mexico

“…This paper addresses this problem analyzing the baseline data: demographic characteristics, substance use characteristics, related problems, clinical features, and addic-tion severity of participants from a multi-site randomized clinical trial that tested an adaptation of CTN 0021: Motivational Enhancement Treatment for Spanish Speakers (METS;Carroll et al, 2009) for the Mexican population (Intervención de Incremento Motivacional or IIM). This was the first trial implemented in the Mexican Clinical Trials Network on Addiction and Mental Health (REC-INPRFM, acronym for the Spanish name; Marín-Navarrete, 2012;Horigian et al, unpublished results).…”

Informal discussions in substance abuse treatment sessions with Spanish-speaking clients

“…Each program had a minimum of four Spanish-speaking counselors on staff who delivered substance abuse treatment in Spanish to Hispanic clients. Details on counselor inclusion/exclusion criteria, procedures to ensure counselor Spanish language fluency and comprehension, and counselor characteristics and demographic information are presented in prior reports (Carroll et al, 2009; Suarez-Morales et al, 2007). Counselors were ineligible to participate in the protocol if they did not pass a Spanish fluency test or had received formal MET training 3 months prior to protocol initiation, a timeframe in which MET skills are likely to diminish without ongoing performance feedback and coaching (Miller, Yahne, Moyers, Martinez, & Pirritano, 2004).…”

“…Recently, the effectiveness of MET was tested in two separate protocols within the National Institute on Drug Abuse Clinical Trials Network (CTN; Hanson, Leshner, & Tai, 2002), one delivered to primary English speakers (Ball et al, 2007) and one delivered solely to monolingual Spanish speakers (Carroll et al, 2009). Identical in most ways (other than language and relevant cultural adaptations), both protocols examined the effectiveness of a three-session MET intervention to counseling-as-usual (CAU) in five U.S.-based community substance abuse treatment programs.…”

“…While both the MET and CAU interventions resulted in reductions in substance use during the 4-week treatment phase, MET resulted in sustained reductions during the subsequent 12 weeks of the study, whereas CAU was associated with increases in substance use over this follow-up period. Relative to CAU, MET led to a greater reduction in frequency of alcohol use in the subgroup of participants whose primary substance was alcohol (see Ball et al, 2007 and Carroll et al, 2009). …”

“…To address these issues, we examined the extent to which community program bilingual counselors talked informally with their Hispanic clients and how certain cultural factors affected informal discussions within the CTN Spanish MET protocol (Carroll et al, 2009). First, we examined the frequency and content of informal discussions.…”