Change talk subtypes as predictors of alcohol use following brief motivational intervention.

Abstract

Objective: To examine the relative importance of client change language subtypes as predictors of alcohol use following motivational interviewing (MI). Method: Participants were 164 heavy drinkers (57.3% female, Mage = 28.5 years, 13.4% Hispanic/Latinx, 82.9% White) recruited during an emergency department visit who received MI for alcohol and human immunodeficiency virus/sexual risk in a randomized-controlled trial. MI sessions were coded with the motivational interviewing skill code (MISC) and the generalized behavioral intervention analysis system (GBIAS). Variable importance analyses used targeted maximum likelihood estimation to rank order change language subtypes defined by these systems as predictors of alcohol use over 9 months of follow-up. Results: Among GBIAS change language subtypes, higher sustain talk (ST) around change planning was ranked the most important predictor of drinks per week (b = −5.57, 95% CI [−8.11, −3.02]) and heavy drinking days (b = −2.07, 95% CI [−3.17, −0.98]); this talk reflected (a) rejection of alcohol abstinence as a desired change goal, (b) rejection of specific change strategies, or (c) discussion of anticipated challenges in changing drinking. Among MISC change language subtypes, higher ST around taking steps—reflecting recent escalations in drinking described by a small minority of participants—was ranked the most important predictor of drinks per week (b = 22.71, 95% CI [20.29, 25.13]) and heavy drinking days (b = −2.45, 95% CI [1.68, 3.21]). Conclusions: Results challenge the assumption that all ST during MI is a negative prognostic indicator and highlight the importance of the context in which change language emerges.