Exploration of treatment matching of problem drinker characteristics to motivational interviewing and non-directive client-centered psychotherapy

Abstract

Motivational Interviewing (MI) is a known effective intervention for alcohol use disorder (AUD). MI's mechanisms of action remain inconsistently substantiated, and research in this area has been reliant on identifying relationships through strength of association rather than experimental manipulation of active ingredients. In two previous studies, a pilot and a larger replication study, we disaggregated MI into its hypothesized active ingredients by creating three conditions: MI, Spirit Only MI (SOMI, in which evocation of change talk was proscribed), and a non-therapy condition (NTC). Results from both studies yielded equivalent findings across all three conditions. In the current analyses, data from both studies were combined to test five participant characteristics as moderators of MI's component parts: 1) severity of baseline drinking, 2) severe AUD (met 6 or more criteria), 3) baseline self-efficacy to moderate drinking, 4) mean daily confidence to resist heavy drinking in the week prior to treatment initiation, and 5) depression. There were no significant findings related to baseline drinking, severe AUD, or baseline self-efficacy. Confidence yielded a significant interaction effect. When participants had high baseline confidence, drinking for those in MI increased compared to those in SOMI. Depression also yielded a significant moderating effect such that in the context of higher depressive symptoms, receipt of either therapy reduced drinking relative to NTC. Results are discussed in light of existing literature on MOBC with MI and the potential role exploring ambivalence may play for participants with particular characteristics.

Is fidelity to motivational interviewing associated with alcohol outcomes in treatment-seeking 60+ year-old citizens?

“…Speculations about this result could either be because the therapist provided MI even though the client was committed to change and therefore not timing the delivery of high adherent MI behavior correct. This is in line with previous findings of lower effectiveness of MI when the client is already committed to change (Kahler et al, 2004;Kuerbis et al, 2018;Project MATCH Research Group, 1997b). Another explanation could be, that the therapist provided MI because the client was still ambivalent after four sessions of Motivational Enhancement Therapy (MET) and this unresolved ambivalence could be associated with higher drinking level at 26 weeks follow-up.…”

“…Given their low ambivalence about changing, it is possible that MI sessions in the Danish drinkers should have focused more attention on planning, rather than addressing the ambivalence that is more common in real-world clients who are considering a change in their drinking. In fact, there are studies indicating a disordinal effect of MI for individuals who are not ambivalent, but rather committed to the change they have already initiated (Kahler et al, 2004;Kuerbis, Houser, Levak, Shao, and Morgenstern, 2018;Project MATCH Reserach Group, 1997b;Rohsenow et al, 2004).…”

Impact of Motivational Interviewing by Social Workers on Service Users: A Systematic Review

“…In addition to the findings by Kuerbis et. al (2018), Bager et al (2010) reported that MI increased the post discharge alcohol abstinence at two months (Bager et al, 2010), moreover, the statistical analysis reported 75% abstinence in the intervention group and 25% in the control group.…”

“…The research team were however confident that this was a true pattern of alcohol consumption because blood samples taken from the first 14 patients correlated with reported drinking behaviour. However, Kuerbis et al (2018) hypothesized that MI would be a stronger predictor of reduced alcohol consumption compared with spirit only MI and that both forms of MI would result in a reduction in drinking behaviour compared with a nontherapy group. This study combined the data from two previously conducted RCT's conducted by the authors in 2012 and 2017 respectively.…”

“…From three papers focused on alcohol misuse, binge drinking in young women (Palm et al, 2016) and patients with alcohol related health problems (Bager et al, 2010;Kuerbis et al, 2018), only Kuerbis et al (2018) have reported findings around MI affecting depression and/or self-efficacy and related self-confidence. Kuerbis et al (2018) has shown that the level of depressive symptoms has decreased with therapy and reduced drinking. He also reported that depression had a mediating effect on confidence.…”