How does brief motivational intervention change heavy drinking and harm among underage young adult drinkers?

Abstract

Objective This study tested mediating processes hypothesized to explain the therapeutic benefit of an efficacious motivational interview (MI). The constructs of interest were motivation to change, cognitive dissonance about current drinking, self-efficacy for change, perceived young adult drinking norms, future drinking intentions, and the use of protective behavioral strategies. Method A randomized controlled trial compared the efficacy of a brief MI to a time- and attention-matched control of meditation and relaxation training for alcohol use. Participants were underage, past-month heavy drinkers recruited from community (i.e., non four-year college or university) settings (N=167; ages 17–20; 58% female; 61% White). Statistical analyses assessed mechanisms of MI effects on follow up (6-week; 3-month) percent heavy drinking days (HDD) and alcohol consequences (AC) with a series of temporally-lagged mediation models. Results MI efficacy for reducing 6-week HDD was mediated by baseline to post-session changes in the following three processes: increasing motivation and self-efficacy, and decreasing the amount these young adults intended to drink in the future. For 6-week AC, MI efficacy was mediated through one process: decreased perceived drinking norms. At 3-month follow up, increased cognitive dissonance mediated HDD, but not AC. Further, increased use of certain protective behavioral strategies (i.e., avoidance of and seeking alternatives to drinking contexts) from baseline to 6-weeks mediated both 3-month HDD and AC. Conclusions Findings suggest that within-session cognitive changes are key mechanisms of MI’s effect on short-term alcohol outcomes among community young adults while protective behaviors may be more operative at subsequent follow up.

Active Ingredients and Mechanisms of Change in Motivational Interviewing for Medication Adherence. A Mixed Methods Study of Patient-Therapist Interaction in Patients With Schizophrenia

“…In contrast to Magill et al (21) our model differentiates between clinician factors and client factors, consistent the description by Nock (15). The influence of client factors in psychological interventions is recognizable in MI, since the mere act of "eliciting change talk" does not stimulate a mechanism of change.…”

“…Most of the present knowledge about active ingredients and mechanisms of change in MI originates from alcohol dependency research [e.g., (17,19,21,22)]. Magill et al (21) used mediation analysis to test a model with active ingredients, mechanisms of change and patient outcomes in a brief motivational interviewing intervention in heavy drinking underage young adults.…”

“…Most of the present knowledge about active ingredients and mechanisms of change in MI originates from alcohol dependency research [e.g., (17,19,21,22)]. Magill et al (21) used mediation analysis to test a model with active ingredients, mechanisms of change and patient outcomes in a brief motivational interviewing intervention in heavy drinking underage young adults. Despite the differences between the studies in target populations, target behavior, and study design, two out of three of the MI-specific mechanisms of change of the model by Magill et al (21), were also found in our study ("experiencing discrepancy", which we consider an active ingredient, and "increasing motivation for change"), but we did not find "increasing self-efficacy" in our sample.…”

“…The clinician and client factors of interest are those that form the active ingredients of MI. In literature on MI-theory (12,14,(16)(17)(18) and in research (19)(20)(21)(22)(23) there are several hypothesized active ingredients of MI in general, such as the clinician factor "discussing ambivalence" (17,18), and the client factor "experiencing discrepancy" (19,23). There are also some hypothesized mechanisms of change of MI, e.g.…”

Brief alcohol intervention for risky drinking in young people aged 14–15 years in secondary schools: the SIPS JR-HIGH RCT

“…[61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] The majority (n = 13) were studies conducted in the USA, 61,[64][65][66][67][69][70][71][72][73][74][75][76] with one in Germany, 68 one in Mexico 63 and one in Western Australia. 62 The setting was mainly emergency departments (n = 8), 62,66,68,[70][71][72][73]75 with three in universities, 61,67,74 one with homeless adolescents, 76 one with young people referred from not-for-profit agencies, 65 one based in the community 64 and two based in schools. 63,69 The ASBIs used largely followed a manual and/or used MI techn...…”