Impact of group motivational interviewing on enhancing treatment engagement for homeless Veterans with nicotine dependence and other substance use disorders: A pilot investigation

Abstract

Background: Prior studies have shown that Group Motivational Interviewing (GMI) for dually diagnosed patients holds promise for increasing treatment engagement. Objectives: The current study evaluated the impact of a novel GMI protocol that included tobacco-specific components (referred to as ‘Tobacco GMI or T-GMI’) targeting enhanced engagement in smoking cessation treatment. Methods: Thirty-seven primary alcohol and nicotine-dependent cigarette smoking homeless Veterans with co-morbid psychiatric conditions were recruited to receive four GMI sessions over four consecutive days. The first 16 participants received standard GMI, aimed at enhancing engagement in substance abuse treatment and for reducing substance use, while the remaining 21 participants received a modified ‘tobacco-specific’ GMI protocol (T-GMI) that included additional content specific to cessation of tobacco use and enhancing smoking cessation treatment, in addition to the standard substance abuse content of GMI. Results: Participants in T-GMI were more likely to attend tobacco cessation programming (p = 0.05) as well as to attend combined tobacco cessation programming with prescribed nicotine replacement therapy (p = 0.03), compared to those in standard GMI. Differences between treatment conditions with respect to alcohol and illicit drug use outcomes were not significant, although overall substance use declined over time in both groups. Conclusions and Scientific Significance Results suggest that inclusion of tobacco-specific components in the context of GMI for substance abuse may enhance treatment engagement for tobacco cessation behaviors among dually diagnosed nicotine dependent homeless patients, a highly vulnerable population for which interventional resources targeting engagement in smoking cessation treatment has historically been lacking.

Predictors of smoking cessation group treatment engagement among veterans with serious mental illness

“…The finding that veterans with greater positive symptoms were more likely to engage showed the opposite. Similar to a study finding that greater length of time in treatment was predictive of SC among individuals with SMI (Santa Ana, LaRowe, Armeson, Lamb, & Hartwell, 2016), perhaps individuals with greater symptomatology had a longer history of treatment and more clinical support to encourage group attendance.…”

Prevalence of and Risk Factors Associated With Nonfatal Overdose Among Veterans Who Have Experienced Homelessness

“…This could be advanced through outreach, colocation of mental health and primary care services, or enhancing the capacity of primary care clinicians to deliver mental health care. Motivational interviewing to address substance use has been shown to be effective in homeless populations, [44][45][46][47] provided there are viable addiction treatment options available. 48,49 While federal grants have expanded care for opioid use disorder, block grants from the Substance Abuse and Mental Health Services Administration, such as those that would assist with alcohol use disorder, have received flat funding since 2014 and fallen relative to inflation.…”

Substance use disorders in military veterans: prevalence and treatment challenges

“…Client-centered motivational interviewing approaches focus on helping increase motivation to engage in treatment and reduce or abstain from substances. 41 Walker et al conducted a randomized controlled trial of motivational interviewing among 242 Army personnel. Participants received one session of motivational interviewing plus feedback or a psychoeducation control.…”