The In-Session and Long-Term Role of a Significant Other in Motivational Enhancement Therapy for Alcohol Use Disorders

Abstract

Objective To examine how significant other (SO) language in support of or against client abstinence from alcohol influences clients’ in-session speech and drinking behavior over the 9 months post-Motivational Enhancement Therapy (MET). Method Sequential analyses were used to examine the language of Project MATCH clients who invited an SO to participate in an MET session. Hierarchical regressions investigated the predictive relationship between SO language and clients’ post-treatment drinking behavior. A cohort analytic design compared the change language of these SO-involved participants against a matched group who chose client-only therapy. Results 'SO Support Change' language increased the odds of client Change Talk in the next utterance (p < .01). SO Support Change did not significantly predict reduced post-treatment drinking whereas 'SO Against Change' significantly predicted an increase in average drinks per drinking day (DDD) across months 7-9 post-MET (p = .04). In the matched comparison, the proportion of change-related client language was comparable across the SO-involved and client-only groups. Conclusions Motivational interviewing theory was supported by the sequential association between SO and client language as well as the predictive link between SO Against Change and client drinking intensity. Given the centrality of pro-sobriety language in the literature, it was surprising that SO Support Change did not predict alcohol use outcomes. Findings are discussed in relation to contemporary treatment process research and clinical practice.

Inside Alcohol Behavioral Couple Therapy (ABCT): In-session speech trajectories and drinking outcomes

“…The interplay between IP and SO CT and ST, and the changes in this interplay from the first session to midtreatment, is notable. In both sessions, it appears that SO use of CT has a powerful influence on the IP, as reflected in previous studies of select conjoint treatment sessions from Project MATCH (Apodaca et al, 2013;Bourke et al, 2016;Manuel et al, 2012). However, our study shows that the nature of that influence changes over the course of treatment.…”

“…It is reasonable to expect that partners could facilitate change talk by offering encouragement or solutions and, conversely, promote sustain talk by expressing skepticism or blame, disagreeing with the client, or focusing on negative consequences of drinking. Studies that have examined the impact of significant others (SOs) on client speech relied on therapy sessions in which a family member, partner, or friend functioned as an occasional adjunct to individual AUD treatment and a general source of feedback and support (Apodaca, Magill, Longabaugh, Jackson, & Monti, 2013;Bourke, Magill, & Apodaca, 2016;Manuel, Houck, & Moyers, 2012). Manuel and colleagues (2012) found several significant correlations among SO behaviors, client change talk, and drinking outcomes, but they were limited by a small sample size of a subset of sessions from Project MATCH.…”

“…ABCT is focused on improving the reciprocal association between AUD and romantic relationship dynamics (McCrady, 2012) rather than simply including a general SO (family member, friend, etc.) as an adjunct to individual therapy; thus, our study builds on the results of analyses of Project MATCH (Apodaca et al, 2013;Bourke et al, 2016;Manuel, et al, 2012) with a stronger dyadic focus. We focused on two different types of client and partner speech: change talk and sustain talk (Miller & Rollnick, 2013) as applied specifically to drinking, and positive and negative behaviors as indicators of overall relationship functioning (Doss et al, 2005).…”

A qualitative interview study of patient experiences of receiving motivational enhancement therapy in a Swedish addiction specialist treatment setting

“…In a meta-analysis [ 30 ], the involvement of a SO in treatment was shown to be associated with a reduction of both substance use and problems related to the substance use. In MI for AUD specifically, the involvement of a SO in treatment can lead to more change talk and better treatment outcomes [ 5 , 31 ]. Despite recommendations of SO involvement in treatment, other studies have also noted that few SOs participate in sessions.…”

College Women’s Perceptions of A Friend-Based Intervention to Prevent Alcohol-Involved Sexual Assault

“…For years, MI was conducted only in a traditional one-on-one (interventionist to client) format. However, increasingly research has shown that MI lends itself well to a dyadic format, with two people who know one another (e.g., peers, co-workers, friends, romantic partners), as it is within this kind of relationship that people can most successfully work together toward behavior change (Bourke et al, 2016; D’Amico et al, 2017; Miller & Rose, 2010; Monti et al, 2014). Importantly, a peer-based MI can use the responsibility and relationship of friends as a framework to foster collaborative efforts to increase readiness and decrease barriers to helping behavior.…”