Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics

Abstract

The effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use was evaluated in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites.

Figure 1

CONSORT diagram of eligibility, enrollment, randomization, treatment, and follow-up rates. CAU = counseling as usual; MET = motivational enhancement therapy.

Figure 2

Therapy Condition × Weeks × Phase interaction (see arrow) for days per week of primary substance use across therapy (Weeks 0–4) and follow-up (Weeks 5–16) phases. CAU = counseling as usual; MET = motivational enhancement therapy.