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Meta-Analysis
. 2011 May 11;2011(5):CD008063.
doi: 10.1002/14651858.CD008063.pub2.

Motivational interviewing for substance abuse

Geir Smedslund  1 , Rigmor C Berg, Karianne T Hammerstrøm, Asbjørn Steiro, Kari A Leiknes, Helene M Dahl, Kjetil Karlsen
Affiliations
Meta-Analysis

Motivational interviewing for substance abuse

Geir Smedslund et al. Cochrane Database Syst Rev. .

Update in

  • Motivational interviewing for substance use reduction.
    Schwenker R, Dietrich CE, Hirpa S, Nothacker M, Smedslund G, Frese T, Unverzagt S. Schwenker R, et al. Cochrane Database Syst Rev. 2023 Dec 12;12(12):CD008063. doi: 10.1002/14651858.CD008063.pub3. Cochrane Database Syst Rev. 2023. PMID: 38084817 Free PMC article.

Abstract

Background: There are 76.3 million people with alcohol use disorders worldwide and 15.3 million with drug use disorders. Motivational interviewing (MI) is a client-centred, semi-directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The intervention is used widely, and therefore it is important to find out whether it helps, harms or is ineffective.

Objectives: To assess the effectiveness of motivational interviewing for substance abuse on drug use, retention in treatment, readiness to change, and number of repeat convictions.

Search strategy: We searched 18 electronic databases, 5 web sites, 4 mailing lists, and reference lists from included studies and reviews. Search dates were November 30, 2010 for Cochrane Library, Medline, Embase and PsychINFO.

Selection criteria: Randomized controlled trials with persons dependent or abusing substance. Interventions were MI or motivational enhancement therapy. The outcomes were extent of substance abuse, retention in treatment, motivation for change, repeat conviction.

Data collection and analysis: Three authors independently assessed studies for inclusion, and two authors extracted data. Results were categorized into (1) MI versus no-treatment control, (2) MI versus treatment as usual, (3) MI versus assessment and feedback, and (4) MI versus other active treatment. Within each category, we computed meta-analyses separately for post-intervention, short, medium and long follow-ups.

Main results: We included 59 studies with a total of 13,342 participants. Compared to no treatment control MI showed a significant effect on substance use which was strongest at post-intervention SMD 0.79, (95% CI 0.48 to 1.09) and weaker at short SMD 0.17 (95% CI 0.09 to 0.26], and medium follow-up SMD 0.15 (95% CI 0.04 to 0.25]). For long follow-up, the effect was not significant SMD 0.06 (95% CI-0.16 to 0.28). There were no significant differences between MI and treatment as usual for either follow-up post-intervention, short and medium follow up. MI did better than assessment and feedback for medium follow-up SMD 0.38 (95% CI 0.10 to 0.66). For short follow-up, there was no significant effect . For other active intervention there were no significant effects for either follow-up.There was not enough data to conclude about effects of MI on the secondary outcomes.

Authors' conclusions: MI can reduce the extent of substance abuse compared to no intervention. The evidence is mostly of low quality, so further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

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Conflict of interest statement

None.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Funnel plot of comparison: 1 MI versus no intervention, outcome: 1.1 Amount of substance use.
4
4
Funnel plot of comparison: 4 MI versus treatment as usual, outcome: 4.1 Amount of substance use.
5
5
Funnel plot of comparison: 2 MI versus assessment and feedback, outcome: 2.1 Amount of substance use.
6
6
Funnel plot of comparison: 3 MI versus other active intervention, outcome: 3.1 Amount of substance use.
1.1
1.1. Analysis
Comparison 1 MI versus no intervention, Outcome 1 Extent of substance use.
1.2
1.2. Analysis
Comparison 1 MI versus no intervention, Outcome 2 Readiness to change.
1.3
1.3. Analysis
Comparison 1 MI versus no intervention, Outcome 3 Retention in treatment.
2.1
2.1. Analysis
Comparison 2 MI versus treatment as usual, Outcome 1 Extent of substance use.
2.2
2.2. Analysis
Comparison 2 MI versus treatment as usual, Outcome 2 Retention in treatment.
3.1
3.1. Analysis
Comparison 3 MI versus assessment and feedback, Outcome 1 Extent of substance use.
4.1
4.1. Analysis
Comparison 4 MI versus other active intervention, Outcome 1 Extent of substance use.
4.2
4.2. Analysis
Comparison 4 MI versus other active intervention, Outcome 2 Readiness to change.
4.3
4.3. Analysis
Comparison 4 MI versus other active intervention, Outcome 3 Retention in treatment.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

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Ball 2007a {published data only}
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Ball 2007b {published data only}
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Barnett 2007 {published data only}
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Bazargan‐Hejazi 2005 {published data only}
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Bell 2007 {published data only}
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Bernstein 2009 {published data only}
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Bien 1993 {published data only}
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Borsari 2005 {published data only}
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Brown 2010 {published data only}
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Carey 2006 {published data only}
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Carroll 2006a {published data only}
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Carroll 2006b {published data only}
    1. Carroll KM, Easton CJ, Nich C, Hunkele KA, Neavins TM, Sinha R, et al. The use of contingency management and motivational/skills‐building therapy to treat young adults with marijuana dependence. Journal of Consulting and Clinical Psychology 2006;74(5):955‐66. - PMC - PubMed
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Carroll 2009 {published data only}
    1. Carroll KM, Martino S, Ball SA, Nich C, Frankforter T, Anez LM, Paris M, Suarez‐Morales L, Szapocznik J, Miller WR, Rosa C, Matthews J, Farentinos C. A multi site randomised effectiveness trial of motivational enhancement therapy for Spanish‐speaking substance users. Journal of Consulting and Clinical Psychology 2009;77(5):993‐9. - PMC - PubMed
Chanut 2007 {published data only}
    1. Chanut F, Dongier M, Legault L, Tremblay J, Nadeau L, Ouimet MC, et al. Pilot study of motivational interviewing among persons convicted of driving under the influence. Drogues, sante et societe 2007;6(2):83‐115.
Connors 2002 {published data only}
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Copeland 2001 {published data only}
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D'Amico 2008 {published data only}
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De Wildt 2002 {published data only}
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Emmen 2005 {published data only}
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Feldstein 2007 {published data only}
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Freyer‐Adam 2008 {published data only}
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Kadden 2007 {published data only}
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Kahler 2004 {published data only}
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Kavanagh 2004 {published data only}
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Kay‐Lambkin 2009 {published data only}
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Kelly 2000 {published data only}
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Maisto 2001 {published data only}
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MarijuanaTP 2004 {published data only}
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Marsden 2006 {published data only}
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Martin 2008 {published data only}
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Martino 2006 {published data only}
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Mastroleo 2010 {published data only}
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MATCH 1993 {published data only}
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McCambridge 2008 {published data only}
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Miller 2003 {published data only}
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Morgenstern 2009 {published data only}
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Naar‐King 2007 {published data only}
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Parsons 2009 {published data only}
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Peterson 2006 {published data only}
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Rohsenow 2004 {published data only}
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Saitz 2007 {published data only}
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Schaus 2009 {published data only}
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Sellman 2001 {published data only}
    1. Adamson SJ, Sellman JD. Five‐year outcomes of alcohol‐dependent persons treated with motivational enhancement. Journal of Studies on Alcohol and Drugs 2008;69(4):589‐93. - PubMed
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Stein 2002 {published data only}
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Stein 2009 {published data only}
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Stein 2010 {published data only}
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Stephens 2007 {published data only}
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Stotts 2001 {published data only}
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Stotts 2006 {published data only}
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Thush 2009 {published data only}
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UKATT 2005 {published data only}
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Walitzer 2008 {published data only}
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Walker 2006 {published data only}
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Walters 2009 {published data only}
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White 2006 {published data only}
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Winhusen 2008 {published data only}
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Winters 2007 {published data only}
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Wood 2007 {published data only}
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References to studies excluded from this review

Adamson 2001 {published data only}
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Baker 2002 {published data only}
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Baker 2006 {published data only}
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Barrowclough 2001 {published data only}
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Bernstein 2005 {published data only}
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Borsari 2003 {published data only}
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Brown 1993 {published data only}
    1. Brown JM, Miller WR. Impact of motivational interviewing on participation in residential alcoholism treatment. Psychology of Addictive Behaviors 1993;7:211‐8.
Brown 2007 {published data only}
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    1. Bux DA Jr, Morgenstern J, Labouvie E, Morgan T, Blanchard K. The role of therapeutic alliance in alcohol and drug abuse treatment outcome. 67th Annual Scientific Meeting of the College on Problems of Drug Dependence. 2005; Vol. 67:Cochrane ID: CN‐00591076.
Ceperich 2002 {published data only}
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    1. Chavez R, Miller WR, Tonigan JS. Negative consequences, substance use, and motivation for change: a predictive model of drug abusers motivation to change behavior. 65th Annual Scientific Meeting of the College on Problems of Drug Dependence. 2003; Vol. 65:Cochrane ID: CN‐00462116.
Clinton‐Sherrod 2008 {published data only}
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Corrigan 2005 {published data only}
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D'Angelo 2005 {published data only}
    1. D'Angelo MS. A comparative study of motivational interviewing and traditional treatment approach on movement along stages of change, treatment completion, compliance with aftercare plan, and length of abstinence. Dissertation Abstracts International: Section B: The Sciences and Engineering 2006; Vol. 66, issue 7B:3935.
Daeppen 2007 {published data only}
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    1. Davidson D, Gulliver SB, Longabaugh R, Wirtz PW, Swift R. Building better cognitive‐behavioral therapy: is broad‐spectrum treatment more effective than motivational‐enhancement therapy for alcohol‐dependent patients treated with naltrexone?. Journal of Studies on Alcohol 2007;68(2):238‐47. - PubMed
Davis 2003 {published data only}
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Demmel 2003 {published data only}
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Dench 2000 {published data only}
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Dent 2008 {published data only}
    1. Dent AW, Weiland TJ, Phillips GA, Lee NK. Opportunistic screening and clinician‐delivered brief intervention for high‐risk alcohol use among emergency department attendees: A randomised controlled trial. EMA ‐ Emergency Medicine Australasia 2008;20(2):121‐8. - PubMed
Dermen 2000 {published data only}
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Dunn 1997 {published data only}
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Easton 2000 {published data only}
    1. Easton C, Swan S, Sinha R. Motivation to change substance use among offenders of domestic violence. Journal of Substance Abuse Treatment 2000;19(1):1‐5. - PubMed
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Fergusin 1998 {published data only}
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Floyd 2007 {published data only}
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Gauthier‐Faille 2006 {published data only}
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Gentilello 2001 {published data only}
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Ginsburg 2001 {published data only}
    1. Ginsburg Joel Isser David. Using motivational interviewing to enhance treatment readiness in offenders with symptoms of alcohol dependence. Dissertation Abstracts International: Section B: The Sciences and Engineering 2001; Vol. 61, issue 8‐B:Feb‐B.
Godley 2010 {unpublished data only}
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Hayes 2007 {published data only}
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Hicks 1999 {published data only}
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Larimer 2001 {published data only}
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Longabaugh 2001 {published data only}
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Stotts 2004 {published data only}
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Swanson 1999 {published data only}
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Tapert 2003 {published data only}
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Tevyaw 2007 {published data only}
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Thevos 1998 {published data only}
    1. Thevos AK. Alcoholism with and without social phobia: A comparison of pre and post treatment differences in drinking and social support. Dissertation Abstracts International: Section B: The Sciences and Engineering 1998; Vol. 58, issue 11‐B:May‐B.
Thush 2007 {published data only}
    1. Thush C, Wiers RW, Theunissen N, Bosch J, Opdenacker J, Empelen P, et al. A randomised clinical trial of a targeted intervention to moderate alcohol use and alcohol‐related problems in at‐risk adolescents. Pharmacology, Biochemistry, and Behavior 2007;86(2):368‐76. - PubMed
Tirado 2005 {published data only}
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Vanderburg 2003 {published data only}
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Velasquez 2009 {published data only}
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Wain 2006 {published data only}
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Walters 2000 {published data only}
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Weinrieb 2005 {published data only}
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Wells 1998 {published data only}
    1. Wells EA, Calsyn DA, Clark LL, Jackson TR. Motivational enhancement to increase treatment readiness among stimulant users: A pilot evaluation. NIDA Research Monograph. 1998; Vol. Cochrane ID: CN‐00591223.
Wells 2004 {published data only}
    1. Wells EA, Beadnell B, Calsyn DA, Rosengren DB, Nahom D, Ricardo‐Bulis E, et al. Motivational enhancement to decrease drug use among cocaine users: Six‐month follow‐up results. Sixty Sixth Annual Scientific Meeting of the College on Problems of Drug Dependence. 2004; Vol. 66:Cochrane ID: CN‐00496626.
Wertz 1994 {published data only}
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Whitten 2006 {published data only}
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Wilbourne 2005 {published data only}
    1. Wilbourne PL. An empirical basis for the treatment of alcohol problems. Dissertation Abstracts International: Section B: The Sciences and Engineering 2005; Vol. 66, issue 5‐B:pp‐B.
Woodall 2007 {published data only}
    1. Woodall WG, Delaney HD, Kunitz SJ, Westerberg VS, Zhao H. A randomised trial of a DWI intervention program for first offenders: intervention outcomes and interactions with antisocial personality disorder among a primarily American‐Indian sample. Alcoholism, Clinical and Experimental Research 2007;31(6):974‐87. - PubMed
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Yonkers 2009 {published data only}
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Zahradnik 2009 {published data only}
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Zule 2009 {published data only}
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References to studies awaiting assessment

Barrowclough 2010 {published data only}
    1. Barrowclough C, Haddock G, Beardmore R, Conrod P, Craig T, Davies L, Dunn G, Lewis S, Moring J, Tarrier N, Wykes T. Evaluating integrated MI and CBT for people with psychosis and substance misuse: Recruitment, retention and sample characteristics of the MIDAS trial. Addictive Behaviors 2009;34(10):859‐866. - PubMed
    1. Barrowclough C, Haddock G, Tarrier N, Lewis SW, Moring J, O'Brien R, Schefield N, McGovern J. Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. American Journal of Psychiatry 2001;158(10):1706‐1713. - PubMed
    1. Barrowclough C, Haddock G, Wykes T, Beardmore R, Conrod P, Craig T, et al. Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial. BMJ 2010;341(1468‐5833 (Electronic), 0959‐535X (Linking)):c6325. - PMC - PubMed
Walters 2010 {published data only}
    1. Walters ST, Vader AM, Nguyen N, Harris TR, Eells J. Motivational Interviewing as a Supervision Strategy inProbation: A Randomized Effectiveness Trial. Journal of Offender Rehabilitation 2010;49(5):309‐323.

References to ongoing studies

Dubertret 2010 {unpublished data only}
    1. Effect of motivational therapy on schizophrenia with cannabis misuse.. Ongoing study November 2008..
Forsberg 2010 {unpublished data only}
    1. Effects of Motivational Interviewing in Prison.. Ongoing study April 2004..
Hansen 2010 {unpublished data only}
    1. Brief intervention for heavy drinkers.. Ongoing study January 2008..
Morken 2010 {unpublished data only}
    1. Motivational interviewing to acutely admitted psychiatric patients with comorbid substance use. Ongoing study October 2004..

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MeSH terms