Motivational interviewing for substance use reduction
- PMID: 38084817
- PMCID: PMC10714668
- DOI: 10.1002/14651858.CD008063.pub3
Motivational interviewing for substance use reduction
Abstract
Background: Substance use is a global issue, with around 30 to 35 million individuals estimated to have a substance-use disorder. Motivational interviewing (MI) is a client-centred method that aims to strengthen a person's motivation and commitment to a specific goal by exploring their reasons for change and resolving ambivalence, in an atmosphere of acceptance and compassion. This review updates the 2011 version by Smedslund and colleagues.
Objectives: To assess the effectiveness of motivational interviewing for substance use on the extent of substance use, readiness to change, and retention in treatment.
Search methods: We searched 18 electronic databases, six websites, four mailing lists, and the reference lists of included studies and reviews. The last search dates were in February 2021 and November 2022.
Selection criteria: We included randomised controlled trials with individuals using drugs, alcohol, or both. Interventions were MI or motivational enhancement therapy (MET), delivered individually and face to face. Eligible control interventions were no intervention, treatment as usual, assessment and feedback, or other active intervention.
Data collection and analysis: We used standard methodological procedures expected by Cochrane, and assessed the certainty of evidence with GRADE. We conducted meta-analyses for the three outcomes (extent of substance use, readiness to change, retention in treatment) at four time points (post-intervention, short-, medium-, and long-term follow-up).
Main results: We included 93 studies with 22,776 participants. MI was delivered in one to nine sessions. Session durations varied, from as little as 10 minutes to as long as 148 minutes per session, across included studies. Study settings included inpatient and outpatient clinics, universities, army recruitment centres, veterans' health centres, and prisons. We judged 69 studies to be at high risk of bias in at least one domain and 24 studies to be at low or unclear risk. Comparing MI to no intervention revealed a small to moderate effect of MI in substance use post-intervention (standardised mean difference (SMD) 0.48, 95% confidence interval (CI) 0.07 to 0.89; I2 = 75%; 6 studies, 471 participants; low-certainty evidence). The effect was weaker at short-term follow-up (SMD 0.20, 95% CI 0.12 to 0.28; 19 studies, 3351 participants; very low-certainty evidence). This comparison revealed a difference in favour of MI at medium-term follow-up (SMD 0.12, 95% CI 0.05 to 0.20; 16 studies, 3137 participants; low-certainty evidence) and no difference at long-term follow-up (SMD 0.12, 95% CI -0.00 to 0.25; 9 studies, 1525 participants; very low-certainty evidence). There was no difference in readiness to change (SMD 0.05, 95% CI -0.11 to 0.22; 5 studies, 1495 participants; very low-certainty evidence). Retention in treatment was slightly higher with MI (SMD 0.26, 95% CI -0.00 to 0.52; 2 studies, 427 participants; very low-certainty evidence). Comparing MI to treatment as usual revealed a very small negative effect in substance use post-intervention (SMD -0.14, 95% CI -0.27 to -0.02; 5 studies, 976 participants; very low-certainty evidence). There was no difference at short-term follow-up (SMD 0.07, 95% CI -0.03 to 0.17; 14 studies, 3066 participants), a very small benefit of MI at medium-term follow-up (SMD 0.12, 95% CI 0.02 to 0.22; 9 studies, 1624 participants), and no difference at long-term follow-up (SMD 0.06, 95% CI -0.05 to 0.17; 8 studies, 1449 participants), all with low-certainty evidence. There was no difference in readiness to change (SMD 0.06, 95% CI -0.27 to 0.39; 2 studies, 150 participants) and retention in treatment (SMD -0.09, 95% CI -0.34 to 0.16; 5 studies, 1295 participants), both with very low-certainty evidence. Comparing MI to assessment and feedback revealed no difference in substance use at short-term follow-up (SMD 0.09, 95% CI -0.05 to 0.23; 7 studies, 854 participants; low-certainty evidence). A small benefit for MI was shown at medium-term (SMD 0.24, 95% CI 0.08 to 0.40; 6 studies, 688 participants) and long-term follow-up (SMD 0.24, 95% CI 0.07 to 0.41; 3 studies, 448 participants), both with moderate-certainty evidence. None of the studies in this comparison measured substance use at the post-intervention time point, readiness to change, and retention in treatment. Comparing MI to another active intervention revealed no difference in substance use at any follow-up time point, all with low-certainty evidence: post-intervention (SMD 0.07, 95% CI -0.15 to 0.29; 3 studies, 338 participants); short-term (SMD 0.05, 95% CI -0.03 to 0.13; 18 studies, 2795 participants); medium-term (SMD 0.08, 95% CI -0.01 to 0.17; 15 studies, 2352 participants); and long-term follow-up (SMD 0.03, 95% CI -0.07 to 0.13; 10 studies, 1908 participants). There was no difference in readiness to change (SMD 0.15, 95% CI -0.00 to 0.30; 5 studies, 988 participants; low-certainty evidence) and retention in treatment (SMD -0.04, 95% CI -0.23 to 0.14; 12 studies, 1945 participants; moderate-certainty evidence). We downgraded the certainty of evidence due to inconsistency, study limitations, publication bias, and imprecision.
Authors' conclusions: Motivational interviewing may reduce substance use compared with no intervention up to a short follow-up period. MI probably reduces substance use slightly compared with assessment and feedback over medium- and long-term periods. MI may make little to no difference to substance use compared to treatment as usual and another active intervention. It is unclear if MI has an effect on readiness to change and retention in treatment. The studies included in this review were heterogeneous in many respects, including the characteristics of participants, substance(s) used, and interventions. Given the widespread use of MI and the many studies examining MI, it is very important that counsellors adhere to and report quality conditions so that only studies in which the intervention implemented was actually MI are included in evidence syntheses and systematic reviews. Overall, we have moderate to no confidence in the evidence, which forces us to be careful about our conclusions. Consequently, future studies are likely to change the findings and conclusions of this review.
Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Conflict of interest statement
Rosemarie Schwenker: no conflict of interest known.
Carla Emilia Dietrich: no conflict of interest known.
Selamawit Hirpa: no conflict of interest known.
Monika Nothacker: no conflict of interest known.
Geir Smedslund: no conflict of interest known.
Thomas Frese: no conflict of interest known.
Susanne Unverzagt: no conflict of interest known.
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Update of
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Motivational interviewing for substance abuse.Cochrane Database Syst Rev. 2011 May 11;2011(5):CD008063. doi: 10.1002/14651858.CD008063.pub2. Cochrane Database Syst Rev. 2011. Update in: Cochrane Database Syst Rev. 2023 Dec 12;12:CD008063. doi: 10.1002/14651858.CD008063.pub3. PMID: 21563163 Free PMC article. Updated.
References
References to studies included in this review
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Morgenstern 2017 {published and unpublished data}
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Murphy 2018 {published data only}
Naar‐King 2006 {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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Schaus 2009 {published data only}
Sellman 2001 {published data only}
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Slesnick 2013 {published and unpublished data}
Slesnick 2015 {published and unpublished data}
Stein 2002 {published data only}
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UKATT 2005 {published data only}
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Walitzer 2009 {published data only}
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Acuff 2019 {published data only}
Adamson 2001 {published data only}
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Baer 2001 {published data only}
Bagoien 2013 {published data only}
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Baker 2002 {published data only}
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Baker 2002b {published data only}
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Baker 2005 {published data only}
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Baker 2006 {published data only}
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Bechdolf 2012 {published data only}
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Blow 2010 {published data only}
Bohnert 2016 {published data only}
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Clinton‐Sherrod 2008 {published data only}
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Clinton‐Sherrod 2011 {published data only}
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Davidson 2007 {published data only}
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Davis 2003 {published data only}
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Dhital 2015 {published data only}
Diaz‐Martinez 2011 {published data only}
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Dunn 2004 {published data only}
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- Dunn C, Droesch RM, Johnston BD, Rivara FP. Motivational interviewing with injured adolescents in the emergency department: in-session predictors of change. Behavioural and Cognitive Psychotherapy 2004;32(1):113-6.
Easton 2000 {published data only}
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Eisenberg 2013 {published data only}
Field 2014 {published data only}
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Gamage 2021 {published data only}
Garner 2017 {published data only}
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Grow 2014 {published data only}
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Hurlocker 2021 {published data only}
Ingersoll 2013 {published data only}
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Vanderburg 2003 {published data only}
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Vederhus 2014 {published data only}
Villegas 2016 {published data only}
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- Villegas DL. Predictors of change in college freshmen and sophomore cognitions of alcohol expectancies. Dissertation Abstracts International: Section B: The Sciences and Engineering 2016;77(4):Not specified.
Wain 2006 {published data only}
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Walters 2010 {published data only}
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- Walters ST, Vader AM, Nguyen N, Harris TR, Eells J. Motivational interviewing as a supervision strategy in probation: a randomized effectiveness trial. Journal of Offender Rehabilitation 2010;49(5):309-23.
Wandera 2017 {published data only}
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- Wandera B, Tumwesigye NM, Nankabirwa JI, Mafigiri DK, Parkes-Ratanshi RM, Kapiga S, et al. Efficacy of a single, brief alcohol reduction intervention among men and women living with HIV/AIDS and using alcohol in Kampala, Uganda: a randomized trial. Journal of the International Association of Providers of AIDS Care 2017;16(3):276-85. - PMC - PubMed
Ward 2015 {published data only}
Wertz 1994 {published data only}
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Whitten 2006 {published data only}
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Wilson 2012a {published data only}
Wood 2010 {published data only}
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Zhang 2018 {published data only}
Zule 2009 {published data only}
References to studies awaiting assessment
ACTRN12611000135910 {published data only}
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- ACTRN12611000135910. Screening and treatment for alcohol related trauma using brief interventions (START Brief Interventions) project. anzctr.org.au/ACTRN12611000135910.aspx (first received 4 February 2011).
Blow 2012 {published data only}
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- Blow FC, Barry KL, Chermack ST, Walton MA. Screening and brief intervention for at-risk drinking in older adults: mental and physical health outcomes. Alcoholism: Clinical and Experimental Research 2012;36:24A.
Corno 2011 {published data only}
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Dash 2021 {published data only}
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Gaume 2020 {published data only}
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Gonzales 2019 {published data only}
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Hides 2018 {published data only}
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Horner 2010 {published data only}
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Hospital 2012 {published data only}
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Ingesson 2022 {published data only}
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IRCT20140907019077N4 {published data only}
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- IRCT20140907019077N4. Effect of motivational interviewing-based behavior change model on returning to opium addiction among women of reproductive age. en.irct.ir/trial/17156 (first registered 12 December 2017).
Jaiswal 2018 {published data only}
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- Jaiswal R, Gupta S. Evaluating motivational enhancement therapy versus life skill training along with pharmacotherapy in management of opioid use disorder. Indian Journal of Psychiatry. Conference: 70th Annual National Conference of the Indian Psychiatric Society, ANCIPS 2018. India 2018;60(5):S155-6.
Lakshmana 2016 {published data only}
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Lauckner 2021 {published data only}
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Lee 2015 {published data only}
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- Lee CS, Tavares TL. Addressing the effects of social stressors on drinking behavior in a randomized controlled trial of motivational interviewing with Hispanics. Alcoholism: Clinical and Experimental Research 2015;39:262A.
Lopes 2018 {published data only}
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- Lopes A. The impact of the motivational interview on the behaviors and conditions of individuals with disorders for the use of psychotropic substances - a randomized clinical trial. No source identified 2018.
Lunny 2012 {published data only}
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- Lunny KF, Bacio GA, Webb JN, Heydari A, Guzman IY, Ray LA. Single session of motivational interviewing for non-treatment seeking alcohol dependent patients: an open label trial. Alcoholism: Clinical and Experimental Research 2012;36:162A.
Lygidakis 2013 {published data only}
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- Lygidakis C, Struzzo P, Scafato E, McGregor R, Vedova RD, Verbano L, et al. Risky drinkers in primary care: effectiveness of facilitated access to an alcohol reduction website. European Journal of General Practice 2013;19(1):50.
Martens 2011 {published data only}
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- Martens MP, Smith AE, Murphy JG. A randomized controlled trial examining the comparative efficacy of single-component brief alcohol interventions for at-risk college drinkers. Alcoholism: Clinical and Experimental Research 2011;35:298A.
Mastroleo 2010a {published data only}
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- Mastroleo NR, Magill M. Student defensiveness and motivational readiness as moderators of drinking outcome in a brief peer-delivered intervention. Alcoholism: Clinical and Experimental Research 2010;34(6):60A.
Mastroleo 2022 {published data only}
NCT00229983 {published data only}
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- NCT00229983. Medical office intervention for adolescent drug use. clinicaltrials.gov/ct2/show/NCT00229983 (first received 29 September 2005).
NCT01143792 {published data only}
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- NCT01143792. Evaluation of treatments for homeless youths [Evaluation of treatments for homeless youths: CRA, MET and Case Management]. clinicaltrials.gov/show/NCT01143792 (first received 11 June 2010).
NCT01616212 {published data only}
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- NCT01616212. Early Intervention for Minors in Possession of Alcohol/Drugs: A Feasibility Study (MAST1). clinicaltrials.gov/ct2/show/NCT01616212 (first received 29 May 2012).
NCT01621334 {published data only}
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- NCT01621334. The men's domestic abuse check-up engages adult men concerned about their abusive behavior and alcohol or drug use [Stage 1B Study Motivating Substance Abusing Batterers to Seek Treatment]. clinicaltrials.gov/ct2/show/NCT01621334 (first received 18 June 2012).
NCT02159391 {published data only}
-
- NCT02159391. The efficacy of brief motivational interviewing for trauma patients related to alcohol or other abuse drugs (MOTIVA). clinicaltrials.gov/ct2/show/NCT02159391 (first received 6 June 2014).
NCT02409888 {published data only}
-
- NCT02409888. Evaluating interventions for alcohol use disorder. clinicaltrials.gov/ct2/show/study/NCT02409888 (first received 1 April 2015).
NTR2420 {published data only}
-
- NTR2420. Effect of a short motivation enhancing intervention for judicial supervised criminal addicts on entering addiction treatment and treatment drop out. www.onderzoekmetmensen.nl/en/trial/24218 (first received 21 July 2010).
NTR2710 {published data only}
-
- NTR2710. Effectiveness of the "Wiet-Check", the Dutch version of the Adolescent Cannabis Check-Up (ACCU), amongst adolescents aged 14-21 years with frequent cannabis use. www.onderzoekmetmensen.nl/en/trial/27383 (first received 25 January 2011).
NTR3182 {published data only}
-
- NTR3182. Study of Integrated Dual Diagnosis Treatment in the Netherlands. www.onderzoekmetmensen.nl/en/trial/23336 (first posted 7 December 2011).
NTR3730 {published data only}
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- NTR3730. A study to assess whether the intervention Moti-4 is effective in influencing adolescents cannabis use. www.onderzoekmetmensen.nl/en/trial/20952 (first received 29 November 2012).
Parry 2019 {published data only}
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- Parry C, Shuper P, Londani BM, Myers B, Nkosi S, Morojele N. Drinking among patients on antiretroviral therapy in South Africa: Gender differences and outcomes of a clinical trial. Alcoholism: Clinical and Experimental Research 2019;43:266A.
Puentes 2016 {published data only}
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- Puentes RP, Rangel LM, Field CA. A latent growth curve analysis: Approximating spill-over effects of an alcohol-focused brief intervention on marijuana use. Alcoholism: Clinical and Experimental Research 2016;40:69A.
Pujam 2022 {published data only}
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- Pujam SN. A clinical trial to study the effects of mindfulness on relapsing factors like craving and emotion regulation in patients with alcohol dependence syndrome. No source identified 2022.
Rinker 2017 {published data only}
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- Rinker DV, Young CM, Neighbors C. A randomized controlled trial of injunctive norms feedback with and with out motivational interviewing. Alcoholism: Clinical and Experimental Research 2017;41:252A.
Rose 2013 {published data only}
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- Rose SJ, Lebel T, Begun A. Perceptions of barriers to care expressed by incarcerated mothers. Alcoholism: Clinical and Experimental Research 2013;37:294A.
Sander 2012 {published data only}
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- Sander AM. A randomized, dual-center controlled trial of brief intervention for problem alcohol abuse in persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation 2012;93(10):E7.
Sawant 2016 {published data only}
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- Sawant M, Hospital M, Wagner E. Motivational interviewing with at risk American Indian teens: results from a randomized clinical trial. Alcoholism: Clinical and Experimental Research 2016;40:266A.
Tate 2010 {published data only}
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- Tate SR, Mrnak-Meyer J, Tripp JC, Brown SA. Brief health focused motivational intervention for alcohol dependent veterans. Alcoholism: Clinical and Experimental Research 2010;34(6):230A.
Whiteside 2011 {published data only}
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- Whiteside U. A brief personalized feedback intervention integrating a motivational interviewing therapeutic style and dialectical behavioral therapy skills for depressed or anxious heavy drinking young adults. Dissertation Abstracts International: Section B: The Sciences and Engineering 2011;71(12):7745.
References to ongoing studies
CTRI/2019/08/020530 {published data only}
-
- CTRI/2019/08/020530. Effect of a brief motivational intervention in reducing alcohol consumption in the emergency department [Effect of a brief motivational interventions in reducing alcohol consumption among young patients visiting emergency department: a randomized controlled trial]. www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=35795 (first receveived 2 August 2019).
CTRI/2022/06/043527 {published data only}
-
- CTRI/2022/06/043527. Usefulness of screening and brief intervention in patient with alcohol use disorder who are on opioid agonist treatment [Efficacy of screening and brief Intervention for hazardous and harmful alcohol use among patients on opioid agonist treatment (OAT): a randomized controlled trial ]. www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=67862 (first received 27 June 2022).
IRCT20151103024866N13 {published data only}
-
- IRCT20151103024866N13. Investigating the effect of motivational enhancement therapy on the pattern of drug use [The effect of motivational-enhancement therapy (MET) on the pattern of postpartum drug use in addicted women referring to Afzali Pour kerman hospital in 2018]. en.irct.ir/trial/30172 (first received 4 January 2019).
KCT0004748 {published data only}
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- KCT0004748. Effect of early intervention based on motivational interviewing for high risk drinker: a randomized controlled trial [Development of early intervention system for reducing high-risk drinking]. cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=15843 (first received 19 February 2020).
NCT04147520 {published data only}
-
- NCT04147520. Reducing hazardous alcohol use in social networks using targeted intervention: 21 rising. clinicaltrials.gov/ct2/show/record/NCT04147520 (first received 23 October 2019).
NCT04345302 {published data only}
-
- NCT04345302. Brief motivational therapy versus usual care for alcohol use disorders in primary care [Brief motivational therapy versus enhanced usual care for alcohol use disorder in primary care in chile, an exploratory randomised trial]. ClinicalTrials.gov/show/NCT04345302 (first received 8 April 2020).
NCT04822168 {published data only}
-
- NCT04822168. Effects of remote motivational enhancement & MySafeRx on post-detox engagement in B/N Treatment -RCT [Effects of remote motivational enhancement & MySafeRx on post-detox engagement and retention in B/N treatment (MySafeRx) - RCT]. clinicaltrials.gov/ct2/show/NCT04822168 (first received 27 February 2018).
NCT04881500 {published data only}
-
- NCT04881500. Impact of a brief motivational intervention including counter-marketing arguments with a population of patients with moderate to severe alcohol use disorders who are followed up on an outpatient basis. www.clinicaltrials.gov/ct2/show/NCT04881500 (first received 3 May 2021).
NCT04998045 {published data only}
-
- NCT04998045. Feasibility and acceptability of a substance use screening and brief intervention for youth living with HIV in Kenya. clinicaltrials.gov/ct2/show/NCT04998045 (first received 26 June 2021).
NCT05010187 {published data only}
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- NCT05010187. Preventing alcohol misuse and consequences in vulnerable women. clinicaltrials.gov/ct2/show/NCT05010187 (first received 20 July 2021).
NCT05489068 {published data only}
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- NCT05489068. Motivational interviewing at intake vs intake as usual on client engagement in addiction treatment. clinicaltrials.gov/show/NCT05489068 (first received 26 July 2022).
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