Do Brief Alcohol Motivational Interventions Work Like We Think They Do?

Authors

  • Nicolas Bertholet,

    Corresponding author
    1. Department of Community Medicine and Health, Alcohol Treatment Center, Lausanne University Hospital and Medical School, Lausanne, Switzerland
    • Reprint requests: Nicolas Bertholet, MD, MSc, Alcohol Treatment Center, Beaumont 21b, P2, 02, 1011 Lausanne CHUV, Switzerland; Tel.: +41 21 314 73 51; Fax: +41 21 314 05 62; E-mail: Nicolas.Bertholet@chuv.ch

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  • Tibor Palfai,

    1. Department of Psychology, Boston University, Boston, Massachusetts
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  • Jacques Gaume,

    1. Department of Community Medicine and Health, Alcohol Treatment Center, Lausanne University Hospital and Medical School, Lausanne, Switzerland
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  • Jean-Bernard Daeppen,

    1. Department of Community Medicine and Health, Alcohol Treatment Center, Lausanne University Hospital and Medical School, Lausanne, Switzerland
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  • Richard Saitz

    1. Section of General Internal Medicine, Boston University and Boston Medical Center, Boston, Massachusetts
    2. Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Abstract

Background

Questions remain about how brief motivational interventions (BMIs) for unhealthy alcohol use work, and addressing these questions may be important for improving their efficacy. Therefore, we assessed the effects of various characteristics of BMIs on drinking outcomes across 3 randomized controlled trials (RCTs).

Methods

Audio recordings of 314 BMIs were coded. We used the global rating scales of the Motivational Interviewing Skills Code (MISC) 2.1: counselor's acceptance, empathy, and motivational interviewing (MI) spirit, and patient's self-exploration were rated. MI proficiency was defined as counselor's rating scale scores ≥5. We also used the structure, confrontation, and advice subscale scores of the Therapy Process Rating Scale and the Working Alliance Inventory. We examined these process characteristics in interventions across 1 U.S. RCT of middle-aged medical inpatients with unhealthy alcohol use (n = 124) and 2 Swiss RCTs of young men with binge drinking in a nonclinical setting: Swiss-one (n = 62) and Swiss-two (n = 128). We assessed the associations between these characteristics and drinks/d reported by participants 3 to 6 months after study entry.

Results

In all 3 RCTs, mean MISC counselor's rating scales scores were consistent with MI proficiency. In overdispersed Poisson regression models, most BMI characteristics were not significantly associated with drinks/d in follow-up. In the U.S. RCT, confrontation and self-exploration were associated with more drinking. Giving advice was significantly associated with less drinking in the Swiss-one RCT. Contrary to expectations, MI spirit was not consistently associated with drinking across studies.

Conclusions

Across different populations and settings, intervention characteristics viewed as central to efficacious BMIs were neither robust nor consistent predictors of drinking outcome. Although there may be alternative reasons why the level of MI processes was not predictive of outcomes in these studies (limited variability in scores), efforts to understand what makes BMIs efficacious may require attention to factors beyond intervention process characteristics typically examined.

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