Change talk sequence during brief motivational intervention, towards or away from drinking


Nicolas Bertholet, Centre de Traitement en Alcoologie, Département Universitaire de Médecine et Santé Communautaires, Mont-Paisible 16, 1011 Lausanne, CHUV, Switzerland. E-mail:


Aim  To investigate whether different sequences of ‘change talk’ utterances within a brief motivational intervention (BMI) are associated with drinking outcomes.

Design  Speech content analysis of recorded BMI.

Setting  BMI delivered in an emergency department for at-risk drinking.

Participants  Ninety-seven subjects who received a BMI.

Measurements  Ninety-seven BMI were coded in duplicate by two psychologists with the Motivational Interviewing Skill Code (MISC), a Hidden Markov Model was used to identify three different patient states reflecting attitudes regarding changing their drinking behaviour within a BMI: towards change, away from change and non-determined. Adjusted regression models were used to predict drinking at 12 months' follow-up using patient attitudes regarding changing drinking at the beginning, during the intervention and at the end.

Findings  The dynamic process at place within a BMI was marked mainly by stability: at each point during the intervention, staying in the same attitude was far more likely than transitioning from one attitude to another. When subjects did change from one attitude to another, they were more likely to move from an ‘away from change’ to a ‘towards change’ state. At 12 months, subjects with an attitude towards change at the end of the BMI drank significantly less (13.1 drinks per week) than subjects with an attitude away from change, independent of their attitude at the beginning of the intervention.

Conclusions  Transition in ‘change talk’ between ‘away from change’ and ‘towards change’ appears to be rare in brief motivational intervention for excessive alcohol consumption. Moreover, change talk ‘towards change’ at the end of the intervention is associated with improved outcomes at follow-up, independently of the type of change talk at the beginning of the intervention, suggesting that it is important to end a BMI session with a positive attitude towards change by the client.