Initiating people into illicit drug injection

Abstract

Aims: Although a body of literature supports the effectiveness ofMotivational Enhancement Therapy (MET) in reducing substance use for the general population, several studies report inconsistent findings, especially among African Americans (AA). In the National DrugAbuseTreatmentClinical TrialsNetwork, nooverall difference was found betweenMET and Counseling as Usual (CAU) in the CTN0004 protocol. Among AA overall, MET showed significantly more days of primary substance use than CAU; however, this patternwas reversedamong thosewithhighbaseline readiness to change (RTC). We therefore hypothesized a mediator relationship in AA patients, such that (1) MET would positively influence RTC over time and (2) increased RTC would be correlated with successful treatment outcomes. Methods: We conducted secondary analyses of 194 AA in CTN0004. RTC was assessed at baseline, 4, 8, and 16 weeks by the University of Rhode Island Change Assessment (URICA), based on precontemplation, contemplation, preparation, andaction.Ourprimary outcome assessed was the total number of days using the primary substance during the 16 week period. Results: Over the 16 week period, average total RTC score declined slightly, with no significant difference observed between MET and CAU treatment groups. Overall, the MET group reported 6.6 days of primary substance use vs. 3.1 days in the CAU group (p=0.08). We observed an inconsistent role for RTC as a mediator, with RTC change from baseline to 8 weeks significantly associated with substance use in the MET arm (p=0.03), but RTC change to other timepoints not significant. The MET treatment effect was similar in models with and without controlling for baseline RTC and RTC change over time. Conclusions: These results provide limited evidence for RTC as a mediator of MET effect in AA patients. It is possible that RTC plays a larger role inmaintenance of abstinence at the beginning of treatment. Financial Support: U10 DA013727 (Brady) and U10 DA013732 (Winhusen).