Brief Motivational Interviewing Research Articles

Testing the efficacy of narrator empathy, self-disclosure, gender, and use of brief motivational interviewing techniques in a brief internet-based intervention for alcohol use.

Nonspecific relational factors, such as therapist empathy, play an important role in therapy effectiveness. Building on this literature, some researchers have attempted to incorporate relational factors into electronic brief interventions (e-BIs) by using interactive narrators to guide participants through the intervention. However, few studies have examined which characteristics of these interactive narrators increase intervention acceptability and efficacy. The present study sought to systematically manipulate animated narrator characteristics in an e-BI and to examine their effects on respondents' alcohol use and subjective reactions. Participants (N = 348) were randomly assigned to 1-16 possible combinations of four narrator-level characteristics in a 2 × 2 × 2 × 2 factorial trial evaluating narrator empathy, self-disclosure, gender, and the use of brief motivational interviewing (BMI) techniques. We measured main and interaction effects of these characteristics on the primary outcome of typical drinks per week at 1-month follow-up. Secondary outcomes included maximum drinks, alcohol consequences, and subjective reactions to the intervention, with additional secondary analyses evaluating moderation by participant gender. Participants showed reductions in all alcohol outcomes. These reductions were stronger for participants exposed to either narrator disclosure or BMI techniques (vs. neither). Participants in the high empathy condition rated the intervention as more supportive, while those exposed to BMI techniques reported feeling more criticized by the intervention. Specific narrator-level characteristics, such as narrator self-disclosure and empathy, may improve the efficacy or acceptability of e-BIs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Educational interventions using a primer and motivational interviewing: randomized clinical trial.

Many educational technologies have been used to promote the health of the population. Thus, the objective was to assess the effect of using an individual educational primer along with the Brief Motivational Interviewing (BMI) for increasing maternal self-efficacy for preventing childhood diarrhoea. Randomized clinical trial, conducted in Fortaleza/Ceará-Brazil, composed of 181 mothers and/or guardians of children under five years, who were randomized into three groups: experimental group A (EG A)-who read the primer, experimental group B (EG B)-application of the primer and BMI and the control group (CG). The participants' assessment was based on the Maternal Self-Efficacy Scale for Preventing Childhood Diarrhoea and the diarrhoea Investigation Form at the beginning of the intervention and then 30 and 60 days after the first contact with the participants. There were 60 participants in EG A and CG and 61 in EG B. It was noted a greater incidence of participants with high self-efficacy in EG B after applying the technologies. All groups manifested diarrhoea among children after the interventions, although with a lower number in EG B, one-month post-intervention (P = 0.025). The combined use of the primer and the BMI contributed significantly over time to increase maternal self-efficacy in preventing childhood diarrhoea and reduce cases of this disease.

Treatment Initiation and Alcohol Use Violations Among Adults with DWI Arrests Who Received a Tailored Brief Intervention.

This program evaluation examined rates of treatment initiation and alcohol related violations among adults who completed a brief motivational interviewing (BMI) session after a driving while intoxicated arrest. Adults attending orientation for pretrial bond supervision were assessed for eligibility to receive services by counselors in an outpatient clinic. A total of 118 male and female adults with DWI arrests completed a single BMI session. Treatment initiation was assessed one-week after the BMI session and alcohol-related violations were assessed 6-months later. Fifty-three percent of those with DWI arrests who received the BMI session-initiated treatment and of those who initiated treatment, alcohol-related violations were significantly lower than for those who did not initiate treatment. The results provide preliminary support that a single session BMI delivered soon after arrest and before pretrial conditions are implemented has promise for spurring clients to take steps to initiate treatment and is related to better rates of compliance with alcohol-related pretrial conditions.

Motivational interviewing technical process and moderated relational process with underage young adult heavy drinkers.

This study tested technical and relational processes hypothesized to explain the therapeutic benefit of an efficacious brief motivational interview (BMI). A randomized controlled trial compared the efficacy of a BMI to an attention-matched control (i.e., relaxation training [REL]) for reducing heavy alcohol consumption and associated negative consequences. Participants were underage, past-month heavy drinkers recruited from community settings (N = 167; ages 17-20; 62% female; 59% White). Data were collected on session recordings, using established motivational interviewing process measures. Statistical analyses followed 3 steps. First, a latent class model determined the optimal class solution for characterizing proportion change talk means within BMI and REL. Next, the probability of proportion change talk class membership was examined as a mediator and then as a moderated mediator of BMI efficacy. The latent class model yielded a 3-class solution, including a low-increasing proportion change talk class (n = 61), a moderate-increasing proportion change talk class (n = 97), and a nonlinear proportion change talk class (n = 7). Across the outcomes examined, membership in the moderate-increasing class rather than the low-increasing class mediated BMI effects on alcohol-related consequences at 6 weeks. Mediation tests for consequences at 3 months and heavy drinking were nonsignificant. Moderated mediation results for therapist empathy and MI Spirit were nonsignificant. Findings suggest that moderate increases in prochange statements, relative to anti- or neutral-change statements, help explain BMI effects on reducing alcohol-related negative consequences soon after intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Role of Behavioral Phenotypes on Impaired Driving Recidivism Risk and Treatment Response to Brief Intervention: A Preliminary Study.

Heterogeneity in the driving while impaired (DWI) offender population and modest outcomes from remedial programs are fueling interest in clarifying clinically significant DWI subtypes to better assess recidivism risk and target interventions. Our previous research identified 2 putative behavior phenotypes of DWI offenders with distinct behavioral, personality, cognitive, and neurobiological profiles: (i) offenders primarily engaging in DWI (pDWI); and (ii) offenders engaging in DWI and other traffic violations (MIXED). Here, we evaluate these phenotypes' clinical significance for prediction of recidivism and intervention targeting. DWI recidivists participating in a previous randomized controlled trial (N=184 comparing brief motivational interviewing (BMI) and an information and advice control condition (IA) were retrospectively classified as either pDWI (n=97) or MIXED (n=87). Secondary analyses then evaluated the effect of this phenotypic classification on self-reported 6- and 12-month alcohol misuse outcomes and documented 5-year DWI recidivism violations, and in response to either BMI or IA (i.e., pDWI-BMI, n=46; MIXED-BMI, n=45; pDWI-IA, n=51; MIXED-IA, n=42). Two hypotheses were tested: (i) MIXED classification is associated with poorer alcohol misuse outcomes and recidivism outcomes than pDWI classification; and (ii) pDWI paired with BMI is associated with better outcomes compared to MIXED paired with BMI. MIXED classification was associated with significantly greater risk of recidivism over the 5-year follow-up compared to pDWI classification. Moreover, the pDWI-BMI pairing was associated with significantly decreased recidivism risk compared to the MIXED-BMI pairing. Analyses of 6- and 12-month alcohol use outcomes produced null findings. The clinical significance of phenotypic classification for risk assessment and targeting intervention was partially supported with respect to recidivism risk. Prospective investigation of this and other behavioral phenotypes is indicated.

215EMF Development of a Brief Motivational Interview Intervention to Promote Advance Care Planning for Older Adults After Leaving the Emergency Department

The majority of older adults with serious illnesses visit the ED near the end of life, yet most do not have advance directives. In the time-pressured ED environment, the lack of a feasible method to facilitate advance care planning (ACP) constrains our current practice. We sought to develop and refine a brief motivational interview (BMI) intervention for older adults to engage in ACP conversations with their primary outpatient clinician. We conducted iterative cognitive interviews to refine our BMI intervention. We adapted a well-established BMI intervention previously designed for alcohol dependence to empower older adults to seek ACP conversations with their primary outpatient clinicians. Using an expert panel consisting of palliative care researchers and BMI researchers, we created a prototype to meet the needs of older adults with serious illness. The prototype was refined using mock clinical encounters and iterative cognitive interviews. Emergency medicine clinicians administered the intervention to the patient family advisory council members (prior ED patients who volunteered to improve the care we deliver) and standardized patients. After the mock encounters, individual cognitive interviews were performed to understand both the clinician and patient perspectives. An acceptability Likert-scale survey was administered to all participants. The scripted text was refined based on participants’ inputs, and the iterative refinements were reviewed by a second, blinded, attending emergency physician and the expert panel to ensure feasibility in the ED and maintenance of BMI and serious illness communication principles. This process was deemed when >75% of participants rated the intervention acceptable. We conducted 16 mock clinical encounters with 11 attending emergency physicians, 3 physician assistants, and 7 patients. 71% of the clinicians were male. Clinicians had broad range of clinical experience (57% with <5 years, 7% with 5 to 10 year, and 36% with >10 years of experience after training). Patients were 50% male, including 3 standardized patients. The mean acceptability Likert scale (0 not acceptable, 1-4 somewhat unacceptable, 6-9 somewhat acceptable and 10 completely acceptable) was 7. Clinicians spent mean of 6.8 minutes administering the BMI intervention. Examples of refinement included explicit stating the need for goals of care in the setting of worsening serious illness, using patient-centered language, eliminating readiness numerical scale, focusing to prepare for ACP conversation at the follow-up outpatient visit, allowing administering clinicians to use their judgment to avoid redundancy, and including specific actionable items that patients can take home to prepare for their follow-up visit. Participants also recommended shortening the script in concern for time, including caregiver (if present), and offering an opt-out process for patients to refuse the intervention if necessary can further improve the intervention acceptability. An ED BMI intervention for ACP conversations has been developed and refined. This intervention may improve the rate of ACP conversations for older adults after leaving the ED. Further study is needed to understand how older adults in the ED perceive this intervention.

Integrating motivational interviewing in career counseling: A case study

Motivational interviewing (MI) is receiving increasing attention in the field of career counseling. However, none of the previous studies have concretely presented how this method could and why it should be integrated in career counseling. Through the use of a single case study design, this paper illustrates how a brief MI (BMI) intervention can be integrated into career counseling interventions to help resolve career dilemmas. An analysis of the interactions between the client and his counselor using the Motivational Interviewing Skills Code 2.1 illustrates why this method can be useful for career counseling. Immediate and long-term effects of the global career counseling intervention on the client's career decision-making difficulties, as well as the specific impacts of the BMI intervention, are assessed. This case study shows that the BMI approach can be integrated in a career counseling intervention to help career counseling clients overcome career dilemmas and increase their readiness to make career choices.

Motivational enhancement mitigates the effects of problematic alcohol use on treatment compliance among partner violent offenders: Results of a randomized clinical trial.

Treatment programs for intimate partner violence (IPV) evidence high rates of noncompliance, which is associated with repeat offending. Problematic alcohol use is reported in approximately half of all partner violent offenders and represents a strong risk factor for treatment noncompliance. However, previous research with IPV offenders mandated to treatment has not evaluated methods to mitigate the effects of alcohol misuse on treatment compliance. In the current study, 60 male IPV offenders (25 binge drinkers) were randomly assigned to a single-session brief motivational interview (BMI) or control intervention prior to treatment commencement. Treatment compliance data were collected 6 months later. Findings indicated that binge drinkers had lower treatment compliance than non-binge-drinking participants, and that binge-drinking BMI participants attended more treatment sessions and evidenced lower dropout rates than binge-drinking control participants. Findings highlight the importance of individualized treatment planning for IPV offenders in order to maximize available resources while accommodating the needs of males at greatest risk for noncompliance and continued violence.

Mechanisms of action of brief alcohol interventions remain largely unknown - a narrative review.

A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and harmful alcohol use in primary health care settings. Evidence for efficacy in other settings and effectiveness when implemented at larger scale are disappointing. Indeed, BI comprises varying content; exploring BI content and mechanisms of action may be a promising way to enhance efficacy and effectiveness. Medline and PsychInfo, as well as references of retrieved publications were searched for original research or review on active ingredients (components or mechanisms) of face-to-face BIs [and its subtypes, including brief advice and brief motivational interviewing (BMI)] for alcohol. Overall, BI active ingredients have been scarcely investigated, almost only within BMI, and mostly among patients in the emergency room, young adults, and US college students. This body of research has shown that personalized feedback may be an effective component; specific MI techniques showed mixed findings; decisional balance findings tended to suggest a potential detrimental effect; while change plan exercises, advice to reduce or stop drinking, presenting alternative change options, and moderation strategies are promising but need further study. Client change talk is a potential mediator of BMI effects; change in norm perceptions and enhanced discrepancy between current behavior and broader life goals and values have received preliminary support; readiness to change was only partially supported as a mediator; while enhanced awareness of drinking, perceived risks/benefits of alcohol use, alcohol treatment seeking, and self-efficacy were seldom studied and have as yet found no significant support as such. Research is obviously limited and has provided no clear and consistent evidence on the mechanisms of alcohol BI. How BI achieves the effects seen in randomized trials remains mostly unknown and should be investigated to inform the development of more effective interventions.

Toward an Understanding of the Effective Mechanisms of Alcohol Brief Interventions

Research on effective mechanisms of alcohol brief interventions has been neglected, but Bertholet and colleagues provide an example of such research in a re-analysis of combined data from 3 trials of brief motivational interviewing (BMI). However, it is disappointing that, in a well-designed and well-conducted analysis, little support was found for highly plausible hypotheses relating treatment processes to outcome of intervention. It is argued here that, because BMI must be assumed to work by increasing client motivation to cut down drinking, some measure of overall motivation before and after intervention is necessary to elucidate the pathway by which treatment processes are translated into positive outcomes. In pioneering research on physician advice on smoking cessation by Russell and colleagues, it was possible to distinguish between whether intervention worked by motivating more people to try to stop smoking, by increasing the success rate among those who did try, or by reducing the relapse rate among those who quit. It is recommended that similar measures be employed in research on how alcohol brief interventions work. A further consideration bearing on the relationship between treatment processes and outcome is whether or not individuals are dependent on alcohol and this is reminiscent of a dispute in the literature concerning the relative priority that should be given to motivational or dependence variables in the prediction of smoking cessation. In order to improve the effectiveness of alcohol brief interventions, future research should focus more on effective mechanisms of behavior change.

Prevention of Type 2 Diabetes (T2DM) in South Africa - a Focus on Facilitating Physical Activity Behaviour Change in Peri-Urban Youth

This paper focuses on type 2 diabetes mellitus (T2DM), and the significant health implications it has on individuals living in currently disadvantaged peri-urban areas in South Africa. Given the significant public health and socio-economic burden South Africa faces due to scarce resources and escalating rates of chronic diseases, prevention strategies which impact on modifiable risk factors for T2DM are vital. The population of interest was children and adolescents living in informal settlements on the outskirts of Cape Town. The suggested behaviour change was the increase and maintenance of a more physically active and healthy lifestyle, thereby facilitating weight loss and lowering the risk for developing T2DM. Brief motivational interviewing (BMI) based interventions, aimed at encouraging children and adolescents to modify their behaviour patterns are introduced. Transformative communication, self-efficacy and social support are also emphasised as crucial factors contributing to the promotion and maintenance of the desired health behaviour changes.

A Randomized Controlled Trial of Brief Motivational Interviewing in Impaired Driving Recidivists: A 5‐Year Follow‐Up of Traffic Offenses and Crashes

BackgroundIn a previously published randomized controlled trial (Brown et al. Alcohol Clin Exp Res 2010; 34, 292–301), our research team showed that a 30-minute brief motivational interviewing (BMI) session was more effective in reducing percentages of risky drinking days in drunk driving recidivists than a control information–advice intervention at 12-month follow-up. In this sequel to the initial study, 2 main hypotheses were tested: (i) exposure to BMI increases the time to further arrests and crashes compared with exposure to the control intervention (CTL) and (ii) characteristics, such as age, moderate the benefit of BMI.MethodsA sample of 180 community-recruited recidivists who had drinking problems participated in the study. Participants gave access to their provincial driving records at baseline and were followed up for a mean of 1,684.5 days (SD = 155.7) after randomization to a 30-minute BMI or CTL session. Measured outcomes were driving arrests followed by convictions including driving while impaired (DWI), speeding, or other moving violations as well as crashes. Age, readiness to change alcohol consumption, alcohol misuse severity, and number of previous DWI convictions were included as potential moderators of the effect of the interventions.ResultsFor arrests, Cox proportional hazards modeling revealed no significant differences between the BMI and the CTL group. When analyses were adjusted to age tertile categories, a significant effect of BMI in the youngest age tertile (<43 years old) emerged. For crashes, no between-group differences were detected.ConclusionsBMI was better at delaying DWI and other dangerous traffic violations in at-risk younger drivers compared with a CTL similar to that provided in many remedial programs. BMI may be useful as an opportunistic intervention for DWI recidivism prevention in settings such as DWI courts. Treatment effectiveness studies are needed to ascertain how the present findings generalize to the real-world conditions of mandated relicensing programs.

The Change Questionnaire predicts change in hazardous tobacco and alcohol use

IntroductionAssessing motivation for change is deemed an important step in the treatment process that allows further refinement of the intervention in motivational interviewing (MI) and brief MI (BMI) adaptations. During MI (and BMI) sessions, motivation for change is expressed by the client as “change talk”, i.e. all statements inclined toward or away from change. We tested the predictive validity of the Change Questionnaire, a 12-item instrument assessing motivation to change, on hazardous tobacco and alcohol use. MethodsAs part of the baseline measurements for a randomized controlled trial on multi-substance BMI at the Lausanne recruitment center (army conscription is mandatory in Switzerland for males at age 20, and thus provides a unique opportunity to address a non-clinical and largely representative sample of young men), 213 participants completed the questionnaire on tobacco and 95 on alcohol and were followed-up six months later. The overall Change Questionnaire score and its six subscales (Desire, Ability, Reasons, Need, Commitment, and Taking steps) were used as predictors of hazardous tobacco use (defined as daily smoking) and hazardous alcohol use (defined as more than one occasion with six standard drinks or more per month, and/or more than 21 standard drinks per week) in bivariate logistic regression models at follow-up. ResultsHigher overall Change scores were significant predictors of decreased risk for hazardous tobacco (odds ratio [OR]=0.83, p=0.046) and alcohol (OR=0.76, p=0.03) use. Several sub-dimensions were associated with the outcomes in bivariate analyses. Using a principal components analysis to reduce the number of predictors for multivariate models, we obtained two components. ‘Ability to change’ was strongly related to change in hazardous tobacco use (OR=0.54, p<0.001), the second we interpreted as ‘Other change language dimensions’ and which was significantly related to change in hazardous alcohol use (OR=0.81, p=0.05). ConclusionsThe present findings lend initial support for the predictive validity of the Change Questionnaire on hazardous tobacco and alcohol use, making it an interesting and potentially useful tool for assessing motivation to change among young males.

Impact of single‐session motivational interviewing on clinical outcomes following periodontal maintenance therapy

Patient engagement in effective oral hygiene following periodontal therapy is essential to long-term success. Motivational interviewing (MI) is a behavioural counselling approach documented to positively influence behaviour change related to smoking, diabetes control and medication adherence. Emerging evidence suggests utility of MI to improve oral health. The objective of this study was to evaluate whether the use of brief motivational interviewing (BMI) is effective in improving internal motivation for oral hygiene behaviour. A convenience sample of fifty-six previously treated periodontal patients who were in maintenance yet presented with signs of clinical inflammation were recruited to participate in this single blind, randomized controlled trial. Patients were randomly assigned to receive either BMI in conjunction with traditional oral health education (TOHE), (n = 29) or TOHE alone (n = 27). Bleeding on probing scores (BOP), plaque index (PI), pocket depths (PD), motivation (M), autonomous regulation (AR) controlled regulation (CR) and oral health knowledge (K) were assessed at baseline, 6 weeks and 12 weeks. Statistically significant decreases were found over time for BOP (P = 0.001), PI (P = 0.001) and PD 4-6 mm (P = 0.001) for both groups. Differences in clinical parameters between groups were not evident at either 6 or 12 weeks. Results show that a one-time MI session is insufficient for improving oral hygiene in long-standing maintenance patients.

Evaluate, assess, treat: development and evaluation of the EAT framework to increase effective communication regarding sensitive oral-systemic health issues.

Oral healthcare providers are likely to encounter a number of sensitive oral/systemic health issues whilst interacting with patients. The purpose of the current study was to develop and evaluate a framework aimed at oral healthcare providers to engage in active secondary prevention of eating disorders (i.e. early detection of oral manifestations of disordered eating behaviours, patient approach and communication, patient-specific oral treatment, and referral to care) for patients presenting with signs of disordered eating behaviours. The EAT Framework was developed based on the Brief Motivational Interviewing (B-MI) conceptual framework and comprises three continuous steps: Evaluating, Assessing, and Treating. Using a group-randomized control design, 11 dental hygiene (DH) and seven dental (D) classes from eight institutions were randomized to either the intervention or control conditions. Both groups completed pre- and post-intervention assessments. Hierarchical linear models were conducted to measure the effects of the intervention whilst controlling for baseline levels. Statistically significant improvements from pre- to post-intervention were observed in the Intervention group compared with the Control group on knowledge of eating disorders and oral findings, skills-based knowledge, and self-efficacy (all P < 0.01). Effect sizes ranged from 0.57 to 0.95. No statistically significant differences in outcomes were observed by type of student. Although the EAT Framework was developed as part of a larger study on secondary prevention of eating disorders, the procedures and skills presented can be applied to other sensitive oral/systemic health issues. Because the EAT Framework was developed by translating B-MI principles and procedures, the framework can be easily adopted as a non-confrontational method for patient communication.

A randomized controlled trial of a behavioral economic supplement to brief motivational interventions for college drinking.

Behavioral economic theory suggests that a reduction in substance use is most likely when there is an increase in rewarding substance-free activities. The goal of this randomized controlled clinical trial was to evaluate the incremental efficacy of a novel behavioral economic supplement (Substance-Free Activity Session [SFAS]) to a standard alcohol brief motivational interviewing (BMI) session for heavy-drinking college students. Participants were 82 first-year college students (50% female; 81.7% White/European American; M age = 18.5 years, SD = 0.71) who reported 2 or more past-month heavy drinking episodes. After completing a baseline assessment and an individual alcohol-focused BMI, participants were randomized to either the SFAS or to a Relaxation Training (RT) control session. The SFAS was delivered in an MI style and attempted to increase the salience of delayed academic and career rewards and the patterns of behavior leading to those rewards. The combination of an alcohol BMI plus the SFAS was associated with significantly greater reductions in alcohol problems compared with an alcohol BMI plus RT at the 1-month and 6-month follow-up assessments (p = .015, ηp² = .07), an effect that was partially mediated by increases in protective behavioral strategies. BMI + SFAS was also associated with greater reductions in heavy drinking among participants who at baseline reported low levels of substance-free reinforcement or symptoms of depression. These results are consistent with behavioral economic theory and suggest that a single session focused on increasing engagement in alternatives to drinking can enhance the effects of brief alcohol interventions.

Brief motivational interviewing to reduce alcohol consumption among freshmen: secondary effects on polydrug use

Background & Aims: This study investigated high-risk drinking and polydrug use (PU) over 6 months for freshmen college students. Methods: The Brief Alcohol Screening and Intervention for College Students (BASICS) brief motivational interviewing (BMI) intervention was implemented at a public university as a 3-year programme designed to reduce underage drinking among freshmen with a secondary focus on PU. Participants were 299 freshmen from a state-supported university. Participants attended baseline visit, 2-week, 3- and 6-month visits. Analysis: Paired t-tests were used to determine the differences between alcohol consumption at different time points. McNemar’s test was used to compare correlated proportions. Results: At the baseline, 30% of the participants were drinking and using illicit drugs, compared with 25% at the sixth month visit. Conclusion: The findings suggest that a decrease in alcohol consumption will also reduce the probability of PU. These findings can assist in developing health professional strategies for effective use of BMI interventions aimed at alcohol and PU.

IS IT TIME TO START DISCUSSING WHAT TYPE OF COMPUTER‐DELIVERED INTERVENTION?

. [1] have conducted a randomized trialcomparing face-to-face brief motivational interviewing(BMI) with two different computer-delivered interven-tions (CDIs) for college students facing sanctions for vio-lating campus alcohol policies in the United States. Thefindings,ingeneral,leantowardssupportingthestrengthof the face-to-face BMI over the two CDIs. I applaudCarey’s continued research to attempt to elucidate whatinterventions might work best for problem drinkers andforwhomdifferentinterventionsareeffective(e.g.genderdifferences in the current study). It can be a challenge todemonstrate intervention effects when comparing a briefintervention to a minimally active comparator, let alonewhen comparing the intervention to another putativelyactive intervention.I was, however, left with one primary concern afterreading the study. That is, is it time to start discussingwhat types of computer-delivered interventions arebeing employed in this brief intervention research? BMIis perhaps the most-validated and -researched briefinterventionforproblemdrinkerswithaconsistenttrackrecord of measurable impact [2]. CDIs are still reallyin their infancy but there have been enough trials toconduct several recently published meta-analyses[3,4]. While these analyses note limitations with thecurrentliterature,thereisperhapsenoughresearchcon-ducted to date to at least divide CDIs into two groups: (i)those that have been developed by modifying clinicallyresearched and validated brief interventions for problemdrinkers (e.g. the various personalized feedback inter-ventions that could loosely be said to be descendentsof the Drinker’s Check-up tradition) [5]; and (ii) thosethat are education-orientated, stemming from a desireto promote safe (or no) drinking on American collegecampuses or that are automated versions of educationalprograms for those same students facing sanctions fordrinking on campus. My reading of this literature is thatit is the first group of CDIs—those which trace theirdevelopment from clinically based brief interventions—which have generally been more likely to have publishedtrials which report significant intervention effects. Cer-tainly, it is too early to say definitely that one of thesegroups of CDIs is superior to the other. However, it isnot too early to select a CDI which already has someevidence of efficacy (i.e. has at least one publishedrandomized trial with positive results) when settingout to conduct a trial that most readers may take as acomparison of face-to-face brief interventions versuscomputerized interventions. Personally, I suspect that awell-delivered face-to-face intervention from a skilledclinician will always be superior to a computerizedsubstitute. However, it would be good to have a test todemonstrate this superiority using the state-of-the-artversion of both of these candidates.

Alcohol Screening and Brief Interventions for College Freshmen

This study examined the effectiveness of the Brief Alcohol Screening and Intervention for College Students using theory-driven harm reduction brief motivational interviewing (BMI) for decreasing high-risk drinking and negative consequences. Three surveys were administered to 102 volunteer freshmen college students at baseline and 3 months postintervention. The BMI intervention was administered at baseline and 2 weeks later. Descriptive statistics and summary graphs were used to determine longitudinal changes in drinking quantity, frequency, and negative outcomes. Number of drinks, hours of drinking, and negative consequences decreased, indicating a significant decrease in alcohol consumption and negative consequences. This study contributes valuable implications for the design of theory-driven harm reduction, evidence-based interventions for high-risk drinking among freshmen college students.

Brief Motivational Interviewing for DWI Recidivists Who Abuse Alcohol and Are Not Participating in DWI Intervention: A Randomized Controlled Trial

Driving while impaired (DWI) recidivists with unresolved alcohol use problems pose an ongoing risk for traffic safety. Following conviction, many do not participate in mandated alcohol evaluation and intervention programs, or continue to drink problematically after being relicensed. This study investigated if, in DWI recidivists with alcohol problems and not currently involved in DWI intervention, Brief Motivational Interviewing (BMI) produced greater reductions in risky drinking at 6- and 12-month follow-up compared to an information-advice control condition. Additional analyses explored whether BMI was associated with greater readiness to change, subsequent substance abuse treatment service utilization, and satisfaction compared to the control condition. Male and female recidivists with drinking problems and not currently engaged in DWI intervention were recruited, evaluated, and then randomly assigned to receive 1 of 2 manualized interventions: 30-minute BMI session or information-advice. Participants, interviewers, researchers, and statisticians were blind to assignment. Outcomes were changed in: percent of risky drinking days (i.e., > or =3 standard drinks/d for males; > or =2 for females) in the previous 6 months derived from the Timeline Followback, biomarkers of alcohol abuse (GGT, AST, ALT, MCV) by blood assay, and alcohol abuse-related behaviors using the MMPI-Mac scale. Data from the Readiness to Change Questionnaire, a substance abuse service utilization questionnaire, and the Client Satisfaction Scale were also collected. Analyses revealed significant declines in risky drinking with both interventions. BMI (n = 92) resulted in a 25% reduction in risky drinking days at 12-month follow-up, which compared to the control intervention (n = 92) represented a significant decline from 6-month levels. Exposure to BMI also produced significantly greater improvement at 6-month follow-up in a biomarker of alcohol abuse and a behavioral measure related to recidivism risk. Exploration of readiness to change, substance abuse service utilization, and satisfaction with intervention indicated a perception of BMI being more useful in coping with problems. Brief MI approaches warrant further implementation and effectiveness research as an opportunistic DWI intervention strategy to reduce risks associated with alcohol use outside of clinical and DWI relicensing settings.