Group Motivational Interviewing Research Articles

0564 Group Motivational Interviewing to Improve APAP Adherence: A Quality Improvement Project

0564 Group Motivational Interviewing to Improve APAP Adherence: A Quality Improvement Project

Results from a pilot efficacy trial of a motivational interviewing substance use intervention for Latinx/e youth

AbstractWe conducted a pilot feasibility study to examine the efficacy of a culturally adapted Group Motivational Interviewing for Teens–alternative tobacco product (GMIT‐ATP) intervention among Latinx/e youth and whether, including caregivers, improved outcomes (GMIT‐ATP+P). Adolescents (ages 10–16) and their caregivers were randomized to two groups after completing baseline assessments: (1) GMIT‐ATP (N = 23) and (2) GMIT‐ATP+P (N = 32). Youth in both conditions attended three youth‐only sessions, and parents in the GMIT‐ATP+P condition attended three parent‐only sessions. Parents and youth completed measures before randomization, immediately after the intervention, and 3‐month post‐intervention. No significant differences were found when comparing conditions. However, adolescents’ reports of knowledge of the health effects of tobacco and ATP products increased from pre‐ to post‐intervention and remained stable at the 3‐month follow‐up. Culturally enhancing preventive interventions have positive effects within the Latinx/e community, and there is potential for long‐term sustainability.

Grouping motivational interviewing is only effective for younger patients with alcohol dependence in the rehabilitation stage.

Alcohol dependence (AD) is a risk factor for death and disability. Relapse prevention for AD has been exclusively dominated by psychotherapy intervention for many years. Our study aimed to investigate the efficacy of group motivational interviewing (MI) on the psychological craving for alcohol and depressive symptoms in AD patients in the rehabilitation phase, as well as the impact of age. The participants included 108 individuals with AD in the rehabilitation phase. All participants were assigned to the MI intervention group or the control group and were treated for 6weeks. The severity of psychological craving for alcohol was assessed by the Penn Alcohol Craving Scale (PACS), and psychological status was evaluated by the Hamilton Depression Rating Scale (HAMD). We found that group MI significantly reduced the psychological craving for alcohol in patients with AD in the rehabilitation phase (p < 0.05). In addition, when patients were divided into two groups according to their ages, we found that group MI interventions tended to be effective only in younger patients with AD, but not in older patients. Our findings provide further evidence that the efficacy of group MI interventions was influenced by the age of patients with AD in the rehabilitation stage.

Feasibility and acceptability of incorporating social network visualizations into a culturally centered motivational network intervention to prevent substance use among urban Native American emerging adults: a qualitative study

BackgroundCoupling social network visualizations with Motivational Interviewing in substance use interventions has been shown to be acceptable and feasible in several pilot tests, and has been associated with changes in participants’ substance use and social networks. The objective of this study was to assess acceptability and feasibility of an adaptation of this behavior change approach into a culturally centered behavior change intervention for American Indian/Alaska Native (AI/AN) emerging adults living in urban areas. AI/AN populations experience high rates of health disparities and substance use. Although 70% of AI/AN people live outside of tribal lands, there are few culturally tailored health interventions for these AI/AN populations. Social networks can both increase and discourage substance use. Leveraging healthy social networks and increasing protective factors among urban AI/AN emerging adults may help increase resilience.MethodsWe conducted thirteen focus groups with 91 male and female participants (32 urban AI/AN emerging adults ages 18–25, 26 parents, and 33 providers) and one pilot test of the three workshop sessions with 15 AI/AN emerging adults. Focus group participants provided feedback on a proposed workshop-based intervention curriculum that combined group Motivational Interviewing (MI) and social network visualizations. Pilot workshop participants viewed their own social networks during group MI sessions focused on substance use and traditional practices and discussed their reactions to viewing and discussing their networks during these sessions. We used a combination of open coding of focus group and workshop session transcripts to identify themes across the group sessions and content analysis of comments entered into an online social network interview platform to assess the extent that participants had an intuitive understanding of the information conveyed through network diagrams.ResultsFocus group and pilot test participants reacted positively to the intervention content and approach and provided constructive feedback on components that should be changed. Themes that emerged included feasibility, acceptability, relevance, understandability, and usefulness of viewing personal network visualizations and discussing social networks during group MI workshops. Workshop participants demonstrated an intuitive understanding of network concepts (network composition and structure) when viewing their diagrams for the first time.ConclusionsSocial network visualizations are a promising tool for increasing awareness of social challenges and sources of resilience for urban AI/AN emerging adults. Coupled with Motivational Interviewing in a group context, social network visualizations may enhance discussions of network influences on substance use and engagement in traditional practices.Trial Registration: ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020

Randomized controlled trial of group motivational interviewing for veterans with substance use disorders

BackgroundMotivational interviewing delivered in a group format is understudied yet promising as a treatment for substance use disorders (SUD). We evaluated the efficacy of group motivational interviewing (GMI) relative to a treatment-control (TCC) for enhancing treatment and self-help engagement and decreasing alcohol and drug use among veterans with SUD and co-existing psychiatric disorders. MethodVeterans (n = 118) with alcohol use disorder were recruited within an outpatient SUD treatment program and randomized to GMI or TCC upon program entry. Alcohol use, SUD treatment, and 12-step session attendance were primary outcomes. Drug use days was the secondary outcome. Participants were assessed at baseline and at one-and three-month follow-up. ResultsSignificant differences were observed between GMI and TCC for binge drinking at both one (RR = .74; 95 % CI [.58, .94]) and three-month follow-up (RR = .74; 95 % CI [.59, .91]). At three-month follow-up, significant differences between treatment conditions were observed for alcohol use days (RR = .79; 95 % CI [.67, .94]), number of SUD treatment sessions (RR = 2.53; 95 % CI [1.99, 3.22]), and 12-step sessions attended (RR = 1.64; 95 % CI [1.35–1.98]). Similarly, we observed significant effects for GMI on reducing alcohol consumption in standard drinks (RR = .49; 95 % CI [.25, .95]). Drug use days declined at each follow-up, with no significant differences between treatment conditions. ConclusionsGMI delivered at SUD treatment program entry enhanced treatment session and 12-step group attendance and lowered alcohol consumption among outpatient Veterans. Future research should study how GMI works and its effectiveness in SUD treatment settings.

Do Brief Alcohol Interventions Reduce Driving After Drinking Among College Students? A Two-step Meta-analysis of Individual Participant Data.

AimsCollege students who drink are at an increased risk of driving after drinking and alcohol-involved traffic accidents and deaths. Furthermore, the persistence of driving after drinking over time underscores a need for effective interventions to prevent future drunk driving in adulthood. The present study examined whether brief alcohol interventions (BAIs) for college students reduce driving after drinking.MethodsA two-step meta-analysis of individual participant data (IPD) was conducted using a combined sample of 6801 college students from 15 randomized controlled trials (38% male, 72% White and 58% first-year students). BAIs included individually delivered Motivational Interviewing with Personalized Feedback (MI + PF), Group Motivational Interviewing (GMI), and stand-alone Personalized Feedback (PF) interventions. Two outcome variables, driving after two+/three+ drinks and driving after four+/five+ drinks, were checked, harmonized and analyzed separately for each study and then combined for meta-analysis and meta-regression analysis.ResultsBAIs lowered the risk of driving after four+/five+ drinks (19% difference in the odds of driving after drinking favoring BAIs vs. control), but not the risk of driving after two+/three+ drinks (9% difference). Subsequent subgroup analysis indicated that the MI + PF intervention was comparatively better than PF or GMI.ConclusionsBAIs provide a harm reduction approach to college drinking. Hence, it is encouraging that BAIs reduce the risk of driving after heavy drinking among college students. However, there may be opportunities to enhance the intervention content and timing to be more relevant for driving after drinking and improve the outcome assessment and reporting to demonstrate its effect.

A randomized controlled trial to compare group motivational interviewing to very brief advice for the effectiveness of a workplace smoking cessation counseling intervention

Background Studies show that smokers have a lower work performance due to time spent smoking, increased fatigue perception and are more absent from work due to smoking-related diseases. The workplace could represent an important location to promote smoking cessation. Methods This study is a multi-center, controlled trial for smoking cessation counseling at the participants’ workplace, where 656 randomized participants received four sessions of group motivational interviewing or four sessions of very brief advice and were followed up for 52 weeks. Results The Continuous Quit Rate (CQR) was higher for the smoking cessation counseling group than for the very brief advice group during weeks 9 to 12 (17.5% vs. 3.6%) weeks 9 to 24 (13.4% vs. 3.4%) and weeks 9 to 52 (10.3% vs. 3.1%). Conclusions This study demonstrated that motivational interviewing is an efficacious smoking cessation approach for smokers at their workplace. The short-term and long-term cessation rate of the intervention of the smoking cessation counseling group exceeded that of very brief advice.

Adapting Mindfulness to Engage Latinos and Improve Mental Health in Primary Care: a Pilot Study

Latinos comprise a sizeable and growing population that experiences unmet health needs and health inequities. Mindfulness-based interventions may be a cost-effective way to address mental health problems in primary care. We sought to adapt a mindfulness-based intervention to better serve and improve the mental health of Latinos in the primary care setting. The authors employed a unique set of adaptations to increase retention and engagement of Latinos in a mindfulness-based stress reduction (MBSR) intervention. These adaptations included (1) group motivational interviewing, (2) problem-solving barriers to retention, (3) a testimonial by a prior Latino MBSR participant, and (4) modifications to increase perceived applicability of MBSR for Latinos. Thirty Latino participants were recruited for an 8-week mindfulness intervention adapted (MBSR-A) specifically for Latino populations. Twenty-six out of thirty (87%) participants completed at least five of the eight sessions, which was significantly greater than in previous studies targeting Latino participants (60–66%). Of those who completed and provided pre- and post-data, there were decreases in anxiety and depression, and increases in measures of general mental health and physical health. The adaptations utilized in this pilot study may increase retention and engagement of Latinos in mindfulness-based interventions and may be a cost-effective way to reduce mental health problems in this growing population.

Comparison of group motivational interviewing and multimedia education on elderly lifestyle.

BACKGROUND:Many of the problems caused by aging can be delayed and the health of the elderly maintained by improving and applying a healthy lifestyle during old age. Therefore, the researcher has designed and implemented a study aimed “compare the impact of group motivational interviews with multimedia education on improving lifestyle in the elderly.”METHODS:This study is triple blind before and after clinical trial was performed on three groups of thirty (n = 90) of the elderly with mean age 63.41 ± 6.88 who were members of the elderly centers of Tehran city neighborhoods with average to unfavorable lifestyle score. The first test group was subjected to group motivational interviewing during five sessions. The second test group was subjected to distant multimedia training. No training was given to the third group as the control group. After 3 months, the lifestyle questionnaire was completed in three groups. The results were analyzed by these techniques as statistical tests such as mean, standard deviation, relative frequency, and absolute frequency were used. The inferential statistical tests such as paired t-test and one-way ANOVA were used, respectively, to compare the pre- and post-mean scores and in each group and compare the mean scores of lifestyle dimensions in three groups.RESULTS:Both motivational interviewing and multimedia education have been effective in changing the lifestyle of the elderly, but according to the findings, motivational interviewing has a greater impact on elderly lifestyle. The total lifestyle score in four areas such as nutrition, self-care, mental health, and physical activity was significantly different in the three groups after the intervention (P < 0.001).CONCLUSIONS:Each educational program can somehow improve behavioral skills in individuals. Effective teaching methods should address the learning difficulties and inability to learn during the aging period. The results of this study can be a step toward the elaboration of strategies for education and promotion of healthy lifestyle in the elderly.

The potential of a self-assessment tool to identify healthcare professionals\u2019 strengths and areas in need of professional development to aid effective facilitation of group-based, person-centered diabetes education

BackgroundHealthcare professionals’ person-centered communication skills are pivotal for successful group-based diabetes education. However, healthcare professionals are often insufficiently equipped to facilitate person-centeredness and many have never received post-graduate training. Currently, assessing professionals’ skills in conducting group-based, person-centered diabetes education primarily focus on experts measuring and coding skills on various scales. However, learner-centered approaches such as adequate self-reflective tools have been shown to emphasize professional autonomy and promote engagement. The aim of this study was to explore the potential of a self-assessment tool to identify healthcare professionals’ strengths and areas in need of professional development to aid effective facilitation of group-based, person-centered diabetes education.MethodsThe study entails of two components: 1) Field observations of five different educational settings including 49 persons with diabetes and 13 healthcare professionals, followed by interviews with 5 healthcare professionals and 28 persons with type 2 diabetes. 2) One professional development workshop involving 14 healthcare professionals. Healthcare professionals were asked to assess their person-centered communication skills using a self-assessment tool based on challenges and skills related to four educator roles: Embracer, Facilitator, Translator, and Initiator. Data were analyzed by hermeneutic analysis. Theories derived from theoretical model ‘The Health Education Juggler’ and techniques from ‘Motivational Interviewing in Groups’ were used as a framework to analyze data. Subsequently, the analysis from the field notes and interview transcript were compared with healthcare professionals’ self-assessments of strengths and areas in need to effectively facilitate group-based, person-centered diabetes education.ResultsHealthcare professionals self-assessed the Translator and the Embracer to be the two most skilled roles whereas the Facilitator and the Initiator were identified to be the most challenged roles. Self-assessments corresponded to observations of professional skills in educational programs and were confirmed in the interviews.ConclusionHealthcare professionals self-assessed the same professional skills as observed in practice. Thus, a tool to self-assess professional skills in facilitating group-based diabetes education seems to be useful as a starting point to promote self-reflections and identification of healthcare professionals’ strengths and areas of need of professional development.

Group motivational interviewing for homeless young adults: Associations of change talk with substance use and sexual risk behavior.

Homeless young adults exhibit high rates of alcohol and other drug (AOD) use and sexual risk behaviors. This study is a secondary analysis of data collected in a randomized clinical trial of AWARE, a new 4 session group motivational interviewing intervention. AWARE mainly focused on alcohol use and sexual risk behavior given focus group feedback. We used sequential coding to analyze how the group process affected both AOD use and sexual risk behavior at 3-month follow up among homeless young adults by examining facilitator behavior and participant change talk (CT) and sustain talk (ST). We analyzed 57 group session digital recordings of 100 youth (69% male, 74% heterosexual, 28% non-Hispanic white, 23% African American, 26% Hispanic, 23% multiracial/other; mean age 21.75). Outcomes included importance and readiness to change AOD use and risky sexual behavior, AOD use and consequences, number of partners and unprotected sex, and condom self-efficacy. Sequential analysis indicated that facilitator open-ended questions and reflections of CT increased Group CT. Group CT was associated with a lower likelihood of being a heavy drinker 3 months later; Group ST was associated with decreased readiness and confidence to change alcohol use. There were no associations with CT or ST for drug use or risky sexual behavior. Facilitator speech and peer responses were related to CT and ST during the group sessions with this high risk population, which were then associated with individual changes for alcohol use. Further research is needed to explore associations with drug use and sexual risk behavior. (PsycINFO Database Record

The cost-effectiveness and return-on-investment of a combined social and physical environmental intervention in office employees

This study explored the cost-effectiveness and return-on-investment of a combined social and physical environmental worksite health promotion program compared with usual practice, and of both intervention conditions separately. Participants were randomized to the combined intervention (n = 92), social environmental intervention (n = 118), physical environmental intervention (n = 96), or control group (n = 106). The social environmental intervention consisted of group motivational interviewing and the physical environmental intervention of workplace modifications. Both interventions were aimed at improving physical activity and relaxation. Effects included need for recovery (NFR), general vitality and job satisfaction. Cost-effectiveness analyses were performed from the societal and employer's perspective, and return-on-investment analyses from the employer's perspective. Compared with usual practice, the combined intervention was significantly more effective in improving NFR (-8.4;95% CI:-14.6;-2.2) and significantly more expensive to the employer (3102; 95%CI:598;5969). All other between-group differences were non-significant. For NFR, the combined intervention became the preferred option at willingness-to-pays of ≥€170/point improvement (society) and ≥€300/point improvement (employer). For general vitality and job satisfaction, the interventions' maximum probabilities of cost-effective were low (≤0.55). All interventions had a negative return-on-investment. The combined intervention may be cost-effective for NFR depending on the decision-makers' willingness-to-pay. Both separate interventions are not cost-effective for NFR. All interventions were neither cost-effective for general vitality and job satisfaction, nor cost-saving to the employer.

P.6.c.018 - Treating heroin addiction: a genetic approach in predicting outcome of replacement therapy

Craving is one of the important factors having an effective role in the addiction relapse. As an important factor in the therapy failure, this clinical phenomenon has to be diagnosed and treated.The present research aimed at determining the efficacy of group motivational interviewing in the degree of drug craving in the addicts under the Methadone Maintenance Treatment (MMT).This is a quasi-experimental study carried out on 100 addicted men (aged 18–50 years), who were under the MMT in a drug abstinence clinic affiliated with University of Medical Sciences (Iran) in the second half of 2014. The research sample was selected by the availability criteria based on the inclusion and exclusion criteria, and upon matching, it was divided randomly into two groups of 50 (control and treatment). The treatment group first received 5 sessions of group motivational counseling; then it entered the therapy process. The control group received the usual treatment of the drug abstinence clinic. To assess the drug craving degree (in the pretest, 2, 6 and 12 months after the abstinence), the Visual Cue-induced Craving Task, scored 0 to 100, was used. The data were analyzed by the descriptive statistics through independent t-test, and repeated measures analysis of variance.The means of craving degrees in the control group, 2, 6 and 12 months after the abstinence (73.28 ± 7.52, 65.83 ± 6.69 and 61.25 ± 5.17, respectively) were significantly (p = 0.0001) higher than those in the treatment group (68.94 ± 10.53, 40.48 ± 11.78 and 32.51 ± 9.00). Moreover, the mean of retention in the treatment was 9.24 ± 2.45 months in the treatment group that was significantly (p = 0.001) higher than the 4.88 ± 3.65 months of retention in the control group.The research results support the fact that motivational interviewing decreases the degree of drug craving, and increases the probability of the addicts' retention in long-term therapeutic abstinence programs. Therefore, the use of such an approach as a pretreatment and a complementary therapy in changing health behaviors is recommended.

Group motivational interviewing in schools: Development of a health promotion intervention

Objective: In the light of the shortcomings of curriculum-based health promotion in secondary schools, group motivational interviewing provides a potential alternative approach. This two-phase study set out to establish the key components, feasibility and acceptability of a group motivational interviewing intervention, focused on alcohol consumption. Methods: In phase 1, focus groups with 12 students and 8 teachers explored issues with existing health education in Wales. Phase 2 involved the development of a 1-hour group motivational interviewing session to address the issues raised. The session was delivered to two classes of students aged 13–15 years, facilitated by two motivational interviewing practitioners. Sessions were observed and audio-recorded and coded by two researchers using the Assessment of Motivational Interviewing Groups Observer Scale (AMIGOS). Student acceptability of the session was captured using a satisfaction questionnaire. Results: Sessions were consistent with motivational interviewing principles, providing empathic and focused discussion while maximising participants’ autonomy and strengths. The majority of students felt listened to during the session, considered it was helpful and felt that they could learn more from this kind of experience. Conclusion: A group motivational interviewing session, developed based on key components identified during focus groups, was shown to be acceptable to students and feasible to deliver in secondary schools. The approach requires further research to establish sustainable delivery mechanisms.

Motivational Interviewing in Groups by C. C. Wagner and K. S. Ingersoll (review)

Motivational Interviewing in Groups by C. C. Wagner and K. S. Ingersoll (review)

Group motivational interviewing in the Small Changes weight management project: a quasi-experimental trial

Background - Motivational interviewing has been recommended as an effective counselling intervention for weight management with overweight and obese individuals. Nevertheless, there is a paucity of research for the use of motivational interviewing in weight management groups and research in the area often lacks sufficient 'treatment fidelity', failing to accurately report the consistency, style, content and competence of those delivering the intervention. The current study examined the efficacy of the Small Changes weight management programme comparing motivational interviewing in groups to treatment as usual. Methods - Those in the motivational interviewing group intervention received 12 sessions of 2 hours, which comprised 9 group and 3 one to one sessions over 12 months. The motivational interviewing group were treated in a motivational interviewing consistent manner throughout; for example, change talk was identified, evoked and strengthened via specific micro-skills such as open questions, affirmations and reflections. In the treatment as usual group, subjects also received 9 group and 3 one to one sessions over a 12 month period. The treatment as usual group were required to self-select a 'Small Change' at each meeting with the facilitator. All subjects were measured at five time points: baseline, 3, 6, 9 and 12 months, outcome measures included: weight, body mass index, body-fat percentage, waist to hip ratio, number of minutes of daily physical activity, fruit and vegetable consumption and feelings of well-being. A treatment fidelity framework was applied to the motivational interviewing groups' intervention to ensure a consistent, reliable and reproducible approach. Results - After 12 months, improvements were shown for all variables measured in the motivational interviewing groups; only the composite measure of physical and psychological wellbeing improved statistically in the treatment as usual groups, . When comparing approaches: significant differences were found between motivational interviewing and treatment as usual in favour of the motivational interviewing intervention for mean percentage change in weight and body mass index but not for % body fat, waist to hip ratio, fruit and vegetable consumption, feelings of well-being or physical activity levels. The retention rates in the motivational interviewing groups were higher with 64% of subjects returning for the 12 month outcome measures versus 14% in the treatment as usual groups. Conclusions - This study indicates improvements to weight loss outcome measures after 12 months for an intervention implementing motivational interviewing for weight management groups when compared to an existing weight management programme. Future research is needed to establish the empirical basis for the use of motivational interviewing for weight management groups, with heterogeneity of dose and treatment fidelity as essential features. Keywords : Motivational interviewing, treatment fidelity, weight management

Text message content preferences to improve buprenorphine maintenance treatment in primary care

ABSTRACTFew studies have evaluated text message content preferences to support evidence-based treatment approaches for opioid use disorders, and none in primary care office-based buprenorphine treatment settings. This study assessed the acceptability and preferences for a tailored text message intervention in support of core office-based buprenorphine treatment medical management components (e.g., treatment adherence, encouraging abstinence, 12-step group participation, motivational interviewing, and patient-provider communication as needed). There were 97 patients enrolled in a safety net office-based buprenorphine treatment program who completed a 24-item survey instrument that consisted of multiple-choice responses, 7-point Likert-type scales, binomial “Yes/No” questions, and open-ended responses. The sample was predominately male (81%), had an average age of 46 years, and was diverse (64% ethnic/racial minorities); 56% lacked stable employment. Respondents were interested in receiving text message appointment reminders (90%), information pertaining to their buprenorphine treatment (76%), supportive content (70%), and messages to reduce the risk of relapse (88%). Participants preferred to receive relapse prevention text messages during all phases of treatment: immediately after induction into buprenorphine treatment (81%), a “few months” into treatment (57%), and after discontinuing buprenorphine treatment (72%). Respondents also expressed interest in text message content enhancing self-efficacy, social support, and frequent provider communication to facilitate unobserved “home” induction with buprenorphine. Older participants were significantly less receptive to receiving text message appointment reminders; however, they were as interested in receiving supportive, informational, and relapse prevention components compared to younger respondents. Implications for integrating a text message support system in office-based buprenorphine treatment are discussed.

Temporal variation in facilitator and client behavior during group motivational interviewing sessions.

There is considerable evidence for motivational interviewing (MI) in changing problematic behaviors. Research on the causal chain for MI suggests influence of facilitator speech on client speech. This association has been examined using macro (session-level) and micro (utterance-level) measures; however, effects across sessions have largely been unexplored, particularly with groups. We evaluated a sample of 129 adolescent Group MI sessions, using a behavioral coding system and timing information to generate information on facilitator and client speech (CT; change talk) within 5 successive segments (quintiles) of each group session. We hypothesized that facilitator speech (open-ended questions and reflections of CT) would be related to subsequent CT. Repeated measures analysis indicated significant quadratic and cubic trends for facilitator and client speech across quintiles. Across quintiles, cross-lagged panel analysis using a zero-inflated negative binomial model showed minimal evidence of facilitator speech on client CT, but did indicate several effects of client CT on facilitator speech, and of client CT on subsequent client CT. Results suggest that session-level effects of facilitator speech on client speech do not arise from long-duration effects of facilitator speech; instead, we detected effects of facilitator speech on client speech only at the beginning and end of sessions, when open questions, respectively, suppressed and enhanced client expressions of CT. Findings suggest that clinicians must remain vigilant to client CT throughout the group session, reinforcing it when it arises spontaneously and selectively employing open-ended questions to elicit it when it does not, particularly toward the end of the session.

Efficacy of Group Motivational Interviewing in the Degree of Drug Craving in the Addicts Under the Methadone Maintenance Treatment (MMT) in South East of Iran

Craving is one of the important factors having an effective role in the addiction relapse. As an important factor in the therapy failure, this clinical phenomenon has to be diagnosed and treated. The present research aimed at determining the efficacy of group motivational interviewing in the degree of drug craving in the addicts under the Methadone Maintenance Treatment (MMT). This is a quasi-experimental study carried out on 100 addicted men (aged 18-50 years), who were under the MMT in a drug abstinence clinic affiliated with University of Medical Sciences (Iran) in the second half of 2014. The research sample was selected by the availability criteria based on the inclusion and exclusion criteria, and upon matching, it was divided randomly into two groups of 50 (control and treatment). The treatment group first received 5 sessions of group motivational counseling; then it entered the therapy process. The control group received the usual treatment of the drug abstinence clinic. To assess the drug craving degree (in the pretest, 2, 6 and 12 months after the abstinence), the Visual Cue-induced Craving Task, scored 0 to 100, was used. The data were analyzed by the descriptive statistics through independent t-test, and repeated measures analysis of variance. The means of craving degrees in the control group, 2, 6 and 12 months after the abstinence (73.28 ± 7.52, 65.83 ± 6.69 and 61.25±5.17, respectively) were significantly (p=0.0001) higher than those in the treatment group (68.94 ± 10.53, 40.48 ± 11.78 and 32.51 ± 9.00). Moreover, the mean of retention in the treatment was 9.24 ± 2.45 months in the treatment group that was significantly (p=0.001) higher than the 4.88 ± 3.65 months of retention in the control group. The research results support the fact that motivational interviewing decreases the degree of drug craving, and increases the probability of the addicts' retention in long-term therapeutic abstinence programs. Therefore, the use of such an approach as a pretreatment and a complementary therapy in changing health behaviors is recommended.

Development and Implementation of CHOICES Group to Reduce Drinking, Improve Contraception, and Prevent Alcohol-Exposed Pregnancies in American Indian Women

Public health officials assert that prevention of alcohol-exposed pregnancies (AEP) should begin before conception, by reducing alcohol consumption in women at-risk for or planning pregnancy, and/or preventing pregnancy in women who are drinking at risky levels. One such effort is the Oglala Sioux Tribe (OST) CHOICES Program. While the OST CHOICES Program has been successfully implemented, a community-based needs assessment determined that the OST CHOICES intervention should expand and be delivered in a group setting using group motivational interviewing (MI) techniques. After extensive group MI and CHOICES group trainings, recruitment for CHOICES Group began and within a ten month period, a total of twelve groups with non-pregnant American Indian women were held for this pilot intervention. Evaluations completed by participants indicated that CHOICES Group sessions positively engaged members, had low levels of anger or tension, and had average levels of avoidance of personal responsibility. An evaluation of the CHOICES Group leaders indicated strengths in certain MI skills, although improvement is needed in some core MI and group leadership skills. This is an important expansion of a successful AEP prevention program (CHOICES), as well as a novel application of MI, and recommendations and future plans for this intervention are outlined.