Sessions Of Motivational Enhancement Therapy Research Articles

Sociodemographic Characteristics and Clinical Profile of Inpatients in the Psychiatry Unit of a Tertiary Care Hospital in Assam: A Retrospective Study

Objectives Recent years have seen a significant evolution in the understanding pertaining to mental health issues. The analysis of the intricate interplay between an individual’s sociodemographic factors, genetic makeup, the environment, and clinical profile (diagnosis and treatment) of patients will help us understand the prevalence and types of mental health disorders prevalent in Assam, which is a culturally, ethnically and socially diverse state. The pattern of utilization of electroconvulsive therapy has also been analyzed. The aims and objectives of the study is to analyze the sociodemographic characteristics and clinical profile of patients admitted in Psychiatry ward, Assam Medical College and Hospital. Material and Methods An analysis on the case records of all individuals admitted to the hospital’s Psychiatry ward between August 1, 2022 and July 31, 2023 was done. Data on socio-demographic details such as age, gender, domicile and clinical profile (diagnosis, mode of discharge, duration of stay and treatment) was compiled using semi-structured format designed by authors. Information regarding patients undergoing electroconvulsive therapy was also gathered from the records. Statistical analysis: The data were subjected to analysis utilizing the Statistical Package for Social Sciences (IBM SPSS Statistics for Windows, version 25.0). Results A total of 680 patients got admitted of which higher proportion constituted of male (77.58%) and majority individuals were aged between 30 and 39 years (29.65%). The predominant diagnosis among the inpatients was substance use disorders (39.09%). Out of all the psychotropic drugs, olanzapine (17.94%) was mostly prescribed on discharged followed by risperidone (10.15%). Escitalopram (3.97%) was the mostly prescribed antidepressant on discharge. Patients diagnosed as substance use disorders were mostly discharged on lorazepam (5%), baclofen (14.26%) and received an average number of 1.8 sessions of Motivational Enhancement Therapy (MET). Whereas, schizophrenia and related disorders was the most common diagnosis among inpatients receiving ECT (51.52%). Conclusion Our study helped to understand the socio-demographic attributes and clinical profile of the inpatients to foster better management approaches.

The effectiveness of mobile-based ecological momentary motivational enhancement therapy in reducing craving and severity of cannabis use disorder: Study protocol for a randomized controlled trial

ObjectiveThis study aims to investigate the effectiveness of Ecological Momentary Motivational Enhancement Therapy (EM-MET) in reducing craving and severity of Cannabis Use Disorder (CUD) among young adults. MethodsThis multicenter, single-blinded randomized controlled trial (RCT) will be conducted over a period of 11 weeks. Eighty patients with CUD will be randomly assigned to two equal-sized parallel groups, either the Motivational Enhancement Therapy (MET) group or the EM-MET group. All participants will receive four individual face-to-face sessions of MET (twice a week). The MET group will not receive any other treatments after these sessions; however, in the EM-MET group, the top triggers of patients will be assessed using mobile-based Ecological Momentary Assessment (EMA) five times a day within three weeks (after face-to-face sessions) and they will receive a call from the therapist who provides them with EM-MET (in the form of an emergency telephone helpline) as soon as they report experiencing triggers of cannabis use that are assessed using EMA in their everyday lives. Primary outcomes including CUD severity and the severity of craving will be evaluated using the Leeds Dependence Questionnaire and the Self-efficacy and Temptation Scale, respectively. These assessments will be conducted at pre-treatment, post-treatment, and a six-week follow-up. DiscussionIf proven feasible and effective, the results of this study will offer clinicians an evidence-based treatment approach to address craving and dependency in patients with CUD. Moreover, these patients will receive effective treatment in real time and in real life, when and where it is most needed. However, it is important to consider the limitations of this study, such as the specific population studied in Tehran, Iran, which may affect the generalizability of the results. Nevertheless, the implementation of Ecological Momentary Interventions (EMIs) in real-life settings holds promise for timely and effective treatment.Trial registration: This trial was registered in the Iranian Registry of Clinical Trials on 21 February 2023. Registry No. IRCT20221224056908N1.

Trait mindfulness and cannabis use–related factors in adolescents and young adults with frequent use

Background: Mindfulness-based interventions (MBIs) are effective in adult substance-use treatment and may be helpful for adolescents and young adults (AYAs). One target of MBIs is to improve trait mindfulness, which has been associated with better lifestyle and health outcomes. To inform MBIs for reducing cannabis use in AYAs, we sought to identify how trait mindfulness was associated with cannabis-related problems and quit attempts, as well as with motivation to change use in youth who report frequent use. Methods: Participants aged 15–24 years using cannabis ≥ 3x/week were recruited from AYA clinics in a northeastern US city to participate in a cannabis-use intervention pilot, randomized trial. At baseline, we assessed cannabis-use history, problems associated with use, attempts to quit, and trait mindfulness. All participants were offered two sessions of motivational enhancement therapy, during which they rated motivation to quit cannabis. Regression analyses were conducted to assess associations between trait mindfulness and cannabis use–related problems, attempts to quit, and motivation to change. Results: Seventy participants, mean age 20.7 ± 1.9 years, enrolled. Sixty percent identified as female, 47% as Black non-Hispanic, and 31% as Hispanic. Participants started using cannabis at mean age 15.0 ± 2.8 years and were using ≥ 3x/week by 17.0 ± 2.3 years. Higher mindfulness scores were associated with fewer cannabis-related problems (p = 0.004) and fewer quit attempts (p = 0.035). The number of cannabis-related problems did not significantly mediate the relationship between mindfulness and quit attempts. Trait mindfulness did not predict motivation to change cannabis use. Conclusions: Among AYAs using cannabis frequently, higher trait mindfulness was associated with both fewer cannabis use-–related problems and fewer quit attempts. Future research should assess whether trait mindfulness is an appropriate target for decreasing cannabis use and the utility of MBIs for reducing cannabis-use behaviors.

Efficacy of the Motivational Interviewing-Walk Intervention for Chemotherapy-Induced Peripheral Neuropathy and Quality of Life During Oxaliplatin Treatment: A Pilot Randomized Controlled Trial.

Oxaliplatin-induced peripheral neuropathy (OIPN) is prevalent among gastrointestinal cancer survivors and often impairs quality of life (QOL). This pilot randomized controlled trial aimed to explore the effect of an 8-week home-based brisk walking (the "MI-Walk") intervention on (1) OIPN severity and (2) QOL at 8 weeks, compared with physical activity (PA) education alone in oxaliplatin-receiving adults with gastrointestinal cancer. Participants (N = 57) recruited from 5 infusion sites received PA education at their second oxaliplatin visit, followed by phone assessments of adverse events over 8 weeks. Half (n = 29) received additional MI-Walk intervention motivational supports (eg, a Fitbit Charge 2 and motivational enhancement therapy sessions). Self-reported OIPN, QOL, and PA were measured before and after intervention. The intervention compared with the control condition had no effect on sensory OIPN (mean difference [] = -0.01; P > .99), motor OIPN (=2.39; P = .17), and QOL (= -1.43; P > .99). Eight-week sensory (=11.48 ± 0.38) and motor OIPN severities ( = 7.48 ± 0.36) were mild but higher than baseline (P ≤ .01). Self-reported PA level increased over time in both groups (=44.85; P = .01). Averaging ≥225 moderate to vigorous PA minutes per week led to less sensory OIPN, particularly finger/hand tingling (= -26.35; P = .01). This study failed to detect beneficial effects of the MI-Walk intervention; however, the findings suggest that aerobic walking may blunt but not completely prevent OIPN. Further research is necessary. Although the effectiveness of brisk walking in reducing OIPN is unclear, this study supports prior evidence that moderate to vigorous PA is beneficial and safe during chemotherapy treatment.

Is fidelity to motivational interviewing associated with alcohol outcomes in treatment-seeking 60+ year-old citizens?

BackgroundPart of the variability in treatment outcomes for Motivational Interviewing (MI) may be explained by differences in the fidelity to MI. The Motivational Interviewing Treatment Integrity manual version 4 (MITI 4) is an improved measure of fidelity to elements of MI. It is not known whether the fidelity to MI, as measured by the MITI 4, is related to treatment outcome. ObjectivesTo examine whether fidelity to MI is associated with alcohol use outcomes – predictive validity of the MITI 4. MethodTwenty percent of the recorded sessions at the Danish sites of the Elderly Study were randomly drawn and coded for fidelity to MI with the MITI 4. The Elderly Study was an international, randomized controlled trial, in which people 60 years or older with Alcohol Use Disorders received either four weeks of Motivational Enhancement Therapy (MET) or four weeks of MET combined with up to eight additional sessions of the Community Reinforcement Approach- Senior (MET+CRA-S). Elements of MI and summary scores of the MITI 4 were used as predictors in a mixed effects regression analysis. Treatment outcomes were use of alcohol and consequences of drinking at 26-weeks follow-up. ResultsIn total, 423 sessions representing 238 participants were randomly drawn and coded for fidelity to MI. Mean values of the treatment elements indicated high fidelity to MI, with higher fidelity to MI in the MET sessions, as compared to CRA-S sessions. None of the predictors in the multilevel model analyses were associated with outcome at follow-up. Exploratory analysis indicated reverse associations between one measure of MI-fidelity and drinking outcomes in the combined treatment (CRAS). ConclusionThe fidelity of the MI intervention, received by participants in this study, did not predict better treatment outcomes. MI may be less effective in populations which are already committed to change behavior. As expected and validating for the MITI 4, fidelity to MI-elements was lower in the combination of MI with other treatment approaches. Additionally, the timing of MI in these combined settings might be important for effectiveness.

Lessons learned from measuring fidelity with the Motivational Interviewing Treatment Integrity code (MITI 4)

Background and aimsThe Motivational Interviewing Treatment Integrity code (MITI) measures fidelity to, and the quality of, Motivational Interviewing (MI), and can also be used when MI is combined with other treatment methods. The current study presents a fidelity measurement with the MITI 4.2.1, in both Motivational Enhancement Therapy sessions and the combined Community Reinforcement Approach-Senior (CRAS). MethodThe MITI 4.2.1 was used to evaluate treatment sessions provided in the Elderly Study, a multi-national randomized trial evaluating treatment for alcohol use disorders in the elderly. Following expert recommendations, training was conducted at two international sites as well as at the Danish site. Twenty percent of the sessions at the Danish study site were rated. Twelve percent were multiply rated by all raters. Interrater reliability was assessed by the Intraclass Correlations Coefficient (ICC). ResultsMean ICC of the 52 sessions rated by all raters was 0.78 (95% CI: 0.70; 0.86). The rare measures confront and emphasize autonomy, and the global measure softening sustain talk only reached fair levels of ICC, while the remaining measures were good or excellent. In the sessions of MI combined with other treatment approaches in the CRAS, the MITI 4.2.1 has a similar reliability as in MET sessions only, except for the measure persuade with permission. ConclusionThe MITI 4.2.1 is a reliable instrument for measuring fidelity to Motivational Interviewing elements, also in the context of Community Reinforcement Approach Senior. However, in softening sustain talk, the rare measures, and persuade with permission it has proved more difficult to reach high levels of interrater reliability.

Effectiveness and Cost-effectiveness of Opportunistic Screening and Stepped-care Interventions for Older Alcohol Users in Primary Care.

To compare the clinical effectiveness and cost-effectiveness of a stepped-care intervention versus a minimal intervention for the treatment of older hazardous alcohol users in primary care. Multi-centre, pragmatic RCT, set in Primary Care in UK. Patients aged ≥ 55 years scoring ≥ 8 on the Alcohol Use Disorders Identification Test were allocated either to 5-min of brief advice or to 'Stepped Care': an initial 20-min of behavioural change counselling, with Step 2 being three sessions of Motivational Enhancement Therapy and Step 3 referral to local alcohol services (progression between each Step being determined by outcomes 1 month after each Step). Outcome measures included average drinks per day, AUDIT-C, alcohol-related problems using the Drinking Problems Index, health-related quality of life using the Short Form 12, costs measured from a NHS/Personal Social Care perspective and estimated health gains in quality adjusted life-years measured assessed EQ-5D. Both groups reduced alcohol consumption at 12 months but the difference between groups was small and not significant. No significant differences were observed between the groups on secondary outcomes. In economic terms stepped care was less costly and more effective than the minimal intervention. Stepped care does not confer an advantage over a minimal intervention in terms of reduction in alcohol use for older hazardous alcohol users in primary care. However, stepped care has a greater probability of being more cost-effective. Current controlled trials ISRCTN52557360. A stepped care approach was compared with brief intervention for older at-risk drinkers attending primary care. While consumption reduced in both groups over 12 months there was no significant difference between the groups. An economic analysis indicated the stepped care which had a greater probability of being more cost-effective than brief intervention.

The Starting Treatment for Ethanol in Primary care Trials (STEP Trials): Protocol for Three Parallel Multi-Site Stepped Care Effectiveness Studies for Unhealthy Alcohol Use in HIV-Positive Patients

Unhealthy alcohol use is common among HIV-positive patients, yet effective evidence-based treatments are rarely provided in clinical settings providing HIV care. Further, given patient variability in response to initial treatments, stepped care approaches may be beneficial. We describe the rationale, aims and study design for the current StartingTreatment forEthanol inPrimary care Trials (STEP Trials); three parallel randomized controlled effectiveness trials being conducted in five Infectious Disease Clinics. Participants meeting criteria for: 1) at-risk drinking, 2) moderate alcohol use with liver disease (MALD), or 3) alcohol use disorder (AUD) are randomized to integrated stepped care versus treatment as usual. For those with at-risk drinking or MALD, integrated stepped care starts with a one session brief intervention and follow-up 2-week telephone booster. Based on pre-specified nonresponse criteria, participants may be “stepped up” at week 4 to receive four sessions of motivational enhancement therapy (MET) and “stepped up” again at week 12 for addiction physician management (APM) and consideration of alcohol pharmacotherapy. For those with AUD, integrated stepped care begins with APM. Non-responders may be “stepped up” at week 4 to receive MET and again at week 12 for a higher level of care (e.g. intensive outpatient program). The primary outcome is alcohol consumption assessed at 24weeks, and secondary outcome is the VACS Index, a validated measure of HIV morbidity and mortality risk. Results from the STEP Trials should inform future research and the implementation of interventions to address unhealthy alcohol use among HIV-positive individuals.

Augmenting brief interventions for adolescent marijuana users: The impact of motivational check-ins.

Brief interventions for adolescent marijuana users offered in schools reach users who would not otherwise present for treatment. The current study builds on previous trials of a school-based, 2-session motivational enhancement therapy (MET) intervention by adding periodic, brief motivational check-ins to reinforce gains and bolster motivation. Adolescent participants were randomly assigned to a motivational check-in (MCI; n = 128) or assessment-only check-in (ACI; n = 124) comparison condition. Both conditions received 2 sessions of MET. Participants in the MCI condition then attended 3 MET-based check-in sessions at 4, 7, and 10 months after baseline, whereas the ACI condition participants attended assessment-only check-ins at the same time points. Optional cognitive behavior therapy (CBT) sessions were available as needed for 12 months from baseline in both conditions. Outcomes were assessed at 6, 9, 12, and 15 months after baseline. Participants (59% Caucasian; 68% male; mean age = 15.84) reported using marijuana on an average of 37 of the last 60 days, and 70% met diagnostic criteria for a marijuana use disorder. Both conditions were associated with reduced use and negative consequences that were sustained throughout the 15 months of follow-up. The MCI condition resulted in greater reductions at the 6 months follow-up, but differences between conditions were not found at later follow-ups, and MCI participation did not increase engagement in CBT as predicted. Results replicated the efficacy of the brief intervention for adolescent marijuana use and provided mixed evidence on the utility of adding repeated check-in sessions. (PsycINFO Database Record

A randomized controlled trial of brief interventions for problem gambling in substance abuse treatment patients.

This study evaluated the efficacy of brief gambling treatments in patients attending substance abuse treatment clinics. Substance abuse treatment patients with gambling problems (N = 217) were randomly assigned to a 10- to 15-min brief psychoeducation gambling intervention; a 10- to 15-min brief advice intervention addressing gambling norms, risk factors, and methods to prevent additional problems; or 4 50-min sessions of motivational enhancement therapy plus cognitive behavior therapy for reducing gambling (MET + CBT). Gambling and related problems were assessed at baseline and throughout 24 months. In the sample as a whole, days and dollars wagered and gambling problems decreased markedly from baseline through Month 5; thereafter, reductions in dollars wagered and gambling problems continued to decrease modestly but significantly, and days gambled remained constant. Brief advice significantly reduced days gambled between baseline and Month 5 relative to brief psychoeducation. The MET + CBT condition engendered no benefit beyond brief advice in terms of days gambled but did lead to more precipitous reductions in dollars gambled and problems experienced in the initial 5 months, and greater clinically significant improvements in gambling in both the short and long term. MET + CBT also resulted in initial decreases in self-reported alcohol use and problems but did not differentially impact self-reported illicit drug use or submission of positive samples. Gambling problems tend to dissipate over time regardless of the intervention applied, but offering MET + CBT was more efficacious in decreasing gambling than providing a brief single session intervention. (PsycINFO Database Record

Change in motives among frequent cannabis-using adolescents: Predicting treatment outcomes

BackgroundHeavy cannabis use has been associated with negative outcomes, particularly among individuals who begin use in adolescence. Motives for cannabis use can predict frequency of use and negative use-related problems. The purpose of the current study was to assess change in motives following a motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT) intervention for adolescent users and assess whether change in motives was associated with change in use and self-reported problems negative consequences. MethodsParticipants (n=252) were non-treatment seeking high school student cannabis users. All participants received two sessions of MET and had check-ins scheduled at 4, 7, and 10 months. Participants were randomized to either a motivational check-in condition or an assessment-only check-in. Participants in both conditions had the option of attending additional CBT sessions. Cannabis use frequency, negative consequences, and motives were assessed at baseline and at 6, 9, 12, and 15 month follow-ups. ResultsThere were significant reductions in motives for use following the intervention and reductions in a subset of motives significantly and uniquely predicted change in problematic outcomes beyond current cannabis use frequency. Change in motives was significantly higher among those who utilized the optional CBT sessions. ConclusionsThis study demonstrates that motives can change over the course of treatment and that this change in motives is associated with reductions in use and problematic outcomes. Targeting specific motives in future interventions may improve treatment outcomes.

Exercise as an intervention for sedentary hazardous drinking college students: A pilot study

Young adults 18–24 years have the highest rates of problems associated with alcohol use among all age groups, and substance use is inversely related to engagement in substance-free activities. This pilot study investigated the promotion of one specific substance-free activity, exercise, on alcohol use in college students. Thirty-one sedentary college students who engaged in hazardous drinking (Alcohol Use Disorders Identification Test scores ≥8) were randomized to one of two conditions: (a) one 50-min session of motivational enhancement therapy (MET) focused on increasing exercise, or (b) one 50-min session of MET focused on increasing exercise plus 8 weeks of contingency management (CM) for adhering to specific exercise activities. All participants completed evaluations at baseline and post-treatment (2-months later) assessing exercise participation and alcohol use. Results of the pilot study suggest the interventions were well received by participants, the MET + CM condition showed an increased self-reported frequency of exercise in comparison to the MET alone condition, but other indices of exercise, physical fitness, and alcohol use did not differ between the interventions over time. These results suggest that a larger scale trial could better assess efficacy of this well received combined intervention. Investigation in other clinically relevant populations is also warranted.

Smoking Cessation Among Methadone Users In Mauritius

Background: This study aims to evaluate the aspects of smoking cessation in Mauritian users of methadone. A large number of researchers have suggested examining smoking in this population, as high rate of tobacco use has been reported in this population. With regards to the interventions for smoking cessation, very few are formulated to be used in the treatment of methadone. Method: At the stages of Transtheortical model, methadone users are surveyed in a cross sectional study using the Global Adult Tobacco Survey instrument. Data was collected from two groups and compared. One group was treated with the standards protocol of therapy while other with interventions sessions of motivational enhancement therapy. Both inferential and descriptive statistics encompassing non-parametric tests were used to analyze the collected data. Results: At the baseline for survey, the results demonstrated mean of 9.7 with a standard deviation of 5.8 self reported cigarettes per day. Out of which 56% were in state of precontemplation. Literacy levels were generally low in the whole community. At post intervention, patients reported decreasing their smoking by an average of 2%. Till the session of follow-up, 41% participants of the final sample self-reported a 50% decline in smoking while 26% reported no change. Generally, no major differences were observed between the groups concerning education, methadone intake doses, employment, marital status or age. Conclusion: Motivational enhancement therapy that serves as a catalyst for stage movement as well as a barrier for stage regression.

Real-time, contextual intervention using mobile technology to reduce marijuana use among youth: A pilot study

We evaluated the feasibility, acceptability, and potential efficacy of MOMENT, an intervention to reduce youth marijuana use that combines brief motivational enhancement therapy with mobile self-monitoring and responsive messaging. At baseline, primary care patients ages 15–24 who used marijuana frequently (at least 3 times per week) completed a recall assessment, then 1week of mobile momentary and daily reports on use-related factors. For the intervention, youth participated in two motivational enhancement therapy sessions, during which they identified their top-3 social and emotional triggers for use and discussed healthy ways to manage them. They then completed two weeks of mobile reports. Upon reporting a top-3 trigger for use, desire to use, or recent use, they received a message supporting self-efficacy and prompting consideration of coping strategies. Generalized estimating equations examined changes in momentary-, daily-, and individual-level measures on 3-month recall and mobile assessments. Twenty-seven youth (M=19.2years, 70% female) enrolled; there were 377–677 momentary and 50–106 daily reports per study phase. Participants reported reading the messages and finding them motivating, being comfortable with participation, and not experiencing the study as burdensome. Although proportion of momentary reports of being in a top-3 trigger context did not change (36%–43%), marijuana desire in a top-3 trigger context and marijuana use after top-3 trigger exposure decreased over the study (p<.0001 and p=.03, respectively). Daily- and individual-level measures showed similar, non-significant, improvements. The MOMENT intervention appears feasible, well-accepted, and potentially efficacious for youth who use marijuana frequently.

Does treatment readiness enhance the response of African American substance users to Motivational Enhancement Therapy?

The development of effective treatments for African Americans and other ethnic minorities is essential for reducing health disparities in substance use. Despite research suggesting that Motivational Enhancement Therapy (MET) may reduce substance use among African Americans, the findings have been inconsistent. This research examined the extent to which readiness-to-change (RTC) affects response to MET among African American substance users. The study was a secondary analysis of the 194 African American substance users participating in a multisite randomized clinical trial evaluating MET originally conducted within the National Drug Abuse Treatment Clinical Trials Network. The participants were randomly assigned to receive either three sessions of MET or Counseling-As-Usual (CAU) followed by the ordinary treatment and other services offered at the five participating outpatient programs. Participants were categorized as either high or lower on RTC based on their scores on the University of Rhode Island Change Assessment. The participants reported their substance use at baseline and throughout the 16 weeks after randomization. Among the high RTC participants, those in MET tended to report fewer days of substance use per week over time than participants in CAU. However, among the lower RTC participants, the CAU group tended to report fewer days of substance use over time than MET participants. In contrast to previous thinking, the findings suggest that MET may be more effective for high than lower RTC African American participants.

Therapist focus on ambivalence and commitment: A longitudinal analysis of Motivational Interviewing treatment ingredients.

The present study examines two core therapeutic principles of Motivational Interviewing (MI) with alcohol and other substance use disorders. Specifically, therapist focus on client ambivalence and commitment to change, as well as a more general indicator of goal assessment, were tested as process predictors of subsequent alcohol use across four sessions of Motivational Enhancement Therapy. Participants were adult alcohol users involved in a large multisite clinical trial (Project MATCH; two arms Aftercare [AC] and Outpatient [OP]). A series of multilevel models examined the effect of proposed MI ingredients on alcohol use (percent days abstinent; drinks per drinking day) over a 12-week treatment period, and whether these effects interacted with time and client baseline motivation. Therapist effort to elicit client commitment to change alcohol use was associated with greater rates of abstinence among both AC and OP participants, and reduced drinking quantity among OP participants. However, therapist focus on ambivalence was associated with greater drinking quantity among OP participants, and when motivation was low, among AC participants. Goal assessment was a marginal to nonsignificant predictor across outcomes, and all interactions with time were nonsignificant. Therapist-reported treatment foci are important to subsequent patterns of drinking within a multisession MI, but the role of ambivalence and discrepancy is worthy of further clinical and empirical consideration.

Do the Effects of Psychological Treatments on Improving Glycemic Control in Type 1 Diabetes Persist Over Time? A Long-Term Follow-Up of a Randomized Controlled Trial

In a randomized controlled trial, adults with Type 1 diabetes and suboptimal glycemic control who received motivational enhancement therapy (MET) plus cognitive behavioral therapy (CBT) had a greater reduction in their 12-month hemoglobin A(1c) (Hb(A1c)) than those who received usual care (UC). We tested whether improvements in glycemic control persisted up to 4 years after randomization. In the original trial, participants were randomized to UC (n = 121), 4 sessions of MET (n = 117), or 4 sessions of MET plus 8 sessions of CBT (n = 106). Of the 344 patients who participated in the original trial, 260 (75.6%) consented to take part in this posttrial study. A linear mixed model was fitted to available measurements to assess whether intervention effects on Hb(A1c) at 12 months were sustained at 2, 3, and 4 years. Estimated mean Hb(A1c) level was lower for participants in the two intervention arms when compared with UC at 2, 3, and 4 years, but none of the differences were statistically significant. At 4 years, estimated mean Hb(A1c) level for MET plus CBT was 0.28% (95% confidence interval = -0.22% to 0.77%) lower than that for UC, and estimated mean Hb(A1c) level for MET was 0.17% (95% confidence interval = -0.33% to 0.66%) lower than that for UC. There was no evidence of benefit for patients randomized to MET plus CBT at 2, 3, or 4 years. Larger studies are needed to estimate long-term treatment effects with greater precision. Current models of psychological treatments in diabetes may need to be intensified or include maintenance sessions to maintain improvements in glycemic control.

Motivational enhancement therapy with and without cognitive behaviour therapy for Type 1 diabetes: economic evaluation from a randomized controlled trial

To assess the cost-effectiveness of motivational enhancement therapy and cognitive behaviour therapy for poorly controlled Type 1 diabetes. Within-trial prospective economic evaluation from (i) health and social care and (ii) societal perspectives. Three hundred and forty-four adults with Type 1 diabetes for at least 2 years and persistent, suboptimal glycaemic control were recruited to a three-arm multi-centre randomized controlled trial in London and Manchester, UK. They were randomized to (i) usual care plus four sessions of motivational enhancement therapy (ii) usual care plus four sessions of motivational enhancement therapy and eight sessions of cognitive behaviour therapy or (iii) usual care alone. Outcomes were (i) costs, (ii) Quality-Adjusted Life Year gains measured by the EuroQol 5-dimensional health state index and the 36-item Short Form and (iii) diabetes control measured by change in HbA(1c) level at 1 year. Both intervention groups had significantly higher mean health and social care costs (+ £535 for motivational enhancement therapy and + £790 for combined motivational enhancement and cognitive behavioural therapy), but not societal costs compared with the usual-care group. There were no differences in Quality Adjusted Life Years. There was a significantly greater HbA(1c) improvement in the combined motivational enhancement and cognitive behavioural therapy group (+ 0.45%; incremental cost-effectiveness ratio = £1756), but the not in the motivational enhancement therapy group. Cost-effectiveness acceptability curves suggested that both interventions had low probabilities of cost-effectiveness based on Quality Adjusted Life Years (but high based on HbA(1c) improvements). Imputing missing costs and outcomes confirmed these findings. Neither therapy was undisputedly cost-effective compared with usual care alone, but conclusions vary depending on the relative importance of clinical and quality-of-life outcomes.

Using a Cross-Study Design to Assess the Efficacy of Motivational Enhancement Therapy–Cognitive Behavioral Therapy 5 (MET/CBT5) in Treating Adolescents with Cannabis-Related Disorders

To evaluate how adolescents with marijuana problems who received a research-based treatment (five sessions of motivational enhancement therapy plus cognitive behavioral therapy [MET/CBT5]) in an experimental setting would have fared had they received exemplary community-based outpatient treatment. Twelve-month outcomes representing six domains (substance use problems, substance use frequency, emotional problems, illegal activities, recovery, and institutionalization) were assessed for youth who received MET/CBT5 in the Cannabis Youth Treatment study and youth who received outpatient treatment from one of three community-based programs selected for evidence of efficacy. Groups were matched on pretreatment characteristics using a propensity score weighting strategy. Youth who received MET/CBT5 exhibited greater reductions in substance use frequency, substance use problems, and illegal behaviors 12 months after treatment entry than had they entered the community based outpatient programs. Results showed no evidence that youth who received MET/CBT5 would have fared better with respect to emotional problems, the likelihood of being institutionalized, or achieving a "recovery" status at 12 months had they received community-based treatments. The community-based treatments used in this study have not been assessed relative to "treatment as usual" but were selected as "exemplary" models of adolescent treatment. There is no evidence in this study that these exemplary programs yielded superior 12-month outcomes for the treatment of adolescents with marijuana problems; youth receiving MET/CBT5 experienced greater reductions in substance use and illegal activities. Thus, MET/CBT5 may be a promising treatment for community-based providers to adopt to treat these clients.

Client Language During Motivational Enhancement Therapy and Alcohol Use Outcome

The exact link between the process engaged in during Motivational Interviewing based interventions, such as Motivational Enhancement Therapy (MET), and outcome is yet to be fully understood. This preliminary study examined Client Language during MET and outcome. A modified Motivational Interviewing Skills Code Version 2.0 was used to code 106 audiotaped MET sessions from 28 participants who received 3-4 sessions of MET within the context of a randomized controlled trial for mild-moderate alcohol dependence. Client Language was analyzed within sessions (categorized into Early, Mid, or End Intervals) and across sessions, and in relation to six month drinking outcome (drinking within/over national drinking guidelines, i.e. Remitted/Unremitted Drinkers). Unremitted Drinkers uttered a significantly higher frequency of Sustain Talk, lower Ability Language strength (over all MET and during End Intervals), and lower Commitment Language strength (during Session 2 and 4, and change over MET). Notwithstanding limitations, this exploratory study was unique in examining the strength of Client Language within and across sessions. It produced potentially valuable findings that warrant further investigation including supporting the clinical benefit of monitoring Client Language to predict outcome.