Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1015 — Group Motivational Interviewing for Patients With Substance Use and Co-existing Psychiatric Disorders: Outcomes and Process

Lead/Presenter: Elizabeth Santa Ana, COIN - Charleston
All Authors: Santa Ana EJ (Charleston VAMC; Medical University of South Carolina) Gebregziabher M (Charleston VAMC; Medical University of South Carolina) Morgan-Lopez AA (RTI International) Lamb K (Charleston VAMC) Martino S (VA Connecticut Healthcare System; Yale University School of Medicine)

Objectives:
Despite that it may confer substantial benefits for dually diagnosed patients, Motivational Interviewing, traditionally delivered one-on-one, may be underutilized in substance abuse treatment settings where the predominant mode of treatment is in groups. The effectiveness of group motivational interviewing (GMI) was evaluated relative to a treatment-control condition (TCC) for lowering substance use and enhancing treatment engagement among dually diagnosed patients presenting for treatment in a substance abuse outpatient program.

Methods:
118 outpatients with substance use and co-existing psychiatric disorders were recruited within a Veteran's Affairs substance abuse treatment program and randomized to either GMI or TCC. Binge drinking, alcohol use days, alcohol consumption in standard drinks, drug use days, and substance abuse treatment sessions attended were assessed at baseline and at 1-and 3-month follow-up. Change talk (CT) within group treatment sessions was coded and assessed to determine its potential relationship to substance use and treatment outcome variables.

Results:
Based on Zero Inflated Poisson modeling, there were significant differences between GMI and TCC at follow up for binge and alcohol use days (p < .01), and number of substance abuse treatment sessions attended (outpatient and 12-step sessions; p < .0001). Two component Weibull Analysis revealed significant effects for GMI on reducing alcohol consumption in standard drinks (p < .05). Generalized linear mixed modeling in the structural equation modeling framework revealed that participants in GMI engaged in greater CT over time compared to their counterparts in TCC and that specific types of CT (Desire, Ability, Reasons, Need, Taking Steps) significantly predicted outcomes at 1 and 3-month follow-up. Interrater reliability for therapist adherence to the GMI and TCC treatment protocols was assessed with high degrees of reliability.

Implications:
GMI is a useful intervention that may be easily layered onto existing treatment for enhancing treatment engagement and lowering alcohol consumption in treatment settings that rely on group therapy.

Impacts:
Our results may provide greater encouragement for clinicians who may have been formerly hesitant to use GMI in outpatient settings to expand its availability to patients who may benefit from it and who may otherwise not receive MI.