Abstract

Prescription opioid abuse is epidemic in the US, but little is known about how conversations about opioid use can facilitate adoption of alternative pain strategies. Motivational Interviewing (MI) has been used to enhance patients’ intrinsic motivation to change by exploring and resolving ambivalence.33 This directive, yet non-judgmental, non-confrontational patient- centered approach that has been the foundation for the majority of brief interventions to promote positive behavior change in a variety of populations, including veterans. MI has a strong evidence-base, particularly in decreasing drug and alcohol abuse and hundreds of VA staff have been readily trained to proficiency in MI. MI theory and research has indicates that posits that patient speech expressing a commitment to change (“Change Talk”) is associated with improved patient outcomes and speech opposing change (“Sustain Talk”) is related to poorer outcomes. To date, however, no studies have linked in-session MI counselor behavior with subsequent reductions in prescription opioid risk behavior in chronic pain patients. Furthermore, nothing is known about the means by which MI works to facilitate the adoption of alternative pain care strategies (APCS) in veterans as this is not captured in current coding systems. Our research team just completed a randomized controlled trial (R34 AT888319; PI Seal) with chronic pain in VA primary care who were prescribed opioid pain medications and exhibited at least one “high-risk” opioid use behavior (e.g. obtaining early opioid refills, etc.). Veterans received a pain care assessment and planning session to develop personal pain care goals at baseline by one of the study clinicians and were then randomized to Motivational Interviewing (MI; n = 40) and received 4 telephone MI sessions or Attention Control (AC; n = 36) who received 4 neutral telephone sessions (reviewing opiate risks and checking in with the patients) over 12 weeks. Clinicians were VA psychologists who received ongoing fidelity monitoring and supervision. Veterans in both the MI and AC group reported significantly decreases in scores on the the addiction behavior checklist (ABC), Current Opioid Misuse Measure (COMM) and completion of APCS. This pilot project will be the first to adapt a state of the art MI fidelity coding instrument, the Motivational Interviewing Skills Code 2.5 (MISC 2.5)73 in order to reliably capture change language about APCS (currently not coded by the MISC 2.5). We will use this coding system, then MISC-APCS, to code both the MI and AC group sessions, permitting the examination of what clinician and patient speech during a clinical session (whether evoked during MI or spontaneously shared during the AC) predicts subsequent behavior change. This project combines expertise in addiction research (Dr. Borsari) MI coding (Drs. Manuel and Ladd), opiate risk reduction (Dr. Seal) and quantitative statistics (Dr. Jackson) to be the first to test theory-based hypotheses of how counselor and veterans’ in-session behaviors predict post-session changes in opiate risk and APCS. The next steps are to use the MISC- APCS to code sessions from two current large scale trials examining clinical interventions addressing opiate use in veterans and non-veteran populations. This research will improve the design and implementation of interventions using MI with this high risk and high need population of veterans.

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DRA: Substance Use Disorders, Other Conditions, Musculoskeletal Disorders

DRE: Treatment - Observational, Prevention, Treatment - Implementation

Keywords: Complementary and Alternative Practices, Guideline Development and Implementation, Pain

MeSH Terms: None at this time.