The Case for High-Dose Motivational Enhancement Therapy

Abstract

Motivational Enhancement Therapy (MET) is a brief therapy for treating substance use-related problems that draws upon the stages of the change model of Prochaska et al. () and the clinical techniques of Motivational Interviewing (MI) Miller et al. (). Studies have shown that MET is effective in improving motivation for change and decreasing substance use. However, comparison of MET with more intensive treatment is limited and no studies have compared the standard low dose of MET with higher doses of MET. This article makes the case for a higher dose model. The rationale for the more intensive dose draws upon several sources: 1) Descriptive studies documenting that length of treatment is a predictor of outcome, 2) Well-controlled, randomized psychotherapy trials for other disorders, such as depression, that show a dose-response relationship, and 3) Conceptual considerations about the nature and process of psychotherapy.

• Motivational Enhancement Therapy
• Motivational interviewing
• “Change plan”
• Manualized treatment
• Treatment dose

Resumen

La Terapia de Intensificación Motivacional (MET son las siglas en inglés), es una breve terapia para tratar los problemas del abuso de drogas que se basa en las etapas del modelo de cambio de Prochaska y DiClemente y en las técnicas clínicas del sistema de entrevistas motivacionales (MI son las siglas en inglés) desarrollado por Miller y sus colegas. Las estudios han demostrado que MET es eficaz para mejorar la motivación para promover el cambio y reducir el uso de las drogas. Sin embargo, la comparación entre MET y otros tratamientos más intensos es limitada y no se han llevado a cabo estudios comparando la dosis baja normal de MET con otras dosis más altas de MET. Este artículo tiene por objeto estudiar un modelo con una dosis más alta. La razón para considerar una dosis más intensa se basa en lo siguiente: 1) Estudios descriptivos que documentan que la duración del tratamiento está relacionada con los resultados; 2) Pruebas aleatorias bien controladas de psicoterapia para otras enfermedades mentales, como la depresión, que demuestran una relación entre la dosis administrada y los resultados obtenidos; y 3) Consideraciones conceptuales acerca de la naturaleza y el proceso de psicoterapia.

Résumé

La Thérapie d'augmentation de la motivation, (TAM), est une thérapie brève pour le traitement des abus d'alcool ou de drogues inspirée du modèle des étapes du changement de Prochaska et DiClemente et des techniques cliniques de l'entrevue motivationnelle (EM) développées par Miller et ses collègues. Des études ont montré que la TAM est efficace dans l'augmentation de la motivation au changement et dans la diminution de l'abus d'alcool ou de drogues. Cependant, la comparaison de la TAM à des traitements plus intensifs est limitée, et aucune étude n'a comparé la dose faible standard de la TAM aux doses plus élevées de cette dernière. Ce document présente des arguments pour établir le bien-fondé du modèle à dose plus élevée. La raison en faveur d'un dosage plus intensif se fonde sur plusieurs sources: 1) Des études descriptives établissant que la longueur d'un traitement en prédit ses résultats; 2) Des essais psychothérapiques randomisés et bien contrôlés conduits pour d'autres troubles tels que la dépression, montrant une relation dose-effet; et 3) Des considérations conceptuelles quant à la nature et au processus de la psychothérapie.

Additional information

Notes on contributors

Douglas L. Polcin

Douglas L. Polcin, Ed.D., is a Research Psychologist at the Haight Ashbury Free Clinics, Inc. in San Francisco and an instructor in the Alcohol and Drug Abuse Studies Program at the University of California, Berkeley-Extension. His current research focuses on the use of coercion to facilitate entry into treatment, peer helping, Motivational Enhancement Therapy, and implementing research findings in community treatment programs. He has worked as a clinician, supervisor and administrator in substance abuse treatment for 20 years. Correspondence or requests for reprints should be sent to [email protected].

Gantt P. Galloway

Gantt Galloway, PharmD., is Chief of Pharmacologic Research of the Haight Ashbury Free Clinics and Director of Research at New Leaf Treatment Center. His principal area of interest is developing improved pharmacologic and behavioral treatments of drug and alcohol dependencies. His other interests include HIV and other infections associated with drug use, psychiatric comorbidity, gamma-hydroxybutyrate, psychedelics, methamphetamine, and MIDMA.

James Palmer

James Palmer, M.A., completed a master's degree in Clinical Psychology and is currently a Ph.D. Candidate in Clinical Psychology at the California School of Professional Psychology in Alameda, California. He currently works as a psychotherapist at the 14th Street Clinic in Oakland, California. He is completing a dissertation on a historical-social critique of Thomas Ogden's theory of the psychoanalytic experience. Current research interests include the effectiveness of short-term psychodynamic psychotherapy combined with MET for clients diagnosed as opioid dependent.

William Mains

William Mains is a psychiatrist with a specialization in addiction treatment and dual diagnosis. He is involved in addiction and HIV treatment at the Haight Ashbury Free Clinic and the medical high users case management program at San Francisco General Hospital.