Single-Session Motivational Interviewing for Drug Detoxification Inpatients: Effects on Self-Efficacy, Stages of Change and Substance Use

Abstract

Thirty-five inpatients at a Stockholm hospital drug user detoxification unit received single-session Motivational Interviewing (MI) between 2006 and 2008. At baseline and after 3 months, they were compared to a semirandomized control group of 52 patients with treatment as usual. In the MI group, self-efficacy increased regarding abstention in connection with positive feelings, appreciation of positive drug effects increased, and participants tended to transition toward preparation/action stages of change. Despite implementation challenges, the study demonstrates the feasibility and effectiveness of single-session MI delivery in the inpatient drug detoxification setting and suggests paths for future research on delivery of single-session MI.

RÉSUMÉ

L’Entretien Motivationnel d’une seule séance pour des patients de désintoxication: Effets sur l’auto-efficacité, les phases de changement et l’utilisation des drogues

Entre 2006 et 2008, 35 malades hospitalisés dans l’unité de désintoxication d’un hôpital de Stockholm ont été l’objet dún Entretien Motivationnel (EM) dúne seule séance. Leur situation a été comparée, avant le début du traitement et après 3 mois, avec un groupe semi-randomisé formé de 52 patients qui ont reçu le traitement habituel. Chez les patients du groupe EM, l’auto-efficacité a augmenté par rapport à l’abstinence des drogues dans des situations caractérisées par des sentiments positifs. L’appréciation des effets positifs des drogues a aussi augmenté et les participants ont montré une disposition vers une transition à la préparation du changement ou aux phases d’action. Malgré les difficultés de la mise en œuvre, l’étude montre la faisabilité et l’efficacité de l’utilisation de séances uniques d’EM sur des malades hospitalisés pour désintoxication et signale la nécessité de nouvelles études sur l’application de séances uniques d’EM.

Mots clef: entretien motivationnel, désintoxication, toxicomanie, faisabilité, intervention brève, auto-efficacité

RESUMEN

La Entrevista Motivacional de sesión única para pacientes de desintoxicación: Efectos sobre la autoeficacia, las fases de cambio y la utilización de drogas

Entre 2006 y 2008 se efectuó una Entrevista Motivacional (EM) de una única sesión con 35 pacientes ingresados en la unidad de desintoxicación de un hospital de Estocolmo. Antes del inicio del tratamiento y tras 3 meses se realizó una comparación con un grupo de control semialeatorio formado por 52 pacientes que recibieron el tratamiento habitual. En los pacientes del grupo EM, la autoeficacia aumentó en relación con la abstinencia de las drogas en situaciones caracterizadas por sentimientos positivos, la apreciación de los efectos positivos de las drogas aumentó y los participantes se mostraron propensos a una transición hacia la preparación del cambio o hacia sus fases de acción. A pesar de las dificultades de la puesta en práctica, el estudio demuestra la viabilidad y eficacia del uso de sesiones únicas de EM en pacientes hospitalizados en el contexto de la deshabituación a las toxicomanías y apunta la necesidad de nuevos estudios sobre la aplicación de sesiones únicas de EM.

Palabras clave: entrevista motivacional, deshabituación, toxicomanía, viabilidad, intervención breve, autoeficacia

Keywords:

• motivational interviewing
• detoxification
• substance abuse
• feasibility
• brief intervention
• self-efficacy

THE AUTHORS

Anne H. Berman, Ph.D., is a clinical psychologist and licen sed psychotherapist, with additional academic degrees in law (Diploma) and sociology (B.Sc.). She earned her Ph.D. from the Department of Psychology, Stockholm University, in April, 2004, with a dissertation entitled Enhancing Health Among Drug Users in Prison, which won a prize for Best Ph.D. Dissertation in Psychology in 2004. Her advanced psychotherapy degree is from Uppsala University, the degree in Law is from Stockholm University, and her B.Sc. degree is from Haifa University in Israel. She worked for 10 years in probation and research within the Swedish Prison and Probation Service. Currently, she conducts existential psychotherapy with guided imagery at the Stockholm Center for Dependency Disorders, teaches at the psychology and medicine programs at Karolinska Institutet and Stockholm University, and is principal investigator of two major e-health projects for reducing hazardous use of alcohol and drugs, via the Internet (eScreen) and automated computer telephony (TeleCoach(tm)). Berman has published scientific articles about auricular acupuncture, cognitive-behavioral treatment in prisons, screening of alcohol and drug problems, and coding motivational interviewing. A coedited book on Correctional Work in Practice is forthcoming in 2009.

Lars Forsberg, Ph.D., is a specialist in clinical psychology, licensed psychotherapist and supervisor in Cognitive Behavior Therapy, as well as Senior Lecturer at the Section for Psychotherapy, Department of Clinical Neuroscience, Karolinska Institutet (KI), where he also conducts research. He earned his Ph.D. at the Karolinska Institutet in 2003 with the dissertation: Hazardous or harmful alcohol use in emergency care – early detection, motivation to change and brief intervention. Forsberg has established the Motivational Interviewing Coding Laboratory (MIC lab) at KI; the lab offers an integrity check of motivational interviewing in clinical trials in many areas, including prevention of childhood obesity and sexual risk behaviors. The MIC lab also facilitates learning of motivational interviewing by delivering coding feedback and telephone coaching on taped live conversations. Forsberg is principal investigator of three clinical trials: one on reducing drug use in the prison setting, the second on reducing tobacco use via a telephone quit line, and the third on reducing gambling problems in an outpatient unit. Forsberg has published scientific articles on coding motivational interviewing, measuring motivation change, screening of risky alcohol use in emergency room settings, and brief interventions for harmful alcohol use. He is the author of chapters in several books about treatment with motivational interviewing and with cognitive behavior therapy for dependency disorders.

Natalie Durbeej, M.Sc., is a doctoral candidate in medical science at the Department of Clinical Neuroscience, Karolinska Institutet. She has academic degrees in psychology (M.Sc.) and geography (B.Sc.) from Stockholm University. Her main research project is being conducted within the field of forensic psychiatry with the aim of exploring whether substance abuse treatment may reduce the risk of reoffending among mentally disordered offenders. She is also research coordinator in a study that investigates the outcome of neurodevelopmental problems among adolescents. Previously, she has worked as a research assistant at Karolinska Institutet as well as a teacher at the Department of Psychology, Stockholm University. Other research interests are health problems and health-promoting interventions for LGBT (Lesbian, Gay, Bisexual, Transgender) populations.

Håkan Källmén, Ph.D., is an associate professor in Psychology and has considerable experience doing research on alcohol consumption and the cognitive effects of alcohol inebriation. His particular expertise is in statistics and data analysis. He is currently with the Swedish National Institute of Public Health.

Ulric Hermansson, Ph.D., (Medical Science), is a senior lecturer at Karolinska Institutet (KI). His previous education is from the School of Social Work, Stockholm University 1980 (B.Sc.) and 1984 (M.S.W.). Since 2002 he has been conducting research at the Stockholm Center for Dependency Disorders and KI, developing methods for prevention of drug and alcohol problems at workplaces. He also works part-time as project manager for the Swedish National Institute of Public Health. He has published scientific articles on the feasibility and limitations of alcohol screening and brief intervention in the workplace, as well as articles about Motivational Interviewing. He has also published books in the field of drug and alcohol abuse and prevention.