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Program Profile: Motivational Interviewing for Juvenile Substance Abuse

Evidence Rating: No Effects - One study No Effects - One study

Date: This profile was posted on June 16, 2011

Program Summary

A counseling method that is designed to address the problem of ambivalence and encourage the motivation for behavioral change. The program is rated No Effects. Although both studies reported some positive outcomes and significant findings, the preponderance of evidence showed that the program had no effect in changing the targeted behaviors of juveniles. There were no statistically significant differences on most of the measured outcomes between the treatment and control groups.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals

Motivational Interviewing (MI) is a counseling method that uses collaborative, client-centered, and goal-oriented communication to foster behavioral change in the individual. MI aims to address the key problem of ambivalence toward behavioral change that exists within individuals and encourage an internalization of the desire for change in the client. MI addresses personal motivation through the exploration and identification of the individual’s own reasons and desires for change.

 

Target Population

MI has been applied to many different contexts, but is particularly used in the treatment of substance users and the problems related to substance use (e.g., driving under the influence). MI has been used to counsel juveniles in multiple areas, including substance use, smoking, eating disorders, sexual risk taking, managing illness and disability, and behavioral problems.

 

Program Components

While MI is adapted to each individual and the specific behavioral problems that individual presents, it is a collaborative effort between the therapist and the individual to identify and forge a path to behavioral change using the latter’s own motivations. MI has several core components that guide this process:

 

·         Engaging to establish a rapport and listening reflectively to understand the ambivalence and issues that the individual is presenting

·         Guiding the individual to strategically concentrate on certain aspects of his or her behavior

·         Evoking in the individual his or her own motivations for change through selective questions, responses, and summaries

·         Planning a behavioral change in the individual and solidifying the individual’s commitment

 

Program Theory

MI is developed to act on the ambivalence that exists within an individual contemplating a behavioral change. A traditional argument for change by a therapist can be met by the argument for continuation by the individual. MI seeks to foster, encourage, and elicit the desire and motivation for change that already exists within the individual to drive future behavioral changes. MI adopts a client-centric approach, building a program and motivation for change within the individual in collaboration and partnership with the therapist, while respecting the individual’s autonomy in decision-making.

Evaluation Outcomes

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Although both studies reported some positive outcomes and significant findings, the preponderance of evidence showed that the program had no effect in changing the targeted behaviors of juveniles. There were no statistically significant differences on most of the measured outcomes between the treatment and control groups.

Study 1
Engagement With Treatment
The results of the Stein and colleagues (2006a) study show only one significant result. At the follow-up, the Relaxation Therapy (RT) group showed significantly more negative engagement with substance use therapy than the Motivational Interviewing (MI) group exhibited. While all other outcome measures were favorable to the MI group, these findings did not reach levels of statistical significance. There were no other significant differences between the MI group and the RT group.

Study 2
Driving Under the Influence (and Passenger)
In the second Stein and colleagues (2006b) study, the driving under the influence (DUI) and being a passenger of a driver under the influence (PUI) outcomes were found to be mediated by depressive symptoms. MI significantly decreased DUI–alcohol for adolescents with low levels of depressive symptoms. However, at high levels of depressive symptoms there were no significant differences between MI and RT. Within the RT group, those with high depressive symptoms had significantly fewer DUI–alcohols. In addition, there were no significant results for MI in reducing DUI–marijuana. Within the RT group, however, those with high depressive symptoms reported significantly lower DUI–marijuana scores. Overall, the RT group had better outcomes for those with high depressive symptoms than the MI group in regards to DUI-alcohol and marijuana.

For adolescents with low depressive symptoms, the MI group reported significantly fewer PUI–alcohol events than the RT group did. There were, however, no significant differences between the two groups with high-depressive-symptom adolescents. Within the RT group, adolescents with high depressive symptoms had significantly lower PUI–alcohol scores than low depressive symptom adolescents. There were no significant differences between interventions in the PUI–marijuana scores. Within the RT group, adolescents with high depressive symptoms did report significantly fewer instances of PUI–marijuana. Overall, for most of the measured outcomes, the MI group was not significantly different from the RT comparison group.
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Evaluation Methodology

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Study 1

Stein and colleagues (2006a) examined participants from a northeastern State juvenile facility where adolescents were identified immediately following adjudication. To be included, participants had to be between the ages of 14 and 19, have been sentenced to between 4 and 12 months, have presented regular (or binge) marijuana or alcohol use (monthly or in the month before the offense or in the month before incarceration), and consent to participate (from parents, guardians, or adult adolescents). This study was part of a larger treatment outcome study. The sample (n= 130) was 34.6 percent African American, 28.5 percent Hispanic, and 30.8 percent white. Ninety percent were male. The average age was 17.16 years, and on average they had been incarcerated 2.92 times before the current imprisonment. Sixty-two percent of the sample qualified for alcohol use disorder, while 89 percent qualified for marijuana use disorder in the previous year. The sample was then randomized into a treatment group, who were administered Motivational Interviewing (MI), and a comparison group who received Relaxation Therapy (RT). The purpose of the study was to examine the effects of MI on youth engagement with substance use treatment.

 

The MI was administered by research counselors delivering the four components of MI adapted as appropriate to each adolescent. The RT was delivered by research counselors instructing participants on relaxation and meditation techniques and providing general advice and information on reducing risky behavior and alcohol and marijuana use. Both interventions were 90 minutes at baseline and 60 minutes at booster. Assessment was made at baseline and then at 2 months postadjudication. In addition to these interventions, adolescents received the standard services offered by the facility.

 

Adolescents receive group and individual treatment on a variety of behavioral problems (drug use, sex offending, violence prevention, anger management, etc.). Drug programs at the facility concentrate on increasing the adolescents’ knowledge of the negative effects of drug use, including HIV risks, mental, dental, and psychological services also are available.

 

The measures used at baseline by the study were a record review, a background questionnaire, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (or DSM–IV). At the 2-month follow-up, the average daily behavioral rating was used (adolescents’ behavior is rated with a possible 100 points to accumulate per week) and a treatment participation questionnaire (evaluating their engagement at baseline and at 2-month follow-up). The authors performed Analysis of Covariance (ANCOVA) for each dependent variable (negative treatment engagement, positive treatment engagement, and behavioral ratings).

 

Study 2

The second Stein and colleagues (2006b) study was also part of a larger treatment outcome study using the same inclusion criteria as the previous study. It examined the effects of MI on driving under the influence (DUI) offenses of adolescents after release. The final sample (n= 105) was 34.3 percent African American, 27.6 percent Hispanic, and 32.4 percent white. They were 89.5 percent male, and their average age was 17.06 years old. Sixty-one percent of the sample qualified for alcohol use disorder, while 89 percent qualified for marijuana use disorder in the previous year.

 

Participants were randomly assigned to either the MI group (n= 59) or to a RT comparison group (n= 46). Assessment was made at baseline and then at 3 months postrelease. The measures used at baseline by the study were a record review, a background questionnaire, and the Structured Clinical Interview for DSM–IV. At both points in time, the Center for Epidemiological Studies—Depression Scale and the Risky Behaviors Questionnaire were administered (concentrating on DUI and being a passenger with a driver under the influence—PUI).

 

The methods applied to the data were Analysis of Covariance (ANCOVA) for each dependent variable (number of DUI–marijuana, DUI–alcohol, PUI–marijuana and PUI–alcohol), using baseline measure as a covariate with the intervention condition (MI or RT) and depressive symptoms as independent variables.

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Cost

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There is no cost information available for this program.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Stein, Lynda A.R., Suzanne M. Colby, Nancy P. Barnett, Peter M. Monti, Charles Golembeske, Rebecca Lebeau–Craven, and Robert Miranda. 2006a. “Enhancing Substance Abuse Treatment Engagement in Incarcerated Adolescents.” Psychological Services 3(1):25–34.

Study 2
Stein, Lynda A.R., Suzanne M. Colby, Nancy P. Barnett, Peter M. Monti, Charles Golembeske, and Rebecca Lebeau–Craven. 2006b. “Effects of Motivational Interviewing for Incarcerated Adolescents on Driving Under the Influence After Release.” American Journal on Addictions 15:50–57.
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Related Practices

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Following are CrimeSolutions.gov-rated practices that are related to this program:

Motivational Interviewing for Substance Abuse
A client-centered, semidirective psychological treatment approach that concentrates on improving and strengthening individuals’ motivations to change. The practice is rated Effective. Individuals in the treatment groups significantly reduced their use of substances compared to those in the no-treatment control groups.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
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Program Snapshot

Age: 14 - 19

Gender: Both

Race/Ethnicity: Black, Hispanic, White

Geography: Suburban, Urban

Setting (Delivery): Correctional

Program Type: Alcohol and Drug Therapy/Treatment, Individual Therapy, Motivational Interviewing

Targeted Population: Young Offenders, Alcohol and Other Drug (AOD) Offenders

Current Program Status: Active