The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care Evaluation of a cognitive‐behavioural intervention for HIV prevention among injecting drug users Comparison of extended versus brief treatments for marijuana use. A randomized controlled trial of motivational enhancement therapy (MET) for mild to moderate alcohol dependence. Physician-based activity counseling: Intervention effects on mediators of motivational readiness for physical activity Randomised controlled trial of compliance therapy. 18-month follow-up. Motivational interviewing in a group setting with mandated clients: a pilot study. One-to-one: a motivational intervention for resistant pregnant smokers. A brief motivational intervention to improve dietary adherence in adolescents. The Dietary Intervention Study in Children (DISC) Research Group. Motivational Interviewing to Improve Adherence to a Behavioral Weight-Control Program for Older Obese Women With NIDDM: A pilot study Stages of change for reducing dietary fat intake over 18 months. Motivational interviewing to enhance treatment initiation in substance abusers: an effectiveness study. Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners Early intervention for hazardous drinking in the general hospital. Alcoholism treatment and medical care costs from Project MATCH. Brief physician advice for alcohol problems in older adults: a randomized community-based trial. Relative efficacy of a brief motivational intervention for college student drinkers. Pediatric-based smoking cessation intervention for low-income women: a randomized trial. Using motivational interviewing to promote adherence to antiretroviral medications: a pilot study. Reducing Alcohol Use in College Students: A Controlled Trial of Two Brief Interventions Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population: Worcester Area Trial for Counseling in Hyperlipidemia (WATCH). A pilot study to establish a randomized trial methodology to test the efficacy of a behavioural intervention. Motivational interviewing and treatment adherence among psychiatric and dually diagnosed patients. Maritally distressed women with alcohol problems: the impact of a short-term alcohol-focused intervention on drinking behaviour and marital satisfaction. Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members. A CONTROLLED TRIAL OF NURSE COUNSELLING ON LIFESTYLE CHANGE FOR HYPERTENSIVES TREATED IN GENERAL PRACTICE: PRELIMINARY RESULTS Enhancing motivation for change in problem drinking: a controlled comparison of two therapist styles. Screening and brief intervention for high-risk college student drinkers: results from a 2-year follow-up assessment. Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes. Effects of a brief motivational intervention with college student drinkers. Facilitating treatment entry among out-of-treatment injection drug users. Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Randomized controlled trial of brief cognitive-behavioural interventions among regular users of amphetamine. Engagement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy. Motivational interviewing with cocaine-dependent patients: a pilot study. Helping smokers make decisions: the enhancement of brief intervention for general medical practice. A randomized trial to reduce passive smoke exposure in low-income households with young children. Failure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease. Motivational interviewing in drug abuse services: a randomized trial. Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis. Evaluation of a motivational interview for substance use within psychiatric in-patient services. Preparing clients for alcoholism treatment: effects on treatment participation and outcomes. Motivational subtypes and continuous measures of readiness for change: concurrent and predictive validity. Findings of a pilot study of motivational interviewing with pregnant drinkers. Brief intervention for heavy-drinking college students: 4-year follow-up and natural history. Effects of two types of brief intervention and readiness to change on alcohol use in hazardous drinkers. Controlled evaluation of a brief intervention for HIV prevention among injecting drug users not in treatment. A randomized controlled trial of an intervention designed to improve the care given in general practice to Type II diabetic patients: patient outcomes and professional ability to change behaviour. Brief motivational feedback improves post-incarceration treatment contact among veterans with substance use disorders. The physician-delivered smoking intervention project: can short-term interventions produce long-term effects for a general outpatient population? Brief motivational interviewing in a hospital setting for adolescent smoking: a preliminary study. Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. Randomized clinical trial comparing the effectiveness of two dietary interventions for patients with hyperlipidaemia. A dietary intervention in primary care practice: the Eating Patterns Study. The impact of a brief motivational intervention with opiate users attending a methadone programme. Patient Empowerment: Results of a randomized controlled trial Evaluation of a cognitive-behavioural intervention for pregnant injecting drug users at risk of HIV infection. Enhancing motivation to reduce the risk of HIV infection for economically disadvantaged urban women. A self-help approach for high-risk drinking: effect of an initial assessment. Group therapy for binge eating in Type 2 diabetes: a randomized trial.
Abstract Objective : To evaluate the effectiveness of combinations of three methods to promote physical activity . Design : R and omised controlled trial . Baseline assessment with post-intervention follow up at 12 weeks and 1 year . Setting : One urban general practice , 1995 - 7 . Participants : 523 adults aged 40 to 64 years , r and omised to four intervention groups and a control group . Interventions : Brief ( one interview ) or intensive ( six interviews over 12 weeks ) motivational interviewing based on the stages of change model of behaviour change , with or without financial incentive ( 30 vouchers entitling free access to leisure facilities ) . Main outcome measures : Physical activity score ; sessions of moderate and vigorous activity in the preceding four weeks . Results : Response rate was 81 % at 12 weeks and 85 % at one year . More participants in the intervention group reported increased physical activity scores at 12 weeks than controls ( 38 % v 16 % , difference 22 % , 95 % confidence interval for difference 13 % to 32 % ) , with a 55 % increase observed in those offered six interviews plus vouchers . Vigorous activity increased in 29 % of intervention participants and 11 % of controls ( difference 18 % , 10 % to 26 % ) , but differences between the intervention groups were not significant . Short term increases in activity were not sustained , regardless of intensity of intervention . Conclusions : The most effective intervention for promoting adoption of exercise was the most intensive . Even this did not promote long term adherence to exercise . Brief interventions promoting physical activity that are used by many schemes in the United Kingdom are of question able effectiveness . Key messages Schemes promoting physical activity are currently popular in general practice in Britain , but few have been rigorously evaluated and their effectiveness is unknown . In this study , the most effective intervention for promoting adoption of physical activity was the most intensive , involving six motivational interviews and a financial incentive A comparatively brief intervention ( one interview ) was only effective in the short term in around a third of participants Short term increases in physical activity were not maintained at one year follow up and even the most intensive intervention was ineffective in promoting long term adherence to increased physical activity . National and local government , health authorities , and primary healthcare teams should be cautious about current and future expenditure on , and implementation of , exercise prescription or referral Objective To evaluate the effectiveness of relapse prevention ( RP ) and brief intervention ( BI ) in reducing HIV risk-taking behaviours among injecting drug users ( IDU ) enrolled in methadone programmes . The hypotheses tested were : ( 1 ) that a six-session RP programme would be more effective in reducing HIV risk-taking behaviours than a one-session BI and a non-intervention control condition ( C ) ; and ( 2 ) that Bl would be more effective in reducing HIV risk-taking behaviours than C. Design Clients of methadone programmes were r and omly assigned to either RP , Bl , or C. Follow-up occurred 6 months after pre-intervention assessment and was conducted by independent research assistants who were not aware of subjects ' group allocations . Setting Confidential assessment interviews and interventions generally took place at the methadone unit treating the subject . Participants Ninety-five IDU enrolled in methadone programmes . Study entry criteria were : injection of any drug in the 6 months before the day of pre-intervention assessment ; literacy in English ; agreement to HIV-antibody testing for research purpose s ; and no known diagnosis of a serious mental illness . Eighty subjects were contacted successfully for a 6-month follow-up . Interventions The RP intervention was a six-session programme . Each 60–90-min session was conducted individually . The Bl was a one-session motivational interview lasting 60–90 min , accompanied by a self-help booklet . Main outcome measures All subjects were administered the Drug Use Scale and HIV Risk-Taking Behaviour Scale of the Opiate Treatment Index and consented to the collection of a capillary blood sample for HIV-antibody testing at pre-intervention assessment and follow-up . At follow-up , the Highest HIV Risk-Taking Behaviour Scale , collateral reports from subjects ' sexual partners pertaining to the previous month and urinalysis results for the month before follow-up were collected . Results Compliance with interventions was good . Correspondence of self-reports with urinalysis and collateral reports was satisfactory . There were no significant differences between groups in risk-taking behaviours during the month before follow-up . However , there was evidence of a lower rate of needle-risk behaviour ( sharing and cleaning ) during the heaviest risk-taking month since pre-intervention assessment in the group given RP . There were no indications that Bl was of greater benefit than the usual methadone treatment and neither intervention appeared to reduce sexual risk behaviour . Conclusions The results are cautiously interpreted as showing that individual RP programmes decrease the level of needle-risk behaviour during relapse episodes , but further research is required to replicate this finding Adult marijuana users ( N = 291 ) seeking treatment were r and omly assigned to an extended 14-session cognitive-behavioral group treatment ( relapse prevention support group ; RPSG ) , a brief 2-session individual treatment using motivational interviewing ( individualized assessment and intervention ; IAI ) , or a 4-month delayed treatment control ( DTC ) condition . Results indicated that marijuana use , dependence symptoms , and negative consequences were reduced significantly in relation to pretreatment levels at 1- , 4- , 7- , 13- , and 16-month follow-ups . Participants in the RPSG and IAI treatments showed significantly and substantially greater improvement than DTC participants at the 4-month follow-up . There were no significant differences between RPSG and IAI outcomes at any follow-up . The relative efficacy of brief versus extended interventions for chronic marijuana-using adults is discussed OBJECTIVE This study was design ed to conduct a r and omized controlled trial of motivational enhancement therapy ( MET ) with two control conditions : nondirective reflective listening ( NDRL ) and no further counseling ( NFC ) ; and to conduct this study in a sample of patients with a primary diagnosis of mild to moderate alcohol dependence , in a " real-life " clinical setting . METHOD Patients with mild to moderate alcohol dependence were recruited , assessed and treated at the Community Alcohol and Drug Service of Christchurch , New Zeal and . All patients received a feedback/education session before r and omization to either four sessions of MET , four sessions of NDRL , or NFC . Outcome data on 122 subjects ( 57.4 % men ) were obtained 6 months following the end of treatment , by an interviewer who was blind to the treatment condition . The primary drinking outcome was unequivocal heavy drinking , defined as drinking 10 or more st and ard drinks six or more times in the follow-up period . Global assessment scale ( GAS ) measured general personal/social functioning . RESULTS Of patients treated with MET , 42.9 % showed unequivocal heavy drinking compared with 62.5 % of the NDRL and 65.0 % of the NFC groups ( p = .04 ) . No significant differences were found for GAS score according to treatment condition . CONCLUSIONS In patients with mild to moderate alcohol dependence , MET is more effective for reducing unequivocal heavy drinking than either a feedback/education session alone or four sessions of NDRL . MET can be considered an effective " value added " counseling intervention in a real-life clinical setting . In patients with mild to moderate alcohol dependence , nondirective reflective listening provides no additional advantage over a feedback/education session alone In theory-based interventions for behavior change , there is a need to examine the effects of interventions on the underlying theoretical constructs and the mediating role of such constructs . These two questions are addressed in the Physically Active for Life study , a r and omized trial of physician-based exercise counseling for older adults . Three hundred fifty-five patients participated ( intervention n = 181 , control n = 174 ; mean age = 65.6 years ) . The underlying theories used were the Transtheoretical Model , Social Cognitive Theory and the constructs of decisional balance ( benefits and barriers ) , self-efficacy , and behavioral and cognitive processes of change . Motivational readiness for physical activity and related constructs were assessed at baseline , 6 weeks , and 8 months . Linear or logistic mixed effects models were used to examine intervention effects on the constructs , and logistic mixed effects models were used for mediator analyses . At 6 weeks , the intervention had significant effects on decisional balance , self-efficacy , and behavioral processes , but these effects were not maintained at 8 months . At 6 weeks , only decisional balance and behavioral processes were identified as mediators of motivational readiness outcomes . Results suggest that interventions of greater intensity and duration may be needed for sustained changes in mediators and motivational readiness for physical activity among older adults BACKGROUND A r and omised controlled trial was conducted in an acute treatment setting to examine the effectiveness of compliance therapy , a brief pragmatic intervention targeting treatment adherence in psychotic disorders , based on motivational interviewing and recent cognitive approaches to psychosis . METHOD Seventy-four patients with psychotic disorders according to DSM-III-R criteria recruited from consecutive admissions to an acute in-patient unit , received 4 - 6 sessions of either compliance therapy or non-specific counselling , and were followed-up over 18 months . The principal outcome measures were observer-rated compliance , attitudes to treatment , insight and social functioning . RESULTS Significant advantages were found for the compliance therapy group post-treatment on measures of insight , attitudes to treatment and observer-rated compliance which were retained over the follow-up period . Global social functioning improved relatively more over time in the compliance therapy group compared with the control group . Survival in the community prior to readmission was significantly longer in the compliance therapy group . CONCLUSIONS The results support the effectiveness of compliance therapy in improving functioning and community tenure after an acute psychotic episode Some clients who are court-ordered to undergo substance abuse treatment are not able or willing to identify treatment-related goals . This situation can cause difficulties in the therapeutic relationship and compromise treatment . To address this problem , we offered a group-based motivational enhancement program prior to st and ard treatment . Over 2 years , 73 clients attended the motivation group while 94 did not . Compared to those who did not , those who attended the motivation group were significantly less likely to meet criteria for substance abuse dependence , they attended a higher proportion of their treatment sessions , and they were more likely to have completed treatment . After controlling for diagnosis , employment , and age , attending the motivation group was still related to higher rates of attendance and treatment completion . A motivation group may promote better participation in substance abuse treatment programs among persons who do not identify treatment goals . Additional research is needed to draw firm conclusions The purpose of this prospect i ve , r and omized controlled study was to determine the efficacy of an intensified , late pregnancy , smoking cessation intervention for resistant pregnant smokers ( n = 269 ) . Participants received 3 - 5 min of counseling plus a self-help booklet at their first prenatal visit and seven booklets mailed weekly thereafter ; at 28 weeks , all had been smoking in the past 28 days . The experimental group received a stage of change-based , personalized feedback letter and two telephone counseling calls using Motivational Interviewing ( MI ) strategies . The control group received care as usual . The 34th week cotinine data demonstrated no overall difference between groups . However , an implementation analysis suggested that 43 % of women who received the full intervention ( E2 ) were classified as not smoking compared to 34 % of the control group . At 6 weeks postpartum , 27.1 % of the E2 group reported being abstinent or light smokers vs. 14.6 % of the controls . No differences were detected at 3 and 6 months postpartum . Results lend preliminary but very modest support for this intervention with resistant pregnant smokers . Improvements in the intervention and implementation issues are discussed Motivational interviewing offers health care professionals a potentially effective strategy for increasing a patient 's readiness to change health behaviors . Recently , elements of motivational interviewing and the stages of change model have been simplified and adapted for use with patients in brief clinical encounters . This paper describes in detail a brief motivational intervention model to improve and renew dietary adherence with adolescents in the Dietary Intervention Study in Children ( DISC ) . DISC is a r and omized , multi-center clinical trial assessing the efficacy and safety of lowering dietary fat to decrease low-density lipoprotein cholesterol in high-risk children . In the first 3 years of follow-up covering ages 8 - 13 , intervention participants ( n = 334 ) were exposed to a family-based group intervention approach to change dietary choices . To address adherence and retention obstacles as participants moved into adolescence ( age 13 - 17 ) , an individual-level motivational intervention was implemented . The DISC motivational intervention integrates several intervention models : stages of change , motivational interviewing , brief negotiation and behavioral self-management . A preliminary test of the intervention model suggests that it was acceptable to the participants , popular with interventionists and appeared to be an age-appropriate shift from a family-based intervention model OBJECTIVE The aim of this r and omized pilot study was to examine whether the addition of motivational interviewing strategies to a behavioral obesity intervention enhances adherence and glucose control in older obese women with NIDDM . RESEARCH DESIGN AND METHODS Twenty-two older obese women ( 41 % black ) with NIDDM were r and omly assigned to 1 ) a st and ard 16-week group behavioral weight-control program that provided instruction in diet , exercise , and behavioral modification or 2 ) the same group behavioral program with three individualized motivational interviewing sessions added . RESULTS The motivational group attended significantly more group meetings ( 13.3 vs. 8.9 ) , completed significantly more food diaries ( 15.2 vs. 10.1 ) , and recorded blood glucose significantly more often ( 46.0 vs. 32.2 days ) than the st and ard group . Further , participants in the motivational group had significantly better glucose control post-treatment ( 9.8 vs. 10.8 % ) . Although both groups demonstrated significant weight loss , no differences were apparent between groups . CONCLUSIONS These results suggest that augmenting a st and ard behavioral treatment program for obese women with NIDDM with a motivational interviewing component may significantly enhance adherence to program recommendations and glycemic control . Preliminary data warrant further investigation with larger sample s and a longer follow-up OBJECTIVE To describe the stages of change that take place over 18 months , using the criterion of fat intake < or = 30 % of total energy to define effective action and to investigate the effect of a single dietary feedback report on dietary fat reduction . DESIGN Subjects were r and omly assigned to experimental or control conditions and assessed at 0 , 6 , 12 , and 18 months for fat intake and stage of change . Subjects in the experiment group received 1 feedback report at baseline ; all subjects received a report at 12 months . SUBJECTS Potential subjects ( n = 614 ) were recruited by mail from a r and om sample of nonsmoking adults ( 32 % response rate ) . Subjects were excluded if consuming < or = 30 % of energy from fat or if pregnant or lactating ( n = 145 ) . Although 83 % of subjects ( n = 389 ) completed the 18-month study , only 296 provided complete data for all time points . The study was restricted to these 296 . INTERVENTION Dietary feedback reports plus brief educational material s were provided following the experiment design . ANALYSES Repeated measures analysis of variance with fat intake ( percent of energy from fat ) as the dependent variable and baseline stage and condition as independent variables . In addition , t tests were used to compare groups at specific time points . RESULTS There was a main effect for time ( F3,286 = 39 , P < .0001 ) and baseline stage ( F3,286 = 24 , P < .0001 ) , but no effect of feedback . There was a time-by-feedback interaction ( F4,286 = 4.7 , P < .01 ) . There was a short-term effect of feedback over 6 months ( t = 3.8 , P < .001 ) , but this effect was not significant at other time points . About 9 % to 12 % of subjects in the precontemplation or contemplation stages , 24 % of subjects in the preparation stage , and 40 % of unclassified subjects at baseline progressed to the action stage by 18 months . Between 12 and 18 months , subjects progressing at least 1 stage reduced their fat intake to a greater extent than subjects who failed to progress ( t = 5.1 , P < .0001 ) . IMPLICATION S Interventions targeted to stage of change have the potential for accelerating the rate of change for dietary fat reduction , but reaching the goal of fat intake < or = 30 % of total energy may require more intensive interventions than a single dietary feedback report Sixty individuals referred for a substance abuse evaluation by a child welfare worker were r and omly assigned to either a st and ard evaluation or an evaluation enhanced by Motivational Interviewing techniques , each delivered in a single session . Participants who received the enhanced evaluation were significantly more likely to attend at least one additional treatment session after the initial evaluation ( 59 % versus 29 % ) . This finding suggests that comparatively inexpensive modifications of " st and ard " initial evaluations with substance-using parents may increase engagement of substance-abusing parents in treatment . Moreover , this study adds to an overwhelmingly positive literature supporting Motivational Interviewing with alcohol-using population s and extends prior findings to non- research community setting Abstract Objective : To explore the suitability of a screening based intervention for excessive alcohol use by describing the experiences of general practitioners who tried such an intervention in their everyday practice . Design : Qualitative interviews with general practitioners who had participated in a pragmatic study of a combined programme of screening and a brief intervention for excessive alcohol use . Doctors were interviewed either individually or in focus groups . A computer based , descriptive , phenomenological method was used to directly analyse the digitally recorded interviews . Setting and participants : 24 of 39 general practitioners in four Danish counties who volunteered to take part in the pragmatic study were interviewed . Results : The doctors were surprised at how difficult it was to establish rapport with the patients who had a positive result on the screening and to ensure compliance with the intervention . Although the doctors considered the doctor-patient relationship robust enough to sustain targeting of alcohol use , they often failed to follow up on initial interventions , and some expressed a lack of confidence in their ability to counsel patients effectively on lifestyle issues . The doctors question ed the rationale of screening in young drinkers who may grow out of excessive drinking behaviour . The programme needed considerable re sources , and it interrupted the natural course of consultations and was inflexible . The doctors could not recommend the screening and brief intervention programme , although they thought it important to counsel their patients on drinking . Conclusions : Screening for excessive alcohol use created more problems than it solved for the participating doctors . The results underline the value of carrying out pragmatic studies on the suitability of seemingly efficacious healthcare programmes Male medical in- patients were screened by interview . Those revealing alcohol-related problems or excessive consumption reaching a criterion were allocated at r and om either to no intervention or to brief counselling and a booklet ( n = 156 ) . Follow-up ( n = 134 ) by a blind interviewer after one year with blood tests revealed significantly greater improvement in problem scores and gamma GT ( n = 124 ) in the intervention group than controls and a significantly greater number of cases who reached a criterion of definite improvement confirmed by blood test or relative 's information . Patients were in hospital for conditions which may or may not have been alcohol-related . The screening was brief . The intervention was motivational and behavioural . The medical context was believed to be important AIMS This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality . DESIGN Longitudinal study with pre- and post-treatment initiation . MEASUREMENTS The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment . SETTING Three treatment sites at two of the nine Project MATCH locations ( Milwaukee , WI and Providence , RI ) . PARTICIPANTS Two hundred and seventy-nine patients . INTERVENTION Patients were r and omly assigned to one of three treatment modalities : a 12-session cognitive behavioral therapy ( CBT ) , a four-session motivational enhancement therapy ( MET ) or a 12-session Twelve-Step facilitation ( TSF ) treatment over 12 weeks . FINDINGS Total medical care costs declined from pre- to post-treatment overall and for each modality . Matching effects independent of clinical prognosis showed that MET has potential for medical-care cost-savings . However , patients with poor prognostic characteristics ( alcohol dependence , psychiatric severity and /or social network support for drinking ) have better cost-savings potential with CBT and /or TSF . CONCLUSIONS Matching variables have significant importance in increasing the potential for medical-care cost-reductions following alcoholism treatment BACKGROUND Alcohol use in older adults is common . It is associated with depression , hypertension , diabetes , drug interactions , accidents , and increased rates of emergency department visits and hospitalizations . METHODS A controlled clinical trial ( Project GOAL --Guiding Older Adult Lifestyles ) tested the efficacy of brief physician advice in reducing the alcohol use and use of health care services of older adult problem drinkers . Twenty-four community-based primary care practice s in Wisconsin ( 43 family physicians and internists ) participated in the trial . Of the 6073 patients screened , 105 men and 53 women met inclusion criteria and were r and omized into a control group ( n = 71 ) or an intervention group ( n = 87 ) . Intervention group patients received two 10- to 15-minute physician-delivered counseling sessions that included advice , education , and contracting using a scripted workbook . A total of 146 patients ( 92.4 % ) participated in the 12-month follow-up procedure . RESULTS No significant differences were found between the control and intervention groups at baseline in alcohol use , age , socioeconomic status , depression , onset of alcohol use , smoking status , activity level , or use of mood-altering drugs . The older adults who received the physician intervention demonstrated a significant reduction in 7-day alcohol use , episodes of binge drinking , and frequency of excessive drinking ( P < .005 ) compared with the control group at 3 , 6 , and 12 months after the intervention . There was a 34 % reduction in 7-day alcohol use , 74 % reduction in mean number of binge-drinking episodes , and 62 % reduction in the percentage of older adults drinking more than 21 drinks per week in the intervention group compared with the control group . There were no significant changes in health status . Patterns of health care utilization were not extensively analyzed because of the small number of events . CONCLUSIONS This study provides the first direct evidence that brief physician advice can decrease alcohol use by older adults in community-based primary care practice The authors evaluated the efficacy of Brief Alcohol Screening and Intervention for College Students ( BASICS - L. A. Dimeff , J. S. Baer , D. R. Kivlahan , & G. A. Marlatt , 1999 ) , a single session of drinking-related feedback intended to reduce heavy drinking and related harm .  College student drinkers ( N = 99 ) were assigned to BASICS , an educational intervention , or an assessment -only control group . At 3 months postintervention . there were no overall significant group differences , but heavier drinking BASICS participants showed greater reductions in weekly alcohol consumption and binge drinking than did heavier drinking control and education participants . At 9 months , heavier drinking BASICS participants again showed the largest effect sizes . BASICS participants evaluated the intervention more favorably than did education participants . This study suggests that BASICS may be more efficacious than educational interventions for heavier drinking college students BACKGROUND Continued high rates of smoking among socioeconomically disadvantaged women lead to increases in children 's health problems associated with exposure to tobacco smoke . The pediatric clinic is a " teachable setting " in which to provide advice and assistance to parents who smoke . OBJECTIVE To evaluate a smoking cessation intervention for women . DESIGN Two-arm ( usual care vs intervention ) r and omized trial . SETTING Pediatric clinics serving an ethnically diverse population of low-income families in the greater Seattle , Wash , area . INTERVENTION During the clinic visit , women received a motivational message from the child 's clinician , a guide to quitting smoking , and a 10-minute motivational interview with a nurse or study interventionist . Women received as many as 3 outreach telephone counseling calls from the clinic nurse or interventionist in the 3 months following the visit . PARTICIPANTS Self-identified women smokers ( n = 303 ) whose children received care at participating clinics . MAIN OUTCOME MEASURE Self-reported abstinence from smoking 12 months after enrollment in the study , defined as not smoking , even a puff , during the 7 days prior to assessment . RESULTS Response rates at 3 and 12 months were 80 % and 81 % . At both follow-ups , abstinence rates were twice as great in the intervention group as in the control group ( 7.7 % vs 3.4 % and 13.5 % vs 6.9 % , respectively ) . The 12-month difference was statistically significant . CONCLUSIONS A pediatric clinic smoking cessation intervention has long-term effects in a socioeconomically disadvantaged sample of women smokers . The results encourage implementation of evidence -based clinical guidelines for smoking cessation in pediatric practice This report describes a pilot study of a nursing intervention to increase adherence to combination therapy . The intervention was based on motivational interviewing ( MI ) .  Participants completed a baseline assessment using the computer-administered self-interview with audio ( ACASI ) data collection method and then were r and omly assigned to the MI intervention or control condition . Nurse counselors met with participants in the MI intervention group for three adherence sessions . Two months following baseline , participants completed a follow-up assessment . Mean scores on ratings of missed medications were lower for participants in the intervention group than those in the control group . Although there were no significant differences in the number of medications missed during the past 4 days , participants in the MI group reported being more likely to follow the medication regimen as prescribed by their health care provider . The pilot study provided useful information about the acceptability of ACASI and the adequacy of intervention procedures . The results of this pilot study show promise for the use of MI as an intervention to promote adherence to antiretroviral medications This study tested two forms of alcohol reduction programming for college students . Thirty-seven moderate to heavy drinkers completed measures of quantity/frequency , drinking consequences , and attitude question naires . Participants were r and omly assigned to one of three groups : 1 ) a two-hour information and motivation session plus mailed personal feedback on their drinking ; 2 ) mailed feedback only ; or 3 ) no treatment . At a 6-week follow-up session , the feedback-only group decreased drinks per month as compared to control . No other differences were statistically significant , though decreases favored the treatment conditions about equally over control . Implication s for research and treatment are discussed OBJECTIVE To evaluate the effectiveness of a training program for physician-delivered nutrition counseling , alone and in combination with an office-support program , on dietary fat intake , weight , and blood low-density lipoprotein cholesterol levels in patients with hyperlipidemia . PARTICIPANTS AND METHODS Forty-five primary care internists at the Fallon Community Health Plan , a central Massachusetts health maintenance organization , were r and omized by site into 3 groups : ( 1 ) usual care ; ( 2 ) physician nutrition counseling training ; and ( 3 ) physician nutrition counseling training plus an office-support program .  Eleven hundred sixty-two of their patients with blood total cholesterol levels in the highest 25th percentile , having previously scheduled physician visits , were recruited . Physicians in groups 2 and 3 attended a 3-hour training program on the use of brief patient-centered interactive counseling and the use of an office-support program that included in-office prompts , algorithms , and simple dietary assessment tools . Primary outcome measures included change at 1-year of follow-up in percentage of energy intake from saturated fat ; weight ; and blood low-density lipoprotein cholesterol levels . RESULTS Improvement was seen in all 3 primary outcome measures , but was limited to patients in group 3 . Compared with group 1 , patients in group 3 had average reductions of 1.1 percentage points in percent of energy from saturated fat ( a 10.3 % decrease ) ( P = .01 ) ; a reduction in weight of 2.3 kg ( P<.001 ) ; and a decrease of 0.10 mmol/L ( 3.8 mg/dL ) in low-density lipoprotein cholesterol level ( P = .10 ) . Average time for the initial counseling intervention in group 3 was 8.2 minutes , 5.5 minutes more than in the control group . CONCLUSION Brief supported physician nutrition counseling can produce beneficial changes in diet , weight , and blood lipids How can pregnant women be helped to stop smoking ? This was a pilot study of midwife home-based motivational interviewing .  Clients were 100 consecutive self-reported smokers booking at clinics in Glasgow from March to May 1997 . Smoking guidance is routinely given at booking . In addition , intervention clients received a median of four home-based motivational interviewing sessions from one specially trained midwife . All sessions ( n = 171 ) were audio-taped and interviews ( n = 49 ) from 13 r and omly selected clients were transcribed for content analysis . Three ' experts ' assessed intervention quality using a recognized rating scale . Cotinine measurement on routine blood sample s confirmed self-reported smoking change from late pregnancy telephone interview . Postnatal telephone question naire measured client satisfaction . Focus groups of routine midwives explored acceptability , problems and disruption of normal care . Fisher exact , chi 2 and Mann-Whitney tests compared enrolment characteristics . Two- sample t-tests assessed outcome between groups . Motivational interviewing was satisfactory in more than 75 % of transcribed interviews . In this pilot study , self-reported smoking at booking ( 100 of 100 available ) corroborated by cotinine ( 93 of 100 ) compared with late pregnancy self-reports ( intervention 47 of 48 ; control 49 of 49 ) and cotinine ( intervention 46 of 48 ; control 47 of 49 ) showed no significant difference between groups . Tools have been developed to answer the question : ' Can proactive opportunistic home-based motivational interviewing help pregnant smokers reduce their habit ? ' The effect of motivational interviewing on outpatient treatment adherence among psychiatric and dually diagnosed in patients was investigated . Subjects were 121 psychiatric in patients , 93 ( 77 % ) of whom had concomitant substance abuse/dependence disorders , who were r and omly assigned to : a ) st and ard treatment ( ST ) , including pharmacotherapy , individual and group psychotherapy , activities therapy , milieu treatment , and discharge planning ; or b ) ST plus motivational interviewing ( ST+MI ) , which involved 15 minutes of feedback on the results of a motivational assessment early in the hospitalization , and a 1-hour motivational interview just before discharge . Interviewers utilized motivational techniques described in Miller and Rollnick ( 1991 ) , such as reflective listening , discussion of treatment obstacles , and elicitation of motivational statements . Results indicated that the proportion of patients who attended their first outpatient appointment was significantly higher for the ST+MI group ( 47 % ) than for the ST group ( 21 % ; chi2 = 8.87 , df = 1 , p<.01 ) overall , and for dually diagnosed patients ( 42 % for ST+MI vs. 16 % for ST only ; chi2 = 7.68 , df = 1 , p<.01 ) . Therefore , brief motivational interventions show promise in improving outpatient treatment adherence among psychiatric and dually diagnosed patients AIM To evaluate the efficacy of a short-term alcohol-focused intervention for maritally distressed women , and to explore changes in relationship functioning . DESIGN Participants were assigned r and omly to an alcohol-focused treatment or to a waiting-list control group . The waiting-list control group began the intervention at 1-month follow-up . SETTING The intervention took place at a research and training centre offering outpatient psychology services to the community . PARTICIPANTS A sample of 32 women with alcohol and marital problems were recruited through the media . Participants reported protracted alcohol problems , moderate to severe impact of alcohol on social and occupational functioning , and moderate to severe marital distress . MEASUREMENTS Measures of average alcohol consumption , marital distress , relational efficacy and depression were administered at pre- and post-therapy , and at 1 , 6 and 12-month follow-up . INTERVENTION The intervention involved six 1-hour sessions , consisting of clinical assessment , motivational interviewing , cognitive-behavioural strategies and relapse prevention . RESULTS At 1-month follow-up , the intervention was associated with statistically significant improvements in alcohol consumption , marital satisfaction , relational efficacy and depression , and these effects were sustained at 12-month follow-up . CONCLUSIONS At 1-month follow-up the intervention was associated with decreased alcohol consumption and depression , and increased marital satisfaction and relational efficacy , with evidence of maintained effects at 12-month follow-up . However , it is unlikely that reduced problem drinking and improved confidence in resolving problems were the only factors producing low marital quality in these couples . Further research is needed to identify those individuals who might benefit from marital interventions In a r and omized clinical trial , 130 concerned significant others ( CSOs ) were offered 1 of 3 different counseling approaches : ( a ) an Al-Anon facilitation therapy design ed to encourage involvement in the 12-step program , ( b ) a Johnson Institute intervention to prepare for a confrontational family meeting , or ( c ) a community reinforcement and family training ( CRAFT ) approach teaching behavior change skills to use at home . All were manual-guided , with 12 hr of contact . Follow-up interviews continued for 12 months , with 94 % completed . The CRAFT approach was more effective in engaging initially unmotivated problem drinkers in treatment ( 64 % ) as compared with the more commonly practice d Al-Anon ( 13 % ) and Johnson interventions ( 30 % ) . Two previously reported aspects of the Johnson intervention were replicated : that most CSOs decide not to go through with the family confrontation ( 70 % in this study ) and that among those who do , most ( 75 % ) succeed in getting the drinker into treatment . All 3 approaches were associated with similar improvement in CSO functioning and relationship quality . Overall treatment engagement rates were higher for CSOs who were parents than for spouses . On average , treatment engagement occurred after 4 to 6 sessions 1 . We assessed whether a lifestyle modification programme implemented by nurse counsellors in a general practice setting would improve blood pressure ( BP ) control in treated hypertensive patients To investigate the impact of counselor style , a 2-session motivational checkup was offered to 42 problem drinkers ( 18 women and 24 men ) who were r and omly assigned to 3 groups : ( a ) immediate checkup with directive-confrontational counseling , ( b ) immediate checkup with client-centered counseling , or ( c ) delayed checkup ( waiting-list control ) . Overall , the intervention result ed in a 57 % reduction in drinking within 6 weeks , which was maintained at 1 year . Clients receiving immediate checkup showed significant reduction in drinking relative to controls . The 2 counseling styles were discriminable on therapist behaviors coded from audiotapes . The directive-confrontational style yielded significantly more resistance from clients , which in turn predicted poorer outcomes at 1 year . Therapist styles did not differ in overall impact on drinking , but a single therapist behavior was predictive ( r = .65 ) of 1-year outcome such that the more the therapist confronted , the more the client drank This r and omized controlled trial evaluated the efficacy of a brief intervention design ed to reduce the harmful consequences of heavy drinking among high-risk college students . Students screened for risk while in their senior year of high school ( 188 women and 160 men ) were r and omly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition . A normative group selected from the entire screening pool provided a natural history comparison . Follow-up assessment s over a 2-year period showed significant reductions in both drinking rates and harmful consequences , favoring students receiving the intervention . Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period , most showed a decline in problems over time , suggesting a developmental maturational effect This study reports 3-year outcomes for clients who had been treated in the five outpatient sites of Project MATCH , a multisite clinical trial design ed to test a priori client treatment matching hypotheses . The main purpose of this study was to characterize the status of the matching hypotheses at the 3-year follow-up . This entailed investigating which matching findings were sustained or even strengthened across the 3-year study period , and whether any hypotheses that were not supported earlier eventually emerged at 3 years , or conversely , whether matching findings discerned earlier dissipated at this later time . This research also examines the prognostic effects of the client matching attributes , characterizes the overall outcomes at 37 to 39 months , and explores differential effects of the three treatments at extended follow-up . With regard to the matching effects , client anger demonstrated the most consistent interaction in the trial , with significant matching effects evident at both the 1-year and 3-year follow-ups . As predicted , clients high in anger fared better in Motivational Enhancement Therapy ( MET ) than in the other two MATCH treatments : Cognitive-Behavioral Therapy ( CBT ) and Twelve-Step Facilitation ( TSF ) . Among subjects in the highest third of the anger variable , clients treated in MET had on average 76.4 % abstinent days , whereas their counterparts in the other two treatments ( CBT and TSF ) had on average 66 % abstinent days . Conversely , clients low in anger performed better after treatment in CBT and TSF than in MET . Significant matching effects for the support for drinking variable emerged in the 3-year outcome analysis , such that clients whose social networks were more supportive of drinking derived greater benefit from TSF treatment than from MET . Among subjects in the highest third of the support for drinking variable , TSF participants were abstinent 16.1 % more days than MET participants . At the lower end of this variable , difference in percent days abstinent between MET and TSF was 3 % , with MET clients having more abstinent days . A significant matching effect for psychiatric severity that appeared in the first year posttreatment was not observed after 3 years . Of the 21 client attributes used in testing the matching hypotheses , 11 had prognostic value at 3 years . Among these , readiness-to-change and self-efficacy emerged as the strongest predictors of long-term drinking outcome . With regard to the overall outcomes , the reductions in drinking that were observed in the first year after treatment were sustained over the 3-year follow-up period : almost 30 % of the subjects were totally abstinent in months 37 to 39 , whereas those who did report drinking nevertheless remained abstinent an average of two-thirds of the time . As in the 1-year follow-up , there were few differences among the three treatments , although TSF continued to show a possible slight advantage This study consisted of a r and omized controlled trial of a 1-session motivational intervention for college student binge drinkers . Sixty students who reported binge drinking 2 or more times in the past 30 days were r and omly assigned to either a no-treatment control or a brief intervention group . The intervention provided students with feedback regarding personal consumption , perceived drinking norms , alcohol-related problems , situations associated with heavy drinking , and alcohol expectancies . At 6-week follow-up , the brief intervention group exhibited significant reductions on number of drinks consumed per week , number of times drinking alcohol in the past month , and frequency of binge drinking in the past month . Estimates of typical student drinking mediated these reductions . This study replicates earlier research on the efficacy of brief interventions with college students and extends previous work regarding potential mechanisms of change OBJECTIVE High risk injection practice s are common among injecting drug users ( IDUs ) , even following intervention efforts . Moreover , relapse to risk behaviors has been reported among those who initiate risk reduction . Substance abuse treatment offers the potential to reduce or eliminate injecting risk behaviors through drug cessation . We report on the effectiveness of two intervention strategies in facilitating treatment entry among out-of-treatment IDUs :  motivational interviewing ( MI ) , and intervention developed to help individuals resolve their ambivalence about behavior change , and free treatment for 90 days . These conditions were compared with an intervention focusing on a hierarchy of safer injecting practice , referred to here as risk reduction ( RR ) , and no free treatment . METHODS Nearly 200 out-of-treatment IDUs were r and omly assigned to one of four experimental conditions : MI/free treatment , MI/no free treatment , RR/free treatment , and RR/no free treatment . Regardless of assignment , we assisted anyone desiring treatment by calling to schedule the appointment , providing transportation , and waiving the intake fee . RESULTS Overall , 42 % of study participants entered treatment . No significant differences were found between MI and RR ; however , 52 % of those assigned free treatment entered compare with 32 % for those who had to pay . Other predictors of treatment entry included prior treatment experiences , perceived chance of contracting acquired immunodeficiency syndrome ( AIDS ) greater than 50 % , " determination " stage of change , greater frequency of heroin injecting , and fewer drug-using friends . CONCLUSIONS These findings support the importance of removing barriers to treatment entry OBJECTIVE Alcoholism is the leading risk factor for injury . The authors hypothesized that providing brief alcohol interventions as a routine component of trauma care would significantly reduce alcohol consumption and would decrease the rate of trauma recidivism . METHODS This study was a r and omized , prospect i ve controlled trial in a level 1 trauma center . Patients were screened using a blood alcohol concentration , gamma glutamyl transpeptidase level , and short Michigan Alcoholism Screening Test ( SMAST ) . Those with positive results were r and omized to a brief intervention or control group .  Reinjury was detected by a computerized search of emergency department and statewide hospital discharge records , and 6- and 12-month interviews were conducted to assess alcohol use . RESULTS A total of 2524 patients were screened ; 1153 screened positive ( 46 % ) . Three hundred sixty-six were r and omized to the intervention group , and 396 to controls . At 12 months , the intervention group decreased alcohol consumption by 21.8+/-3.7 drinks per week ; in the control group , the decrease was 6.7+/-5.8 ( p = 0.03 ) . The reduction was most apparent in patients with mild to moderate alcohol problems ( SMAST score 3 to 8) ; they had 21.6+/-4.2 fewer drinks per week , compared to an increase of 2.3+/-8.3 drinks per week in controls ( p < 0.01 ) . There was a 47 % reduction in injuries requiring either emergency department or trauma center admission ( hazard ratio 0.53 , 95 % confidence interval 0.26 to 1.07 , p = 0.07 ) and a 48 % reduction in injuries requiring hospital admission ( 3 years follow-up ) . CONCLUSION Alcohol interventions are associated with a reduction in alcohol intake and a reduced risk of trauma recidivism . Given the prevalence of alcohol problems in trauma centers , screening , intervention , and counseling for alcohol problems should be routine AIMS To identify whether brief cognitive-behavioural interventions are feasible among regular users of amphetamine , to assess the effectiveness of intervention overall and to pilot two- and four-session interventions . DESIGN Subjects were assigned r and omly to individually receive a cognitive-behavioural intervention ( n = 32 ) of either two or four sessions ' duration or a self-help booklet  ( control condition ; n = 32 ) . SETTING Subjects were volunteers recruited from needle exchange schemes and treatment centres in Newcastle , Australia . PARTICIPANTS Regular ( at least monthly ) users of amphetamine were recruited . INTERVENTION Either four sessions of cognitive-behaviour therapy , consisting of a motivational interview and skills training in avoidance of high-risk situations , coping with craving and relapse prevention , or two sessions consisting of a motivational interview and discussion of skills . MEASUREMENTS The Opiate Treatment Index was the main measure at pre-treatment and 6-month follow-up . FINDINGS There was a significant reduction in amphetamine use among the sample as a whole , with inconclusive differences between intervention subgroups . There was a moderate overall intervention effect , with the intervention group reporting over twice the reduction in daily amphetamine use as the control group . Significantly more people in the cognitive-behavioural intervention condition abstained from amphetamine at 6-month follow-up compared to the control condition . CONCLUSION Brief cognitive-behavioural interventions appear feasible among regular users of amphetamine . A larger r and omised controlled trial of the effectiveness of such interventions appears warranted Despite the major advances in the development of treatments for bulimia nervosa , drop-outs and a lack of engagement in treatment , continue to be problems . Recent studies suggest that the transtheoretical model of change may be applicable to bulimia nervosa . The aim of this study was to examine the roles of readiness to change and therapeutic alliance in determining engagement and outcome in the first phase of treatment . One hundred and twenty five consecutive female patients meeting DSM-IV criteria for bulimia nervosa took part in a r and omised controlled treatment trial . The first phase of the sequential treatment compared four sessions of either cognitive behavioural therapy ( CBT ) or motivational enhancement therapy ( MET ) in engaging patients in treatment and reducing symptoms . Patients in the action stage showed greater improvement in symptoms of binge eating than did patients in the contemplation stage . Higher pretreatment scores on action were also related to the development of a better therapeutic alliance ( as perceived by patients ) after four weeks . However , pretreatment stage of change did not predict who dropped out of treatment . There were no differences between MET and CBT in terms of reducing bulimic symptoms or in terms of developing a therapeutic alliance or increasing readiness to change . The results suggest that the transtheoretical model of change may have some validity in the treatment of bulimia nervosa although current measures of readiness to change may require modification . Overall , readiness to change is more strongly related to improvement and the development of a therapeutic alliance than the specific type of treatment A brief motivational interviewing ( MI ) intervention was evaluated within the context of an outpatient , cocaine-detoxification program . MI was hypothesized to assist patients in completing the detoxification program and to improve outcomes during subsequent treatment . Participants ( N = 105 ) were r and omly assigned to MI or to detox-only conditions .  Results indicated that although participants completed the detoxification program at equal rates , completers who received MI increased use of behavioral coping strategies and had fewer cocaine-positive urine sample s on beginning the primary treatment . MI patients with lower initial motivation were more likely to complete detoxification Primary care clinicians are often encouraged by government agencies to intervene systematic ally with all smokers . Pressure of time and pessimism about their own efficacy and patients ' capacity to change are some of the reasons why clinicians do not feel it is appropriate to always advise every patient about unhealthy behaviours . Developments in patient centred approaches to the consultation and progress in the addictions field suggest that new consulting methods could be constructed which are more satisfying than giving brief advice to change . The aim of this study was to develop a structured , teachable and acceptable intervention for clinicians to help patients consider their smoking during general medical consultations . Patient centred strategies derived from the stages of change model and motivational interviewing and its adaptations were explored in experimental consultations with 20 volunteer smokers . Feedback from them and from general practice registrars trained in the use of the method informed its development . Acceptability to clinicians was assessed by semi structured telephone interviews with 24 general practice registrars who participated in a r and omised controlled trial assessing the effectiveness of the method . Anonymous , written question naires were also completed by 20 of the registrars who recruited ten or more patients into the trial . The method is described . Key components are : establishing rapport , assessing motivation and confidence , and then depending on the response , asking st and ard scaling questions , asking about pros and cons of smoking , non-judgmental information sharing , brainstorming solutions and negotiating attainable goals and follow-up . The clinicians used the method with a total of 270 smokers , taking an average of 9.69 min with each patient . Evaluation reveals that it is acceptable to the group of general practice registrars . Longer consultation time was seen as the main drawback . We conclude that acceptable methods for opportunistic health promotion can be developed by taking into account patient centred approaches to the consultation , developments from the addictions field and the practical problems faced by clinicians . The process can be further enhanced by considering feedback from those who are likely to receive and use the interventions OBJECTIVE Passive smoke exposure among children is widespread in the United States ; estimates suggest that almost 40 % of children who are younger than 5 years live with a smoker . Few r and omized studies of passive smoke exposure reduction among children have been conducted , and the impact of interventions that have been evaluated has been limited . The objective of this study was to determine whether a motivational intervention for smoking parents of young children will lead to reduced household passive smoke exposure . METHODS Project KISS ( Keeping Infants Safe From Smoke ) , a theory-driven exposure reduction intervention targeting low-income families with young children , was a r and omized controlled study in which participants -smoking parents/caregivers ( N = 291 ) who had children who were younger than 3 years and who were recruited through primary care setting s-were r and omly assigned to either the motivational intervention ( MI ) or a self-help ( SH ) comparison condition was used . Follow-up assessment s were conducted at 3 and 6 months . The MI condition consisted of a 30- to 45-minute motivational interviewing session at the participant 's home with a trained health educator and 4 follow-up telephone counseling calls . Feedback from baseline household air nicotine assessment s and assessment of the participant 's carbon monoxide level was provided as part of the intervention . Participants in the SH group received a copy of the smoking cessation manual , the passive smoke reduction tip sheet , and the re source guide in the mail . Household nicotine levels were measured by a passive diffusion monitor . RESULTS The 6-month nicotine levels were significantly lower in MI households . Repeated measures analysis of variance across baseline , 3-month , and 6-month time points showed a significant time-by-treatment interaction , whereby nicotine levels for the MI group decreased significantly and nicotine levels for the SH group increased but were not significantly different from baseline . CONCLUSIONS This study targeted a large sample of racially and ethnically diverse low-income families , in whom both exposure and disease burden is likely to be significant . This is the first study to our knowledge that has been effective in reducing objective measures of passive smoke exposure in households with healthy children . These findings have important implication s for pediatric health care providers , who play an important role in working with parents to protect children 's health . Providers can help parents work toward reducing household passive smoke exposure using motivational strategies and providing a menu of approaches regardless of whether the parents are ready to quit Patients ( N = 114 ) consecutively entering a medical service with ulcer , cirrhosis or pancreatitis , currently drinking and not currently active in alcoholism treatment were r and omly assigned to motivational intervention ( MI ) or to a control group . Increased utilization of alcoholism programs and self-reported sobriety at 10 weeks were assessed . MI consisted of three separate discussion s of the relationship of the patient 's disease to continued drinking and the compassionate offer of treatment . Two persons skilled in treatment also met with each MI subject and discussed treatment possibilities for them , facilitating entrance if desired . Patients in both the MI and control group were treated for their medical condition by a medical team and alcoholism treatment was always recommended . Outcome was evaluated for the period from the 10th to the 16th week after return to the community by interview of patient and household contacts and by the keeping of appointments . There were no differences between the control and MI groups , with at least 38 % remaining sober for the 10-week interval ; the study size was sufficient to detect reliably a 30 % improvement . We conclude that additional motivational intervention to this level was not beneficial to the hospitalized alcoholic with disease . There was a statistically significant increase in sobriety among patients who either undertook alcoholism therapy , accepted all parts of the study or kept clinical appointments Motivational interviewing ( MI ) is a directive , client-centered brief intervention to elicit behavior change by helping clients explore and resolve ambivalence . In this clinical trial , 152 out patients and 56 in patients entering public agencies for treatment of drug problems were r and omly assigned to receive or not receive a single session of manual-guided MI .  Drug use was assessed by self-report , urine toxicology , and collateral reports from significant others at baseline , 3 , 6 , 9 , and 12 months . Contrary to prior reports , MI showed no effect on drug use outcomes when added to inpatient or outpatient treatment , although both groups showed substantial increases in abstinence from illicit drugs and alcohol BACKGROUND This report describes the 48-month efficacy and benefit-cost analysis of Project TrEAT ( Trial for Early Alcohol Treatment ) , a r and omized controlled trial of brief physician advice for the treatment of problem drinking . METHODS Four hundred eighty-two men and 292 women , ages 18 - 65 , were r and omly assigned to a control ( n = 382 ) or intervention ( n = 392 ) group . The intervention consisted of two physician visits and two nurse follow-up phone calls . Intervention components included a review of normative drinking , patient-specific alcohol effects , a worksheet on drinking cues , drinking diary cards , and a drinking agreement in the form of a prescription . RESULTS Subjects in the treatment group exhibited significant reductions ( p < 0.01 ) in 7-day alcohol use , number of binge drinking episodes , and frequency of excessive drinking as compared with the control group . The effect occurred within 6 months of the intervention and was maintained over the 48-month follow-up period . The treatment sample also experienced fewer days of hospitalization ( p = 0.05 ) and fewer emergency department visits ( p = 0.08 ) . Seven deaths occurred in the control group and three in the treatment group . The benefit-cost analysis suggests a 43,000 dollars reduction in future health care costs for every 10,000 dollars invested in early intervention . The benefit-cost ratio increases when including the societal benefits of fewer motor vehicle events and crimes . CONCLUSIONS The long-term follow-up of Project TrEAT provides the first direct evidence that brief physician advice is associated with sustained reductions in alcohol use , health care utilization , motor vehicle events , and associated costs . The report suggests that a patient 's personal physician can successfully treat alcohol problems and endorses the implementation of alcohol screening and brief intervention in the US health care system AIMS To assess the effectiveness of a motivational interview among hospitalized psychiatric patients with comorbid substance use disorder in reducing alcohol and other drug ( AOD ) use . DESIGN Subjects were assigned r and omly to receive an individual motivational interview ( n=79 ) or a self-help booklet ( control condition ; n=81 ) . SETTING Subjects were volunteers recruited from a major public psychiatric hospital . PARTICIPANTS Subjects met abuse or dependence criteria on the structured clinical interview for diagnosis ( SCID ) for alcohol , cannabis or amphetamine or they reported hazardous use during the last month of one or more of these drug types on the opiate treatment index ( OTI ) . INTERVENTION Either one 30 - 45-minute motivational interview or brief advice . MEASUREMENTS The SCID and OTI were the main measures . FINDINGS There was a modest short-term effect of the motivational interview on an aggregate index of alcohol and other drug use ( polydrug use on the OTI ) . Cannabis use remained high among the sample over the 12-month follow-up period . CONCLUSION Although motivational interviewing appears feasible among in- patients in psychiatric hospital with comorbid substance use disorders , more extensive interventions are recommended , continuing on an out-patient basis , particularly for cannabis use In this study , 126 clients ( 87 men , 39 women ) entering outpatient alcoholism treatment were assigned r and omly to 1 of 3 preparatory conditions : a role induction ( RI ) session , a motivational interview ( MI ) session , or a no-preparatory session control group ( CG ) . Clients assigned to the MI preparatory condition attended more treatment sessions and had fewer heavy drinking days during and 12 months after treatment relative to CG clients . Clients assigned to MI , relative to CG clients , also had more abstinent days during treatment and during the first 3 months posttreatment , although this difference was not maintained through the remainder of the 12-month follow-up period . Clients assigned to the RI condition showed no significant advantage over those in the CG condition This study compared the concurrent and predictive validity of motivational subtypes versus a continuous measure of readiness for change as measured by the University of Rhode Isl and Change Assessment Scale ( URICA ; E. A. McConnaughy , J. O. Prochaska , & W. F. Velicer , 1983 ) in 252 individuals participating in a substance abuse treatment study ( 38 % female ; mean age = 36 ) . Hierachical cluster analysis identified a 2-cluster solution . Consistent with previous research , both the motivational subtypes and the continuous readiness measure exhibited good concurrent validity with both baseline characteristics and change process variables . Neither readiness-for-change measure predicted end treatment outcomes . Measures of readiness for change based on the URICA exhibit limited clinical utility , because they are not able to predict future behavior OBJECTIVE Cost-effective interventions are needed for counseling pregnant drinkers , in order to reduce risk of fetal alcohol effects . METHOD 42 pregnant women who reported alcohol consumption participated in this pilot study of motivational interviewing . Following a comprehensive alcohol use assessment , the participants were r and omly assigned to receive either written information about the risks related to drinking during pregnancy or a one-hour motivational interview . The motivational interview was an empathic , client-centered , but directive session focusing on the health of the participants ' unborn babies . RESULTS At the end of a 2-month follow-up period , the 34 women ( 81 % ) who remained in the study showed a significant reduction in alcohol consumption and peak intoxication levels . Women who had reported the highest blood alcohol concentration ( BAC ) levels during early pregnancy showed a significantly greater reduction in their estimated BACs at follow-up ( during later pregnancy ) if assigned to the treatment rather than the control condition . CONCLUSIONS Motivational interviewing shows promise as a specific intervention for initiating a reduction in drinking among pregnant women who are at greatest risk . Simpler assessment and advice may suffice for women with lower initial consumption levels OBJECTIVES This study examined long-term response to an individual preventive intervention for high-risk college drinkers relative to the natural history of college drinking . METHODS A single-session , individualized preventive intervention was evaluated within a r and omized controlled trial with college freshmen who reported drinking heavily while in high school . An additional group r and omly selected from the entire screening pool provided a normative comparison . Participant self-report was assessed annually for 4 years . RESULTS High-risk controls showed secular trends for reduced drinking quantity and negative consequences without changes in drinking frequency . Those receiving the brief preventive intervention reported significant additional reductions , particularly with respect to negative consequences . Categorical individual change analyses show that remission is normative , and they suggest that participants receiving the brief intervention are more likely to improve and less likely to worsen regarding negative drinking consequences . CONCLUSIONS Brief individual preventive interventions for high-risk college drinkers can achieve long-term benefits even in the context of maturational trends OBJECTIVE Brief interventions for hazardous and low-dependent drinkers in the primary care setting have considerable empirical support . The purpose of this study was to ( 1 ) evaluate the effects of brief advice ( BA ) and motivational enhancement ( ME ) interventions on alcohol consumption . In addition , a hindsight matching design was used to ( 2 ) study the moderator effects of patient readiness to change ( alcohol use ) on alcohol consumption . METHOD The subjects ( N = 301 , 70 % men ) were patients 21 years of age or older who presented for treatment at one of 12 primary care clinics . After screening for eligibility and providing consent to participate in the study , the patients completed a baseline assessment and were r and omly assigned to the BA , ME or st and ard care ( SC ) interventions condition . Follow-up assessment s were completed at 1- , 3- , 6- , 9- and 12-months postbaseline assessment . RESULTS Evaluation of the first hypothesis ( n = 232 for these analyses ) showed that all participants tended to reduce their alcohol use considerably between the baseline and 12-month assessment s. In addition , evaluation of the second hypothesis showed a moderator effect of readiness to change in predicting the number of drinks at 12 months , such that the BA intervention seemed more effective for patients relatively low in readiness to change compared to those higher in readiness . Readiness to change did not seem to be related to changes in drinking of participants in the SC or ME conditions . CONCLUSIONS The results confirm that , among primary care patients , substantial changes in alcohol consumption are possible . They further suggest that matching studies of patient readiness to change their alcohol use , as well as other variables , are warranted This study evaluated the effectiveness of a brief intervention ( BI ) , a one-session motivational interview , in reducing HIV risk-taking behaviour among injecting drug users ( IDU ) not enrolled in any form of treatment for drug dependence . IDU were r and omly assigned to either BI or a non-intervention control condition ( NIC ) .  One hundred and twenty-one subjects were successfully contacted for a 3-month follow-up and 88 subjects were followed up at 6 months . There were significant reductions for the sample as a whole for injecting risk-taking subscale scores on the HIV Risk-taking Behaviour Scale between pre-treatment and follow-up . There was no significant change in sexual risk-taking behaviour . There were no significant differences between groups on any measure at 3- and 6-month follow-up . There are a number of possible reasons why the sample as a whole showed significant improvements from initial to follow-up assessment s. It is possible that , having had their attention directed to their risk-taking behaviour , subjects attempted to reduce their injecting risk-taking behaviour . If this is the case and subjects in the NIC condition can be considered as having received a BI , this suggests that BIs involving a personal risk assessment are effective in reducing risk behaviours associated with injecting . However , this suggestion could only be confirmed by comparison with a non- assessment control group AIM Our objective was to evaluate the effect of training in a patient-centred intervention for GPs and practice nurses on outcomes for patients with Type II diabetes .  METHODS We carried out a r and omized controlled trial within general practice s as the basis for r and omization and a before- and -after design for measures of patient outcome . A parallel process study examined the use of the method by professionals . The study was carried out in 29 general practice s in South Glamorgan who had participated for at least 2 years in a local scheme of audit and CME in relation to Type II diabetes care . The subjects were 252 Type II diabetic patients recruited by 15 experimental and 14 control practice s. The main outcome measures were changes in glycosylated haemoglobin , patient satisfaction with care and treatment , functional health status and professional ability to apply the intervention . RESULTS Professionals adopted the innovative method with enthusiasm , but after 2 years only 19 % continued to apply the method systematic ally . The trial was , therefore , unable to demonstrate significant biochemical or functional improvements . This highlights the need to underst and the factors associated with professional uptake and subsequent ability to sustain changes in behaviour . CONCLUSIONS The efficacy of this behavioural intervention remains unproved , despite its acceptability to professional staff . Detailed and prolonged development and testing of behavioural interventions is an essential first step before embarking on r and omized controlled trials which involve complex behavioural changes in professionals or patients OBJECTIVES To test the efficacy of providing brief motivational feedback to increase post-incarceration substance use disorders ( SUD ) treatment contact . DESIGN R and omized clinical trial ( feedback vs. control ) with a 2-month post-incarceration follow-up . PARTICIPANTS Veterans ( N = 73 ) incarcerated in a county jail system who met SUD diagnostic criteria . MEASURES Baseline assessment included the Addiction Severity Index , the Form-90 assessment of recent alcohol use , and a DSM-IV SUD criteria checklist . The primary outcome was Veterans Administration ( VA ) appointments . Secondary outcomes were the Addiction Severity Index-Followup and the Treatment Services Review . INTERVENTION All participants received baseline assessment . The feedback condition received personalized feedback and encouragement to explore ambivalence about change and treatment in a single interview . RESULTS Participants receiving feedback were more likely to schedule appointments at a VA addictions clinic within 60 days of their jail release date s ( 67 vs. 41 % ; P < 0.03 ) . Though differences were not statistically significant , more feedback participants attended addictions clinic appointments ( 47 vs. 32 % ; ns ) and were retained in addictions treatment at 90 days ( 31 vs. 14 % ; P < 0.08 ) . Treatment appointments were more likely when intervention occurred close to release . Loss of participants to post-release follow-up interviews was > 50 % , limiting power to detect significant differences by self-report . CONCLUSION Brief motivational feedback shows promise as a way to link incarcerated individuals to SUD treatment services Patterns of smoking cessation using 6- and 12-month follow-up data are reported for 1,261 primary care patients r and omized to 3 physician-delivered smoking interventions : advice only ( AO ) , counseling ( CI ) , and counseling plus availability of nicotine-containing gum ( CI + NCG ) . One-week-point-prevalence cessation rates at 12 months did not differ among the interventions : AO ( 15.2 % ) , CI ( 12.9 % ) and CI + NCG ( 16.7 % ) . However , maintained cessation rates ( abstinent at both 6 and 12 months ) increased with intervention intensity : AO ( 6.0 % ) , CI ( 7.8 % ) and CI + NCG ( 10.0 % ) : Test of trend chi 2 = 5.06 , p = .02 . CI + NCG was significantly higher than AO ( p = .02 ) . The findings support the following conclusions : Brief physician-delivered intervention with availability of nicotine-containing gum can have a beneficial long-term effect on smoking cessation , and cohort data as well as point-prevalence rates are important when assessing the long-term impact of lifestyle interventions This study tested the feasibility and efficacy of a brief smoking intervention for adolescents in a hospital setting . Forty adolescent patients were r and omized to receive either brief advice or a motivational interview , a nonconfrontational therapeutic intervention .  Feasibility of brief smoking interventions with teen patients was supported by high rates of recruitment , retention , and quit attempts , and long periods of continuous abstinence . Although between-groups differences on smoking measures were not significant at 3-month follow-up , an effect size of h = .28 was noted . The sample showed significant decreases in smoking dependence and number of days smoked . Baseline stage of change , smoking rate , and depression were significant prospect i ve predictors of smoking outcome . Implication s for smoking intervention research with adolescents are discussed This study evaluated the use of a brief motivational interview ( MI ) to reduce alcohol-related consequences and use among adolescents treated in an emergency room ( ER ) following an alcohol-related event . Patients aged 18 to 19 years ( N = 94 ) were r and omly assigned to receive either MI or st and ard care ( SC ) . Assessment and intervention were conducted in the ER during or after the patient 's treatment . Follow-up assessment s showed that patients who received the MI had a significantly lower incidence of drinking and driving , traffic violations , alcohol-related injuries , and alcohol-related problems than patients who received SC . Both conditions showed reduced alcohol consumption . The harm-reduction focus of the MI was evident in that MI reduced negative outcomes related to drinking , beyond what was produced by the precipitating event plus SC alone 1 . Intervention trials in free-living population s have shown relatively small reductions in risk factors for cardiovascular disease , including lipid levels , and have led some to question whether diet is an effective treatment for hyperlipidaemia . However , behaviour change is a complex process and it is possible that st and ard intervention methods fail to motivate people sufficiently to comply with dietary advice.2 . This study applied motivational interviewing , a style of behaviour change counselling , to dietary education for people with hyperlipidaemia . One-hundred and twenty-one patients with hyperlipidaemia who had been referred to a hospital dietetic department for dietary advice were r and omized to receive either st and ard or motivational dietary interventions for a period of 3 months . Outcomes assessed included dietary knowledge , stage of change , dietary intakes , lipid levels and body mass indices . 3 . From baseline , both methods of dietary intervention result ed in self-reported changes in dietary habits and knowledge , statistically significant reductions in intake of total fat ( from 32.8 % to 28.4 % ) , saturated fat ( from 11.4 % to 9.2 % ) and energy intakes [ -239 kcal ( -999.98 kJ)/day ] , and in body mass indices ( -0.45 kg/m2 ) . Serum cholesterol did not change significantly in either intervention group.4 . Motivational and st and ard dietary interventions achieved statistically significant changes in reported dietary knowledge and behaviour , and led to a reduction in body weight , but not serum cholesterol . Whether this lack of effect is real or due to subjects overestimating true dietary change can not be determined . Change in body weight was associated with a reported change in energy intake ; this provides some support for there having been a real change in intake OBJECTIVES This study evaluated the effectiveness of a low-intensity dietary intervention in primary care practice in lowering dietary fat intake and raising dietary fiber intake . METHODS A r and omized controlled trial of 28 physician practice s in six primary care clinics enrolled , by telephone , adult patients who had appointments for nonurgent nonacute visits . Of 3490 eligible patients contacted , 2111 completed baseline interview ; 86.1 % also completed a 12-month follow-up . Physicians gave intervention participants a self-help booklet and a brief motivational message . Changes in fat and fiber from baseline to 12-month follow-up were evaluated . RESULTS Intervention and control groups both reported a decrease in fat intake and an increase in fiber intake . The differential change and 95 % confidence interval ( CI ) for the percentage of energy obtained from fat was -1.2 ( CI = -0.71 , -1.7 ) ( P = .0015 ) , for grams fiber/1000 kcal 0.32 ( CI = -0.066 , 0.71 ) ( P = .086 ) , for fat score -0.044 ( CI = -0.016 , -0.072 ) ( P = .010 ) , and for fiber score 0.036 ( CI = 0.011 , 0.061 ) ( P = .014 ) , with greater reductions in fat and greater increase in fiber in the intervention group . CONCLUSIONS This low-intensity intervention was effective in dietary behavior change During the 1980s Motivational Interviewing emerged as one of the memes of the addictions field . This occurred despite the lack of scientific evidence supporting its utility . In this paper findings of a controlled trial of a brief motivational intervention with illicit drug users ( n = 122 ) attending a methadone clinic are reported . Clients who met the study 's inclusion criteria were r and omly allocated to either a motivational ( experimental , n = 57 ) or educational ( control , n = 65 ) procedure . Over the 6-month follow-up period the motivational subjects demonstrated a greater , immediate , commitment to abstention , reported more positive expected outcomes for abstention , reported fewer opiate-related problems , were initially more contemplative of change , complied with the methadone  programme longer and relapsed less quickly than the control group . There was , however , no difference in terms of the severity of reported opiate dependence and the control group fared better on reported self-efficacy . It was concluded that motivational interventions of the type investigated are useful adjuncts to methadone programmes OBJECTIVE The purpose of this study was to determine if participation in a patient empowerment program would result in improved psychosocial self-efficacy and attitudes toward diabetes , as well as a reduction in blood glucose levels . RESEARCH DESIGN AND METHODS This study was conducted as a r and omized , wait-listed control group trial . The intervention group received a six-session ( one session per week ) patient empowerment education program ; the control group was assigned to a wait-list . At the end of 6 weeks , the control group completed the six-session empowerment program . Six weeks after the program , both groups provided follow-up data . RESULTS The intervention group showed gains over the control group on four of the eight self-efficacy subscales and two of the five diabetes attitude subscales . Also , the intervention group showed a significant reduction in glycated hemoglobin levels . Within groups , analysis of data from all program participants showed sustained improvements in all of the self-efficacy areas and two of the five diabetes attitude subscales and a modest improvement in blood glucose levels . CONCLUSIONS This study indicated that patient empowerment is an effective approach to developing educational interventions for addressing the psychosocial aspects of living with diabetes . Furthermore , patient empowerment is conducive to improving blood glucose control . In an ideal setting , patient education would address equally blood glucose management and the psychosocial challenges of living with diabetes Pregnant injecting drug users were r and omly assigned to : ( i ) individually receive a six-session cognitive-behavioural intervention in addition to their usual methadone maintenance treatment ( intervention condition ( I ) ( n = 40 ) ) ; or ( ii ) their usual methadone maintenance treatment only ( control condition ( C ) ( n = 40 ) ) . There was no change in drug use per se in either group after the intervention . However , at 9-month follow-up the I group had significantly reduced some HIV risk-taking behaviours ( in particular injecting risk behaviours ) . The I group reduced the needle risk associated both with " typical " use ( drug use in the month before interview ) and " binge " use ( drug use in the month nominated as the heaviest month of drug use in the previous 6 months ) . The intervention had no effect on sexual risk behaviours . The finding of reduced injecting risk behaviour following the six-session intervention suggests that such an intervention may be of benefit for individuals persisting with injecting risk behaviours despite methadone maintenance treatment and the availability of sterile injection equipment This research evaluated a motivation-based HIV risk reduction intervention for economically disadvantaged urban women . Participants completed a survey that assessed HIV-related knowledge , risk perceptions , behavioral intentions , sexual communication , substance use , and risk behavior . A total of 102 at-risk women ( 76 % African American ) were r and omly assigned to either the risk reduction intervention or to a waiting list . Women were reassessed at 3 and 12 weeks . Results indicated that treated women increased their knowledge and risk awareness , strengthened their intentions to adopt safer sexual practice s , communicated their intentions with partners , reduced substance use proximal to sexual activities , and engaged in fewer acts of unprotected vaginal intercourse . These effects were observed immediately , and most were maintained at follow-up A self-help book was offered to persons wanting to quit or cut down on their alcohol use . Study participants ( 99 men , 56 women ) were recruited through advertisements , screened by telephone , and r and omly assigned to 1 of 2 conditions . Book by mail or Assessment + Book ( 30-min telephone motivational interview plus book by mail ) . At 3-month follow-up , significantly more participants qualified as moderate drinkers in the Assessment + Book condition ( 65 % vs. 43 % ) , by this criterion : < or = 12 drinks/week and < or = 10 % heavy drinking days ( 5 + drinks if male and 4 + drinks if female ; 13.6 g of ethanol per drink ) . At 12 months there was no effect of condition , but significantly more women than men were rated as moderate drinkers ( 71 % vs. 52 % ) . Collateral informants corroborated the participants ' reports of drinking Aims This preliminary study addresses three related issues . First , there is a need to test the effectiveness of cognitive behavioural therapy ( CBT ) for binge eating in population s with Type 2 diabetes . Second , the impact of a treatment for binge eating on diabetes management is unknown . Finally , whilst a number of treatment modalities have been shown to improve binge eating , there has not been a comparison between CBT and a non-specific therapy for binge eating . Methods Group CBT for binge eating was compared with a group non-prescriptive therapy ( NPT ) , a therapy for which there is no theoretical or empirical support in eating disorders , in a r and omized trial which included a post-treatment assessment and a 3-month follow-up . Results There were no differences between CBT and NPT at post-treatment , with both treatments being associated with significant changes in binge eating , mood and body mass index . However , there was a significant relapse in binge eating at the 3-month follow-up in the NPT condition . This was in contrast to the CBT condition , where treatment gains were maintained . Finally , across treatments , reduction in binge eating from pre- to post-treatment was associated with reduction in HbA(1c ) . Conclusions Binge eating in Type 2 diabetes is responsive to psychosocial treatment , and reduction in binge eating appears to improve glycaemic control . However , this is a small study with a short follow-up period . Future studies will need to extend the follow-up period to assess for long-term maintenance of the effects of CBT on binge eating and diabetic control in this population
BACKGROUND Motivational Interviewing is a well-known , scientifically tested method of counselling clients developed by Miller and Rollnick and viewed as a useful intervention strategy in the treatment of lifestyle problems and disease .
AIM To evaluate the effectiveness of motivational interviewing in different areas of disease and to identify factors shaping outcomes .