Background and aims: The Motivational Interviewing Treatment Integrity code (MITI) measures fidelity to, and the quality of, Motivational Interviewing (MI), and can also be used when MI is combined with other treatment methods. The current study presents a fidelity measurement with the MITI 4.2.1, in both Motivational Enhancement Therapy sessions and the combined Community Reinforcement Approach-Senior (CRAeS). Method: The MITI 4.2.1 was used to evaluate treatment sessions provided in the Elderly Study, a multi-national randomized trial evaluating treatment for alcohol use disorders in the elderly. Following expert recommendations, training was conducted at two international sites as well as at the Danish site. Twenty percent of the sessions at the Danish study site were rated. Twelve percent were multiply rated by all raters. Interrater reliability was assessed by the Intraclass Correlations Coefficient (ICC). Results: Mean ICC of the 52 sessions rated by all raters was 0.78 (95% CI: 0.70; 0.86). The rare measures confront and emphasize autonomy, and the global measure softening sustain talk only reached fair levels of ICC, while the remaining measures were good or excellent. In the sessions of MI combined with other treatment approaches in the CRAeS, the MITI 4.2.1 has a similar reliability as in MET sessions only, except for the measure persuade with permission. Conclusion:The MITI 4.2.1 is a reliable instrument for measuring fidelity to Motivational Interviewing elements, also in the context of Community Reinforcement Approach Senior. However, in softening sustain talk, the rare measures, and persuade with permission it has proved more difficult to reach high levels of interrater reliability. Treatment fidelityTreatment fidelity, also called treatment integrity, is defined as the extent to which treatment is implemented as intended

Background: Part of the variability in treatment outcomes for Motivational Interviewing (MI) may be explained by differences in the fidelity to MI. The Motivational Interviewing Treatment Integrity manual version 4 (MITI 4) is an improved measure of fidelity to elements of MI. It is not known whether the fidelity to MI, as measured by the MITI 4, is related to treatment outcome. Objectives: To examine whether fidelity to MI is associated with alcohol use outcomespredictive validity of the MITI 4. Method: Twenty percent of the recorded sessions at the Danish sites of the Elderly Study were randomly drawn and coded for fidelity to MI with the MITI 4. The Elderly Study was an international, randomized controlled trial, in which people 60 years or older with Alcohol Use Disorders received either four weeks of Motivational Enhancement Therapy (MET) or four weeks of MET combined with up to eight additional sessions of the Community Reinforcement Approach-Senior (MET+CRA-S). Elements of MI and summary scores of the MITI 4 were used as predictors in a mixed effects regression analysis. Treatment outcomes were use of alcohol and consequences of drinking at 26-weeks follow-up. Results: In total, 423 sessions representing 238 participants were randomly drawn and coded for fidelity to MI. Mean values of the treatment elements indicated high fidelity to MI, with higher fidelity to MI in the MET sessions, as compared to CRA-S sessions. None of the predictors in the multilevel model analyses were associated with outcome at follow-up. Exploratory analysis indicated reverse associations between one measure of MI-fidelity and drinking outcomes in the combined treatment (CRAeS). Conclusion: The fidelity of the MI intervention, received by participants in this study, did not predict better treatment outcomes. MI may be less effective in populations which are already committed to change behavior. As expected and validating for the MITI 4, fidelity to MI-elements was lower in the combination of MI with other treatment approaches. Additionally, the timing of MI in these combined settings might be important for effectiveness.

Background and aimsThe recommendations of duration of treatment for alcohol use disorders (AUD) in clinical guidelines are based on consensus decisions. There is a risk that patients will receive too little or too much therapy. We hypothesize that there is an association between duration and effect up until a point where the effects of treatment diminish.MethodsA systematic review and meta-analysis of randomized controlled trials of psychosocial interventions in the alcohol outpatient treatment centers. Population: adults (> 17 years) suffering from AUD treated with at least two sessions of therapy.StatisticsMultiple linear regression analysis with outcome measured in percentage of days abstinent (PDA), percentage of heavy days drinking (PHD), drinks per drinking day (DDD) and/or proportion of participants abstinent (ABS) as a function of duration of treatment.ResultsForty-four studies with 8485 participants were included. Mean duration: 18 (8–82) weeks and 15 (2–36) sessions. Mean follow-up time: 43 (8–104) weeks with a mean of 5 (2–18) research assessments. Only ABS was significantly associated with duration of treatment; ABS increased with 1.6%-point (P < 0.01) with each additional week in treatment. Surprisingly the analysis showed that each research assessment increased PDA with 11%-point (P < 0.001), decreased PHD with 4%-point (P < 0.05) and decreased DDD with 8%-point (P < 0.001).ConclusionDuration of treatment was associated positively with proportion of participants abstinent but not percentage of days abstinent drinks per drinking day or percentage of heavy drinking days. The three latter outcomes were affected positively by number of research assessments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

No associations between long-term alcohol use outcomes and planned or actual attended duration of psychosocial treatment in outpatient care. Research assessments and, accordingly, the research project in itself may influence outcome in studies of psychosocial treatment for alcohol use disorder.

We do not know if the delivery of Motivational Interviewing (MI) differs across countries. In an international study targeting Elderly people with Alcohol Use Disorder, The Elderly Study, MI was part of the treatment applied. Treatment delivery was measured by means of the Motivational Interviewing Treatment Integrity code version 4 (MITI 4). Mixed effects models explored potential differences in delivery of MI between the countries. Delivery of MI differed significantly between participating countries: Denmark, Germany and the US. These findings are important to consider when comparing measures of MI integrity across studies from different cultures.