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Among patients receiving buprenorphine-naloxone in primary care for opioid dependence, the efficacy of brief weekly counseling and once-weekly medication dispensing did not differ significantly from that of extended weekly counseling and thrice-weekly dispensing. Strategies to improve buprenorphine-naloxone adherence are needed. (ClinicalTrials.gov number, NCT00023283 [ClinicalTrials.gov].).

The effect of motivational interviewing on outpatient treatment adherence among psychiatric and dually diagnosed inpatients was investigated. Subjects were 121 psychiatric inpatients, 93 (77%) of whom had concomitant substance abuse/dependence disorders, who were randomly assigned to: a) standard 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.

BACKGROUND Brief interventions (BI) have been shown to reduce alcohol use and improve outcomes in Hazardous and Harmful (HH) drinkers but evidence to support their use in emergency department (ED) patients is limited. The use of research assessments in studies of BI may contribute to uncertainty about their effectiveness. METHODS We randomized 889 adult ED patients with HH drinking. A total of 740 received 1) an emergency practitioner (EP)-performed Brief Negotiation Interview (BNI, n=297), 2) BNI with a 1-month follow-up telephone booster (BNI with Booster), (n=295), or 3) standard care (SC, n=148). We also included a standard care with no assessments (SC-NA, n=149) group to examine the impact of assessments on drinking outcomes. Primary outcomes analyzed using mixed models procedures included past 7-day alcohol consumption and 28-day binge episodes at 6 and 12 months collected by Interactive Voice Response. Secondary outcomes included negative health behaviors and consequences collected by phone surveys. RESULTS The reduction in mean number of drinks in the past 7 days from baseline to 6 and 12 months was significantly greater in BNI with Booster: from 20.4 (95% confidence interval [CI], 18.8-22.0) to 11.6 (95% CI, 9.7-13.5) to 13.0 (95% CI, 10.5-15.5) and BNI: from 19.8 (95% CI, 18.3-21.4) to 12.7 (95% CI, 10.8-14.6), to 14.3 (95% CI, 11.9-16.8), than in SC: from 20.9 (95% CI, 18.7-23.2) to 14.2 (95% CI, 11.2-17.1), to 17.6 (95% CI, 14.1-21.2). The reduction in 28-day binge episodes was also greater in BNI with Booster: from 7.5 (95% CI, 6.8-8.2) to 4.4 (95% CI, 3.6-5.2) to 4.7 (95% CI, 3.9-5.6) and in BNI: from 7.2 (95% CI, 6.5-7.9) to 4.8 (95% CI, 4.0-5.6), to 5.1 (95% CI, 4.2-5.9), than in SC: from 7.2 (95% CI, 6.2-8.2) to 5.7 (95% CI, 4.5-6.9), to 5.8 (95% CI, 4.6-7.0). BNI with Booster offered no significant benefit over BNI. There were no differences in drinking outcomes between the SC and SC-NA groups. The reductions in rates of driving after drinking ≥ 3 drinks from baseline to 12 months were greater in the BNI (38% to 29%) and BNI with Booster (39% to 31%) groups than in the SC group (43% to 42%). CONCLUSIONS EP-performed brief interventions can reduce alcohol consumption and episodes of driving after drinking in HH drinkers. These results support the use of brief interventions in ED settings.