A Randomized Clinical Trial of a New Behavioral Treatment for Drug Abuse in People With Severe and Persistent Mental Illness

Bellack, Alan S.; Bennett, Melanie E.; Gearon, Jean S.; Brown, Clayton H.; Yang, Ye

doi:10.1001/archpsyc.63.4.426

Cited by 254 publications

(210 citation statements)

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“…34 MI has been shown to improve patients' general health status or well-being, promote physical activity, help develop healthier nutritional habits, and manage chronic conditions such as mental illness, hypertension, hypercholesterolemia, obesity, and diabetes. [37][38][39][40][41] Randomized controlled trials have shown that brief MI training for clinicians is effective for improving patient medication adherence, especially if there is follow-up contact after an initial training, 42,43 and even at low doses (i.e., two or three sessions). MI is effective as a pretreatment adjunct and as an approach for less motivated or prepared patients, and may be applied for a wide range of medications across diverse populations.…”

Section: Motivational Interviewing and Counselingmentioning

confidence: 99%

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

et al. 2016

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Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decisionmaking for clinicians interested in providing patientcentered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of nonadherence to medications for chronic conditions. A dherence to medications is often suboptimal-up to 50 % of patients do not take their prescribed medication as recommended. 1-4 Medication non-adherence is associated with adverse health outcomes as well as negative social and economic consequences. [5][6][7] The problem of medication nonadherence is often multifaceted and multifactorial; in general, most conceptual models of medication non-adherence take an ecological perspective, and include patient factors (e.g., literacy, cognitive function), provider factors (e.g., complex regimens), social/community factors (e.g., access to providers and pharmacy), health care factors (e.g., interaction with healthcare system, trust, prior authorization, fragmentation), and policy implications (e.g., coverage of medication). 8-10 Thus, to be effective, interventions designed to improve appropriate medication use must adopt a comprehensive approach, often combining numerous proven strategies. Several evidence reviews have identified interventions with modest effects in promoting both overall and condition-specific medication adherence. [11][12][13][14][15][16] Given the complex, multifactorial cause of medication non-adherence, interventions can be similarly multifactorial and multi-level. In this paper we focus on the physician-patient level to furnish providers with a guide to applying adherence research in the clinical encounter.Evidence increasingly demonstrates that adopting a personcentered approach for medication use that incorporates patient beliefs, preferences, goals, and barriers to medication-taking (e.g., cost, technological ability, concerns about medication prescribing and use) leads to better clinical outcomes. 17,18 Clinicians are in a key position to elicit this information from patients and to incorporate it into medication-related decisions, thereby improving medication adherence rates. Person-centered care focuses on providing patients with greater choice, recognizing their roles as consumers of health care who know best their own beliefs and preferences. This care is meant to encourage value concordance-in this case, the match between the treatment that is selected and the treatment that i...

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Section: Motivational Interviewing and Counselingmentioning

confidence: 99%

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

et al. 2016

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“…For treatment compliance, the effect size was medium ( Three studied the effect of MI plus CBT on treatment engagement, all eight studied the effect of MI plus CBT on substance abuse, and one also studied the effect of MI plus CBT on HIV viral load (Parsons, Golub, Rosof, & Holder, 2007). The three studies that examined the effect of MI on engagement showed an increase in participation (Bellack, Bennett, Gearon, Brown, & Yang, 2006;Carroll et al, 2006;Parsons et al, 2007), and six of the eight found at least one positive effect for outcome (Baker et al, 2006;Baker et al, 2005;Bellack et al, 2006;Parsons et al, 2007;Stein, Herman, & Anderson, 2009), suggesting that MI complements other treatments by improving both engagement and outcome.…”

Section: As a Complement To Cbtmentioning

confidence: 99%

Integrating Motivational Interviewing and Self-Determination Theory With Cognitive Behavioral Therapy to Prevent Suicide

Britton

Patrick

Wenzel

et al. 2011

Cognitive and Behavioral Practice

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Cognitive Behavioral Therapy (CBT) has been found to be effective in preventing suicide-related behavior. However, it is often difficult to engage patients who are at-risk in treatment. Motivational Interviewing (MI) has been shown to increase treatment engagement and improve treatment outcomes when it is used to complement other treatments. As a general theory of human motivation that is consistent with MI, Self-Determination Theory (SDT) provides a framework for understanding how MI may be added to CBT to increase treatment engagement and effectiveness. In this paper, we use SDT to explain how MI may complement CBT to reduce suicide-related behavior, provide a case example of using MI with a suicidal patient before CBT-based treatment, and explore future directions for research.In the United States, over 300,000 people died by suicide between 1995 and 2005, making suicide a major public health concern (Centers for Disease Control and Prevention, 2008). Although an estimated 90% of individuals who die from suicide suffer from one or more mental disorders, up to 65% never receive psychological or psychiatric treatment (Cavanagh, Carson, Sharpe, & Lawrie, 2003). Psychosocial interventions such as Cognitive Behavioral Therapy are effective in reducing suicide-related behaviors (CBT; Tarrier, Taylor, & Gooding, 2008); thus, it is important to use theoretically and empirically supported methods to ensure that at-risk clients receive effective mental health treatment. Motivational Interviewing (MI;Miller & Rollnick, 2002) has been shown to increase treatment engagement and improve treatment outcomes when it is used to complement other treatments (Hettema, Steele, & Miller, 2005). However, MI is a clinical approach that currently lacks an underlying theory to explain the mechanisms by which it functions. As a general theory of human motivation that is consistent with the underlying principles of MI, Self-Determination Theory (SDT; Deci & Ryan, 2002) provides a framework for understanding the manner in which MI can be integrated with CBT to increase treatment Correspondence concerning this article should be addressed to Peter C. Britton, Ph.D., Center of Excellence, Department of Veteran Affairs Medical Center, 14424. peter.britton@va.gov. U.S. Department of Veterans AffairsPublic Access Author manuscript Cogn Behav Pract. Author manuscript; available in PMC 2016 October 19. Cognitive Behavioral Therapy (CBT) to Reduce Suicidal BehaviorIn a recent meta-analysis of 28 randomized controlled trials (RCTs), CBT was found to reduce suicide-related behavior (i.e., death by suicide, suicide attempts, suicide intent and/or plans, and ideation) in the 3 months following treatment (Tarrier et al., 2008). The primary cognitive behavioral interventions that were represented in the study included Dialectical Behavioral Therapy (DBT), problem-solving therapy, and Cognitive Therapy (CT). Although the findings were promising, a review of the major studies suggested that attrition was a common problem. For example, in Brown's ...

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“…The significant reduction in cocaine use in the ATM condition is noteworthy because there is limited empirical support for any specific substance abuse treatment for indigent people with concomitant substance use and severe and persistent mental disorders (25). Some of the treatments that have shown promise are quite extensive-residential treatment (26), case management (27), a multi-component biweekly approach (24), and incentivized participation in a Veterans Health Administration work program (28).…”

Section: Discussionmentioning

confidence: 99%

Advisor-Teller Money Manager (ATM) Therapy for Substance Use Disorders

Rosen¹,

Rounsaville²,

Ablondi³

et al. 2010

Psychiatric Services

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Objective-Patients with concomitant psychiatric and substance use disorders are commonly assigned representative payees or case managers to help manage their funds, but money management has not been conceptualized as a theory-based treatment. This randomized clinical trial was conducted to determine the effect of a money management-based therapy, advisor-teller money manager (ATM), on substance abuse or dependence.Methods-Ninety patients at a community mental health center who had a history of cocaine or alcohol abuse or dependence were assessed after random assignment to 36 weeks of ATM (N=47) or a control condition in which use of a financial workbook was reviewed (N=43). Patients assigned to ATM were encouraged to deposit their funds into a third-party account, plan weekly expenditures, and negotiate monthly budgets. Substance use calendars and urine toxicology tests were collected every other week for 36 weeks and again 52 weeks after randomization.Results-Patients assigned to ATM had significantly more negative toxicologies for cocaine metabolite over time than patients in the control group, and treating clinicians rated ATM patients as significantly more likely to be abstinent from illicit drugs. Self-reported abstinence from alcohol did not significantly differ between groups. Unexpectedly, patients assigned to ATM were more likely to be assigned a representative payee or a conservator than control participants during the follow-up period (ten of 47 versus two of 43). One patient in ATM assaulted the therapist when his check had not arrived.Conclusions-ATM is an efficacious therapy for the treatment of cocaine abuse or dependence among people with concomitant psychiatric illness but requires protection of patient autonomy and staff safety.People with severe psychiatric illnesses commonly use alcohol, cocaine, or both (1,2). Because of their substance use and disabling psychiatric illnesses, patients with co-occurring disorders are frequently poor and need to make the most of their limited income to avoid abject poverty. Unfortunately, high proportions of psychiatric patients report difficulty managing their money and have made poor financial decisions under the influence of drugs (3). Patients' desire to have money is a potentially powerful motivation to stop buying alcohol and cocaine, and people who are poor and mentally ill indicate a desire for help with concrete financial concerns (4). DisclosuresThe authors report no competing interests. Advisor-teller money manager therapy (ATM) is a money management-based intervention that targets substance use. ATM attempts to break the linkage between a patient's money and cued associations with drug use by storing the patient's funds and training him or her to budget funds for things other than substances of abuse (5). Patients in the ATM program work with their therapists to make budgets, thus mentally associating their money with planned nondrug expenditures that in turn are linked to long-term goals. Behavioral economists have described how such "men...

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A Randomized Clinical Trial of a New Behavioral Treatment for Drug Abuse in People With Severe and Persistent Mental Illness

Abstract: The BTSAS program is an efficacious treatment. Further work needs to be done to increase the proportion of eligible patients who are able to become engaged in treatment.

Cited by 254 publications

References 49 publications

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

Integrating Motivational Interviewing and Self-Determination Theory With Cognitive Behavioral Therapy to Prevent Suicide

Advisor-Teller Money Manager (ATM) Therapy for Substance Use Disorders

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