Change Plan as an Active Ingredient of Brief Motivational Interventions for Reducing Negative Consequences of Drinking in Hazardous Drinking Emergency-Department Patients

Abstract

ABSTRACT. Objective:Few studies have examined the effects of brief motivational intervention components, such as change-plan completion, on treatment outcomes. This secondary analysis of an opportunistically recruited emergency-department sample of hazardous injured drinkers examines the potential predictive role of an alcohol-related change plan on treatment outcomes after accounting for pretreatment readiness. Written change plans were independently rated. Method: A mediational analysis framework tested directional hypotheses between pretreatment readiness, change plan, and treatment outcomes using linear regressions. The baseline total Drinker Inventory of Consequences (DrInC) score was covaried on 12-month DrInC total score, in all analyses. Participants who completed a brief motivational intervention and a change plan were included (N = 333). Results: Pretreatment readiness was negatively associated with alcohol consequences at 12 months, = -.09, t(254) = -2.07, p < .05, and good-quality change plans, = .18, t(320) = 4.37, p < .001. With change plan and readiness in the same model, the relationship between readiness and treatment outcomes became nonsignifi cant, but change plan remained a signifi cant predictor of treatment outcomes in the expected direction, = -.17, t(254) = -2.89, p < .01. Follow-up generalized linear modeling including an interaction term (change plan and pretreatment readiness) revealed that those with high readiness and a good-quality change plan versus those with low readiness and a poor-quality change plan had better-than-predicted outcomes for either readiness or change plan alone. Conclusions: Study fi ndings suggest that the change plan in brief motivational intervention may be an active ingredient of treatment associated with better outcomes over and above the infl uence of pretreatment readiness. (J. Stud. Alcohol Drugs, 71, 726-733, 2010) (Burke et al., 2003;Hettema et al., 2005) and in diverse health care settings, including primary care and emergency departments (EDs;Gentilello et al., 1999;Longabaugh et al., 2001;Monti et al., 1999). The underlying principles of MI-valuing patient autonomy, collaboration, eliciting the patient's perspectives, building intrinsic motivation to change, and highlighting the discrepancy between where the patient is and where he or she wants to go-are key to its successful implementation, such that in their absence it is unlikely that MI is being delivered (Miller, 1996;Miller and Rollnick, 2002). Brief motivational interventions (BMIs) are an adaptation of MI and its principles and are predominantly used in medical or health care settings targeting a non-treatment-seeking population (Moyer et al., 2002;Rollnick et al., 1992;Saunders et al., 1995). Although BMIs are informed by MI principles, they are distinct from MI because they are more time limited (usually single session) and may include structured strategies, or treatment components, such as the use of personal feedback reports, discussion of pros and cons of use, and change-plan compl...

From Research to Practice: Lay Adherence Counsellors’ Fidelity to an Evidence-Based Intervention for Promoting Adherence to Antiretroviral Treatment in the Western Cape, South Africa

“…The development of an individualised action plan for change is a key aspect of brief motivational interventions thought to be partially responsible their effectiveness [23,43]. Despite diffi managing the readiness-to-change assessment, the majority of counsellors in this study did go on to discuss strategies for change with their patients.…”

“…Adaptations of MI have thus been developed for use in brief consultations that occur in medical and healthcare settings [26]. These interventions, which include Options, are referred to as brief motivational interventions (BMIs) or behaviour change counselling (BCC), and omit some of the more psychotherapeutic elements of the parent method [25].…”

“…These interventions, which include Options, are referred to as brief motivational interventions (BMIs) or behaviour change counselling (BCC), and omit some of the more psychotherapeutic elements of the parent method [25]. Many of the skills and principles from MI still apply in BMIs and BCC, including the demonstration of empathy and respect for client autonomy and choice, the development of action plans for behaviour change [25,26], the spirit of the interaction [27], and the concept and assessment of readiness-tochange [28].…”

Factors associated with alcohol reduction in harmful and hazardous drinkers following alcohol brief intervention in Scotland: a qualitative enquiry

“…Additionally, the literature suggests that ABIs provide a structure to support and implement this change [9]. …”

Lessons learned for follow-up phone booster counseling calls with substance abusing emergency department patients

“…However, a booster session after leaving the ED can remind them of the intervention, encourage and reinforce their commitment to change as well as explore barriers that they may have encountered, and reinforce their putting their change plan into action (Lee, et al, 2010; Longabaugh, et al, 2001). …”