Normative Feedback and Adolescent Readiness to Change

Abstract

For adolescents with substance use problems, it is unknown whether the provision of normative feedback is a necessary active ingredient in motivational interviewing (MI). This study investigated the impact of normative feedback on adolescents’ readiness to change and perceptions of MI quality. Adolescents referred for substance use disorder (SUD) assessments were randomized to MI with normative feedback (NF; MI + NF, n = 26) or MI only (MI, n = 22). There were no significant differences between the MI + NF or MI conditions with reference to changes in readiness, and although not significant, there was a decline in readiness for the overall sample. Treatment satisfaction and ratings of MI quality were generally high with no between-group differences. Post hoc analyses revealed a nonsignificant trend where race interacted with treatment condition. Larger replication studies are needed to further study the effects of NF and potential NF by participant characteristic interactions.

Brief Motivational Interviewing and Normative Feedback for Adolescents: Change Language and Alcohol Use Outcomes

“…Only one study, however, has investigated whether a normative feedback component is an active ingredient in brief MI treatment with adolescents and (Smith, Ureche, Davis, & Walters, 2015) randomly assigned youth ( n = 48) to receive MI or MI plus NF. Adolescents receiving NF had lower post-session readiness to change (Smith et al, 2015), lower self-reported treatment engagement ( d = − .31, ns ; Smith et al, 2015), and fewer days of abstinence (−7.9%, ns ) at 3-months, however these effects showed no differences between groups. These findings, while not significant, echo anecdotal concerns about the appropriateness of NF for adolescents (Winters, Fahnhorst, Botzet, Lee, & Lalone, 2012).…”

“…MI encourages individuals to articulate the potential benefits of change, respects individuals’ autonomy (Barnett, Sussman, Smith, Rohrbach, & Spruijt-Metz, 2012; Smith & Hall, 2007; Smith, Hall, Jang, & Arndt, 2009), and emphasizes the collaborative therapeutic relationship in which therapists elicit and reinforce client change talk (Baer et al, 2008; Barnett et al, 2014a, 2014b). MI is an efficacious intervention for at-risk adolescents (Baer et al, 2008; Carcone et al, 2013; D’Amico et al, 2015; D’Amico et al, 2012; Erickson, Gerstle, & Feldstein, 2005; Feldstein & Ginsburg, 2006; Naar-King & Suarez, 2011; Smith, Davis, Ureche, & Tabb, 2015; Spirito et al, 2011; Walker, Roffman, Stephens, Wakana, & Berghuis, 2006). Few adolescent studies have investigated the active ingredients of MI or its mechanisms of change.…”

“…Using data from a randomized controlled trial examining the impact of MI and MI plus NF among adolescents presenting for a substance use assessment (Smith et al, 2015), we investigated whether the percentage of change talk (PCT) was 1) predictive of 3-month alcohol and cannabis use outcomes and 2) predictive of treatment engagement (attending 3 or more sessions post assessment). Based on prior concerns in the literature, we tested whether receipt of NF interacted with PCT to predict worse alcohol and cannabis use outcomes at 3-month follow up.…”

Motivational Interviewing with and without Normative Feedback for Adolescents with Substance Use Problems: A Preliminary Study

“…In terms of normative feedback comparisons, on average, youth in the NF condition exceeded the outpatient treatment sample norms for past 90-day alcohol use by 2 days, marijuana use by 15 days, and other drug use by 3 days. 5 Additional detail on participant characteristics is reported elsewhere. 5 …”

“…Data were collected in-person, using the Global Appraisal of Individual Needs-Quick (GAIN-Q3; version GQ.3.2.0) 41 at baseline (i.e., treatment intake assessment) and then again three months following the baseline assessment. Whereas a prior report from this study investigated whether MI or MI+NF impacted post-session readiness to change, 5 this study focused on three-month findings.…”