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Persuasive evidence from the US Project MATCH alcohol treatment trial that a non-directive therapeutic style suits clients prone anger or defensiveness or who like to take control, and more structured and directive approaches suit those who welcome being given a lead.
Better than 'treatment as usual' but not than other specific therapies are the headlines from the most comprehensive synthesis of motivational interviewing studies to date. Along the way are insights in to the equivocal value of manuals and of feeding back assessment results to patients.
Data from Britain's largest alcohol treatment trial is used to address possibly the most contentious issue in the field – whether services should offer moderation as well as abstinence goals to dependent clients. 'Let the patient choose' seems the general conclusion.
Substantial minorities of heroin and cocaine users identified while visiting a US hospital for medical care cut back after assessment and brief motivational counselling, extending the potential of this approach beyond heavy drinkers.
This large US study demonstrated that dependent cannabis users can benefit from individualised therapy which extends beyond the brief approaches previously found to produce outcomes equivalent to longer treatments.
Latest update from the respected Cochrane review process still finds no reason to advocate replacing conventional care with specialised therapeutic approaches/teams when severe mental illness is complicated by substance use.
Few studies can manage the painstaking analyses needed to identify what makes for successful counselling. This Swiss study broke new ground in dissecting why some brief interventionists had far better results than others with risky drinking A&E patients.
In the USA two studies have shown that quarterly check-ups on former patients help identify the need for and motivate further treatment, but gains in substance use/problem reductions only became evident when improved procedures were introduced, and even then remained modest.
One of the few 'matches' found by the huge US Project MATCH alcohol treatment trial was that motivational therapy bettered CBT for clients prone to anger. One of the clinics has shown why – because motivational therapists were less directive.
Instead of telling addiction treatment providers what to do to qualify for funding, the US state of Delaware set recruitment and engagement targets and largely left the methods up to the services. Result: more and more engaging treatment without stifling innovation.
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