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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.
STUDY 2010 HTM file
Review of treatment for cocaine dependence
This comprehensive review found strong evidence that some drugs can help treat cocaine dependence and that cognitive-behavioural therapy is a powerful tool to manage cravings and stresses, especially when allied with effective pharmacotherapies.
In the study of Swiss army conscripts, reflective listening emerged as possibly the key active ingredient in a brief alcohol intervention based on motivational interviewing.
At a US emergency department, a brief conversation about the pros and cons of their risky drinking and offers of support for any efforts to reduce harm curbed drinking among alcohol-dependent patients; non-dependent patients tended to do better with assessment and usual care only.
At a US emergency department, a brief conversation about the pros and cons of their drinking and offers of support for any efforts to reduce harm led (compared to assessment and usual care) to extra reductions in the drinking of injured Hispanic patients but not white or black patients.
At a US emergency department, a brief conversation about the pros and cons of their risky drinking and offers of support for any efforts to reduce harm led to extra reductions in the drinking of Hispanic patients which were greatest when they were matched to a Hispanic and Spanish-speaking counsellor.
STUDY 2010 HTM file
What process research tells us about brief intervention efficacy
The disappointing finding of no impact in a Swiss study of a brief alcohol intervention with risky drinking A&E patients prompted painstaking analyses of why some patients did respond, and why some counsellors had far better results than others.
A few minutes with specially hired interventionists can curb the intake of heavy-drinking emergency patients, but in routine practice hospital staff will usually have to do this work. A US study tested this real-world scenario and found the modest drinking reductions were short-lived.
At issue was whether among men in treatment for substance use problems the standard one session of HIV education could be improved on by five sessions including motivational exercises and skills training. In the short term there were greater reductions in sex under the influence but these did not last.
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